After a couple of local neurosurgeons died in their 40s from heart attacks and a neurosurgery resident suffered some mental health problems, faculty members at the Medical University of South Carolina realized they needed to do something.
The status quo is killing them.
“We’re neurosurgeons,” says Dr. Raymond Turner, who is co-director of the Comprehensive Stroke & Cerebrovascular Center. “I don’t go to the doctor. I don’t worry about health issues that I need to.”
Just as schools and corporations have done in recent years, the MUSC neurosurgery department is embarking on a pilot program, which is voluntary, to promote wellness among its ranks.
This summer, nearly all of the 21 residents and faculty members are getting baseline health tests: resting heart rate, blood pressure, body composition analysis, body weight, dry lean mass, body fat index, basal metabolic rate and more. These test are taken in advance of a program that will start Aug. 1 and run through June 1, 2016.
The program will start with a program of logging at least 10,000 steps a day and progress to more intense regimens and lectures on wellness subjects such as nutrition and sleep hygiene, as well as participation in team sport activity, such as basketball, on Thursday afternoons.
At the end of the program, participants will get their baseline health tests taken again.
The program comes on the heels of a recent survey from the Medscape Physician Lifestyle Report of more than 20,000 physicians that found that 46 percent experience emotional exhaustion and lack a sense of accomplishment.
The data should concern the general public because physicians who experience burnout are more likely to make medical errors.
Risk factors for burnout include focusing on one’s professional responsibilities obsessively, excessive workload, lack of sleep and “frontline” exposure to patients such as experienced in primary care and emergency departments.
Ultimately, they hope the pilot program will help revolutionize medical training and the field by emphasizing the importance of physician health and its impact on practicing medicine and extending careers.
“Most physicians are left to their own means of taking care of their own health,” says Sunil Patel, chairman of the department. “During our own training, we’re not taught about our own mental and physical health. We’re taught to wake up, be here and do it from 4 in the morning until we’re tired.”
Patel draws a parallel to the military.
“The Navy SEALs are trained, but while they are getting their physical training, there’s a lot of emphasis on what you eat, when do you exercise and how do you keep your mental health. We don’t do that. We’re not the SEALs, but we feel like sometimes we are in a different way. We’re never taught to take a break or to see burnout. Burnout is a sign of weakness.”
The 53-year-old had a “rude awakening” when he had a check-up and found out his total cholesterol was more than 300 (240 and up is considered high) and his diastolic blood pressure was 110 (90 or more is considered high).
“My blood pressure was stroke level,” exclaimed Patel. “I thought I was invincible. I thought I could wake up early, do neurosurgery all day and do it seven days a week.”
So when faculty leaders, Drs. Turner, Alejandro “Alex” Spiotta and Kyle Fargen, approached him about the program, he backed it. Patel is even planning on turning his office into a small gym with a shower for use by participants.
Spiotta says idea of adding fitness to grindstone of neurosurgery training and practice will be considered radical and extreme for the profession’s culture.
“There are old guard neurosurgeons who will think we’re soft and not so committed. I would argue we’ll be better neurosurgeons, have more endurance and have longer and more productive careers,” he says.
The program is drawing inspiration from President John F. Kennedy’s call in 1962 for Americans to be physically fit, pointing to the example of La Sierra High School in California.
The “proof-of-concept” program at MUSC is being called “Operation La Sierra: Incorporation of a Physical Education and Nutrition Program into Neurosurgery.”
At age 36, Spiotta is only three years out of his neurosurgery training, which takes a whopping eight years after finishing medical school. He sees incorporating wellness at the resident physician level as being critical to setting a healthier track for careers.
“There’s no doubt it takes tremendous dedication and sacrifice to become a surgeon, especially a neurosurgeon. Many enter at 25 and come out at 33. You can’t get away with what you could at 25. You’re not eating well. You’re not sleeping well. And your physiology changes between your 20s and 30s,” says Spiotta.
“Our intent is to teach these residents life-long patterns of being healthy. If you’re mentally fit and physically fit, they both go hand in hand. We want everyone to have long and productive lives.”
While Spiotta is an endurance athlete and often squeezes in training for half-marathons and triathlons between cases, Turner says he’s gained too much weight and is ready to change.
“I’m 39 years old. I don’t want to be 40, fat and ... out of shape and not able to do my job,” says Turner.
“Diabetes and hypertension are silent killers because you can have that for five, 10, 20 years and never know it. And if you’re 45 or 50 years old and then realize you’re hypertensive, the cat’s out of the bag. You’ve already done irreversible damage to your kidneys, brain and blood vessels.
“A lot of it (the program) is increasing awareness of health and what role it plays in what we do. If we can’t take care of ourselves, we can’t take care of our patients.”
Drs. Steve Lowe and Avery Buchholz, who are second-year and fifth-year residents, respectively, applaud the effort.
Lowe, who used to play baseball and hockey, says he has gained 25 pounds since becoming a resident.
“I think Dr. Spiotta and Turner are looking out for us. When I started this year, I would wake up at 4 in the morning, work all day and get home at 8 o’clock at night. Who works out after that?”
Lowe thinks MUSC is the only residency program in the country that is embarking on wellness training and thinks it’s “a chance to revolutionize the way we look at medical training in general.”
Buchholz says many residents in neurosurgery were athletes or athletic in high school, college an even medical school, but that activity grinds to halt with the 80-plus-hour weeks of residency.
Like Patel, Buchholz sees a parallel between military and medical training. The 34-year-old Buchholz is a 2003 graduate of The Citadel, where physical fitness is “one of the pillars of our education.”
“It (physical activity) is a huge part of our training and something most of us (Citadel grads) carry through the rest of our lives.”