The problem of surgeon burnout and depression cannot be overstated and is discussed and evaluated in other chapters in this issue from differing perspectives. There is compelling evidence that the rate of depression and burnout is increasing in the field of general surgery, causing medical errors and loss of productivity. Year over year, self-reported survey data shows that it affects both younger surgeons as well as women to a greater degree. Critical examination of factors affecting resilience and well-being remains limited and the data that exists is not well understood by either physicians or administrators.

Key components of burnout—emotional exhaustion, depersonalization, and depression exist in nursing and the allied professions as well. In fact, important interventions and observations from allied professionals were instrumental in developing metrics to evaluate burnout in physicians. Interventions to promote surgeon well-being and resilience are mostly generalized from those developed in other specialties and subspecialties. This is appropriate because, regardless of specialty, the same stressors that impact other physicians and healthcare professionals also affect surgeons in much the same way. However, there are some key differences in how surgery and surgical errors or complications are perceived by others. Charles Bosk famously says in Forgive and Remember: Managing Medical Failure, “When the patient of an internist dies, the natural question is… ‘What happened?’ When the patient of a surgeon dies, his colleagues ask, ‘What did you do?’”1 While medical therapy is generally viewed, rightly or wrongly, as being disease-driven—the medication is not “strong enough” or the cancer “subverts” the impact of the drugs used–we are told we cannot “blame our tools” but ourselves. It's pretty clear that in order to build personal resilience, we need to move beyond the “captain of the ship” mentality towards a modus operandi that holds both serious responsibility and self-care as non-mutually exclusive propositions. Collaboration, leadership, and self-awareness are all important strategies for embracing this more comprehensive and sustainable way of practicing surgery.

In order to accomplish this, this chapter seeks to describe strategies for promoting physician well-being and resilience and present them not as “opposite” but as a counterpoint for burnout, depression, and the moral injury driven by clinical activity and institutional pressures. Furthermore, the chapter seeks to emphasize and describe the concept of prevention. Factors affecting individual agency and those involving institutional and national programs to prevent burnout and promote resilience are evaluated. It seems very logical that emotional, intellectual, and situational factors affecting depression and burnout exist for even the most resilient surgeons therefore, understanding data supporting strategies to promote and maintain well-being are effective for everyone practicing surgery today.