self-care for surgeons: 'you're just as vulnerable as anybody else'
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“to be a surgeon and not being able to actually do surgery, i was like, ‘who am i now and what do i have to offer people?’,” says dr. paul fedak, left. he felt the layers of who he thought he was unraveling.
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as a young medical student in his early 20s, dr. paul fedak was fascinated when he watched open-heart surgery for the first time. “i was looking over the drapes and seeing this open chest with the beating human heart and then watching this surgeon, this technical virtuoso, doing these amazing things and reconstructing this heart.” he saw the patient before the surgery and after, blown away by the impact of the procedure.
“it transformed them from a person who couldn’t walk across the room being short of breath to having their whole life back and being completely functional. it was this sort of miraculous experience.”
the event set him firmly on the path to build the skill and stamina to become a leading cardiac surgeon in calgary. dr. fedak, 54, describes himself as someone who thrives on challenge and “trying to do the hardest thing,” so he was the right type of person for this demanding role, especially given cardiac surgeries are not straightforward or simple. they can take two to four hours for a more typical case, but easily turn into eight, 10 or 12 hours or more, he says.
then you add being on call for emergencies at night, like an aortic dissection where blood tracks into the vessel wall and could rupture the aorta, which is the largest artery in the body carrying oxygen-rich blood from the heart to all organs and tissues. in other words, urgent situations.
all this takes extreme discipline and drive.
cardiac surgeons operate in high-intensity environments
“you’ve got to be in the moment, at peak performance,” he says of performing surgery. those complex cases are “really high intensity, high acuity, long operations. so, when you’re on call, you’re very likely operating throughout the night.”
while the stress is undeniable with patients’ lives in your hands, dr. fedak says the rewards are certainly the impact on families and the challenges of reconstructive surgery (like plastic surgery on the heart). he also credits the entire or team.
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“it’s also a team sport where you’re in this room with all these very committed people, and you’re very much present in the moment. and interestingly enough, research shows that surgeons’ blood pressure and heart rate actually go down while they’re operating because you would think it’d be the opposite. but you are so hyper-focused on this one task,” he explains, also noting the time constraint that comes with open heart surgery.
once you stop the heart, it can only survive for so long. the longer the heart is stopped, the more injured it becomes.
“it’s this high-intensity, fast, high-impact situation where you’re hyper-focused. and i think it can be very addictive and intoxicating. you can be completely enchanted by doing these things. i think that’s why surgeons are often so passionate about what they do, and they love to operate, and they love to be in the operating room.”
dr. fedak, however, had to stop operating in 2023 because of a neck injury sustained during hours of intense work. he had surgery for the damaged nerve, but it couldn’t be fully restored.
identity crisis spirals into depression
what happened next was a crisis of identity and a deep spiral into depression. he had dedicated his life to being a cardiac surgeon and an expert at fixing others, and loved it all, even though it meant sacrifice and a lot of time away from his wife and children.
“to be a surgeon and not being able to actually do surgery, i was like, ‘who am i now and what do i have to offer people?’,” he says, watching the layers of who he thought he was unravelling.
all of a sudden, he was vulnerable, broken and exposed—things that the medical culture of silence and stoicism doesn’t allow. he had to strip away the “mask” and superhero uniform—the scrubs worn in the sterile or—that held him to a higher purpose of saving lives.
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his wife and a friend in psychiatry recognized his mental distress and encouraged him to get professional help.
but admitting that he needed help and getting help was difficult for him to do. “that to me is the biggest barrier for physicians, particularly surgeons, particularly men. and you only heal through relationships, through bonding and listening and speaking with other people, because you can’t do it alone. that’s not how we’re wired.”
he says that surgeons are typically lone wolves who can conquer anything, and “it’s me against the world.” but that’s more like the opposite of what’s needed to get through a mental health crisis.
now dr. fedak is embracing a new mission to help change the culture so that doctors and other health-care clinicians can take care of themselves and seek help if they need support or therapy. he’s speaking up to share his personal story and forming a national peer-to-peer support network for surgeons. he’s also working with a filmmaker friend on a documentary about how medical schools and the health-care system feed into the expectation that surgeons, for one, never falter or exude anything but authority and confidence.
he says it’s hard for anyone to understand unless they’re living it, although hbo’s hospital er show the pitt is shining a light on the system’s problems, including its effects on mental health. it’s truer to reality than people might realize, he adds.
fragmented, overloaded system contributes to burnout
“we’re kind of swimming in this very anxious, uncertain, unsupported, fragmented, declining system where we count on resources and we count on these checks and balances and they’re not always there anymore. and we’re trying to do this really hard job and we’re taking all this responsibility,” he says of the intense pressure to flawlessly perform.
