SGO Wellness: I Am Graduating Fellowship This Year—Am I Well? | Sarah Page Huepenbecker, MD, MPH

Sarah Page Huepenbecker, MD

I will be graduating gynecologic oncology fellowship in June. It is unbelievable to be so close to the end of 12 years of post-graduate training, hundreds of OR cases, thousands of patients, and countless hours of labor. It is a transitional time, as I soak in the last moments of learning as a trainee and simultaneously arrange to move to a new city and institution to start my attending position. This feels like a good time to reflect on how training has affected me as a physician and person.

Am I well? I find “wellness” difficult to describe. It is highly personal, almost never static, and often aspirational. In publications on the topic, wellness is usually presented as the opposite of burnout, which is helpfully measurable through instruments such as the Perceived Stress Scale¹ and the Maslach Burnout Inventory.² As has been extensively documented, burnout is bad for individuals (alcohol abuse, depression, suicidality) and the medical system (medical errors, patient satisfaction scores, physician attrition),^3,4 including in our own specialty.⁵

That begs the question – am I burnt out? On the abovementioned inventories, I currently have “little sign of burnout” and am “moderately stressed,” which sounds about right. Going into fellowship, I had an idea of how taxing the experience would be and accepted that four more years of training required more late nights, emergency cases, patient deaths, missed family and friend events, and less personal time. But even going into this environment with eyes wide open, it has been stressful with periods of near/actual burnout. There are times when I questioned why I chose this difficult and strenuous profession. But I persevered and, like other fellows approaching June graduation, I can now see the finish line.

Having “little sign of burnout” does not equal wellness, which has been a required part of my fellowship education. After completing my program’s wellness didactics, I feel comfortable discussing these topics. I practice mindfulness, participate in our fellowship’s journaling workshops, and even squeeze in an occasional yoga session. Despite this, and in line with 77.8% of US gyn onc fellows,⁶ I am not satisfied with my current work-life balance. I miss my daughter’s bedtime most nights, I don’t have the time or energy for extra social engagements, I spend weekends on research projects, and I sometimes obsessively stalk the emergency room patient list to forecast who I will be called about overnight.

I have also found happiness. I have gotten married, delivered a beautiful daughter, made lifelong friends, gone on vacation, celebrated (some) holidays with family, completed races, and even read a few books for pleasure. Professionally, I have achieved formal success in publications, presentations, and honors and informal success through feedback from my mentors and comments from my patients. In line with the majority of my peers,⁶ I would choose gynecologic oncology again without hesitation.

So – am I well? The answer remains as personal, fluid, and aspirational as the prompt. I am not burnt out but have been stressed for four years. I have completed wellness curricula but have not achieved work-life balance. I have found meaning in my personal and professional accomplishments and do not regret my choice. During this liminal stage, I am overall grateful to my colleagues, mentors, and patients for the privilege of this education. Ultimately, I feel ready to be done and excited to be a practicing gynecologic oncologist – the best job in the world. And I am optimistic that in the future, I will someday be able to answer whole-heartedly that I am well.

Sarah Page Huepenbecker, MD, MPH, is a PGY8 Gynecologic Oncology and Reproductive Medicine Fellow at The University of Texas MD Anderson Cancer Center in Houston, TX.

References

1. Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983 Dec;24(4):385-96. PMID: 6668417.
2. Worley JA, Vassar M, Wheeler DL, Barnes LL. Factor structure of scores from the Maslach Burnout Inventory: A review and meta-analysis of 45 exploratory and confirmatory factor-analytic studies. Educational and Psychological Measurement. 2008 Oct;68(5):797-823.
3. Panagioti M, Geraghty K, Johnson J, et al. Association between physician burnout and patient safety, professionalism, and patient satisfaction: a systematic review and meta-analysis. JAMA Intern Med.2018;178(10):1317–1330.
4. Dyrbye LN, West CP, Satele D, Boone S, Tan L, Sloan J, Shanafelt TD. Burnout among U.S. medical students, residents, and early career physicians relative to the general U.S. population. Acad Med. 2014 Mar;89(3):443-51. doi:10.1097/ACM.0000000000000134. PMID: 24448053.
5. Rath KS, Huffman LB, Phillips GS, Carpenter KM, Fowler JM. Burnout and associated factors among members of the Society of Gynecologic Oncology. Am J Obstet Gynecol. 2015 Dec;213(6):824.e1-9. doi: 10.1016/j.ajog.2015.07.036. Epub 2015 Jul 29. PMID: 26226551.
6. Szender JB, Grzankowski KS, Eng KH, Odunsi K, Frederick PJ. Evaluation of satisfaction with work-life balance among U.S. Gynecologic Oncology fellows: A cross-sectional study. Gynecol Oncol Rep. 2016 Mar 9;16:17-20. doi: 10.1016/j.gore.2016.03.001. PMID: 27331129; PMCID: PMC4899516.