Surgery is a demanding profession requiring intense commitment, with both great challenges and rewards. The field often draws dedicated, conscientious individuals with attention to detail, but surgeons also tend toward perfectionism and compulsion.1 This combination can impair a surgeon's ability to develop a successful work-life balance and negatively impact both personal and professional quality of life. Although wellness takes many forms based on personal priorities it can be conceptualized loosely through the definition of health by the World Health Organization as "…a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”2 Work-life integration can improve surgeon wellness and requires introspection and intention.3 While being a surgeon has always been a unique calling, the demands placed on surgeons in today's healthcare climate are different from what has been faced in the past. The core principles of dedication to one's patients and one's profession remain central to being a surgeon today, but contemporary surgical practice has challenges not necessarily encountered by preceding surgeons that require creativity and careful thought. This article will examine the concept of wellness as it ties to both workplace and surgeon factors, as well as sustaining a career in surgery in today's climate.

Surgery has a long tradition of workplace requirements, professional regulations, and cultural norms not conducive to work-life balance. In a survey of over 2000 retired surgeons, more than half expressed a desire to have done things differently in their life or career, and the most common element they would have changed was spending more time with family and taking better care of themselves.4 Deprioritization of aspects of life outside of work contributes to a host of deleterious personal and professional outcomes.

Burnout is characterized by feelings of emotional exhaustion, depersonalization, and loss of a sense of personal accomplishment. Approximately 32 % of colon and rectal surgeons have described feelings of burnout and 29 % have described intention to leave over the next 2 years.5 In a recent meta-analysis, the rate of burnout among general surgeons was found to be as high as 69 %. Across 27 studies reviewed, factors associated with burnout included being accused of malpractice, occupational stressors, low annual income, workplace violence, frustrating colleagues, insufficient study time, and poor work-life balance.6 Moreover, there is a well-known link between burnout and struggles with mental illness, broken relationships, alcohol and substance misuse, and physician suicide.6, 7, 8, 9

Compassion fatigue is the emotional and physical burden felt by those helping others in distress that may reduce the capacity for empathy.10 Surgeons develop unique relationships with patients that place them at high risk for developing compassion fatigue, due to a great sense of responsibility, emotionally difficult patient encounters, and cultural expectations that may minimize their traumatic experiences.11 Additionally, imposter syndrome, defined as the internal experience of intellectual phoniness, occurs when high-achieving individuals have a pervasive sense of self-doubt combined with fear of being exposed as a fraud, despite objective measures of success.12 Significant or severe imposter syndrome can compromise mental health and well-being, and is prevalent among general surgeons, regardless of gender, trainee status, or academic achievement.13,14

The consequences of burnout coupled with compassion fatigue and imposter syndrome are profound and can diminish surgeon wellness. The combined effects can result in personal crisis contributing to suboptimal patient care practices and increased medical errors.15,16 Most surgeons will experience burnout during their career, and it is essential to recognize and acknowledge these symptoms before being able to take steps to combat the harmful effects these can bring.