ASRA Pain Medicine Update

As physicians, anesthesiologists, and pain management providers, we have a high risk for job-related burnout. I have experienced firsthand the dissatisfaction associated with arriving to work early to provide a preoperative assessment, manage multiple patients’ preoperative medications and testing requirements, patiently wait for the nursing assessment, start an intravenous line, and finally be interrupted by the surgeon, resident, medical student, research team, etc, before being berated by the surgeon for a 3-minute operating room (OR) delay.

Other sources of job-related stress might include surgeons preferring not to wait for regional anesthesia procedures out of concern for OR delays or feeling pressured by colleagues to provide regional anesthesia for patients with significant relative or absolute contraindications.

Often, stressors are accompanied by an administration that does not understand your workflow or appreciate your absolute commitment to patients. Amid those demands is the need to maintain skills relevant to providing general anesthesia for a wide variety of surgical procedures. At times, it is difficult to not just admit defeat, walk the easy path, and throw in a laryngeal mask airway.

Using a strong network of professional colleagues to recount recent wins and losses can be vital to maintaining career satisfaction.

To survive and flourish in such an environment, pain physicians must establish strategies to build camaraderie and decompress following those busy mornings. Although I certainly do not assume that I am an expert in these matters, our group has adopted daily wind-down sessions that slow the hectic pace of getting all of the first-start OR cases launched. Those sessions include mindfulness exercises and colleague recognition and affirmation. In addition, we plot the remainder of the day, develop staffing strategies to effectively manage scheduled cases, attempt to predict and deal with add-ons, and tend to inpatients with neuraxial or perineural catheters and ketamine infusions. We also evaluate the subsequent day’s schedule and allocate appropriate staff resources to minimize the stress associated with too much work for too few people. The sessions include our block nurses and chronic pain advanced practice providers, so we are able to simultaneously improve patient care through coordinated efforts at pain management.

In addition to daily group affirmation and revitalization sessions, using a strong network of professional colleagues to recount recent wins and losses can be vital to maintaining career satisfaction and preventing feelings of failure and despair. Your network might work with you at your own institution or you may only encounter them at ASRA’s annual meetings; if the latter is your situation, consider sending intermittent text messages or calls to check in and ensure that all is well or recount tales of recent struggles. We live in such an era of Instagrammed success stories that it is easy to feel that you are the only one dealing with a certain scenario or complication. Understanding that others share your struggles can go a long way toward contentment.

In an ongoing era of drug shortages and opioid-tolerant patients, our collective jobs will likely become progressively more difficult. Core to maintaining career satisfaction is reframing what might constitute a success in certain patient populations. We need to avoid focusing only on the negative aspects of our practice (eg, failed blocks, complications) and engineer mechanisms to highlight our positive impact. Finally, I challenge you to identify five people whom you can trust to honestly appraise a work-related situation that you might be dealing with and provide you with guidance and support. If you can’t think of five, now is the time to reach out to your colleagues at ASRA and create a network of support.