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“like if you have surgery with me, i’m going to stop your heart and hold it in my hands. the things around me have to work and they’ve got to be available. and i need the support to do this really hard thing. when that starts to fracture and diminish, which is what we all know has been happening for decades with our health-care system, when you’re holding that heart in your hands and you’re responsible medically, legally and morally.”
he served as a department head and institute director, where he saw many physicians, like himself, “suffering and many of them feel very fragmented, and i’m still unpacking it to be quite frank. i’m still learning and growing and trying to understand what’s going on, what happened to me, what’s happened to my colleagues, and how the system and the culture influences all of this.”
the statistics show what many are calling a crisis situation of physician mental health. as data from the canadian medical association reveal, almost half of physicians are reporting that they’re suffering from burnout or struggling with depression, which skews well above the national average. doctors are starting to be more vocal about exhaustion, bullying and exclusion among clinicians, pushing them to leave the profession.
last april, a quebec pediatrician’s death by suicide was a hard hit to the medical community, as ctv news reports. dr. karina poliquin, based in trois-rivières was only 35 years old, leaving a letter with her friend where she confided, “i can’t ignore the fact that medicine has broken me. this world—despite some incredible people—is so inhuman at times.”
otolaryngologist anthony chin-quee, who left practicing in 2019, told medscape that even early in training, medicine felt restrictive with only two options: academic or private practice. he also felt like an outsider: “i’m black, and that’s a big deal, especially when you’re in medicine. when you get into surgery, and then subspecialized surgery, there really aren’t a lot of us. that is very isolating,” he says, adding he was being “held to a different standard as far as what mistakes were acceptable.”
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as well, discussion about the physician exodus is nothing new, but numbers aren’t slowing down. a 2025 study in annals of internal medicine tracking over 700,000 doctors found that those leaving their clinical practice climbed from 3.5 to 4.9 per cent between 2013 and 2019—before the global pandemic.
‘the numbers are staggering’
debby carreau, a human capital thought leader, is ceo and founder of one of canada’s leading human resources consultancy firms, inspired hr, which partners with health-care clinics and companies across industries. she helps recruit and retain talent with innovative programs like weekly check-in surveys for clinicians on how they’re managing workload and other challenges to normalize the dialogue and open a door to support.
“this truly is a crisis. when you look at the numbers on pre-covid, during covid, and then today, when you survey health-care practitioners on levels of burnout, levels of mental health, just workplace well-being, the numbers are staggering,” she says.
“i think the crux of the problem is, we go to our doctors, we rely on them, they deal with some very, very heavy issues, and we tend to forget that that is their workplace. we actually forget that a caregiver, particularly at that level, this is their job and their well-being is critically important. they’re looking after us. who’s looking after them?”
carreau talks about making change on three levels: the system, the workplace and the individual. the health-care system is overloaded; there are staffing shortages and growing patient demand, so it’s not set up to give physicians a workload that is healthy.
individual workplaces in health clinics, for example, should be looking at staff engagement with a “pulse survey” not once a year but once a week for a quick, anonymous check-in with room for comments.
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what about the person? do they know about the employee and family assistance program that can readily connect them with a professional for support?
“were they trained in medical school about multitasking and about being able to separate the big issues that they maybe don’t have control over? they may know what their patients need, but the system may not be able to deliver that in a timely way,” she says of adequate resources and diminishing budgets. “and so how do they manage these complex issues, also at a personal level? because they’re caregivers, they’re taught to put on a brave face and to not humanize issues. i think that’s got to be really, really frustrating.”
further, she says that there has to be more dialogue about mental health, with an understanding that clinicians are not going to be judged or pulled away from the operating room because they say “i’m struggling.”
carreau also points out that the culture often celebrates physicians who are doing the work of three people, a pattern that is not sustainable. strategies to address overload include scheduling that doesn’t put someone on a night shift followed by an early-morning shift, ensuring people take their vacation time, and adopting technology that reduces administrative work (often 20 per cent or more of a doctor’s time). it’s common for staff members to text or call physicians off duty because physicians always have their phones on.
everyone needs the mental break from work to decompress and reset, so work-life boundaries should be respected.
better patient outcomes depend on quality of care
overall, she advises looking at health care with a workplace wellness lens: “not just the how do we either monetize or how do we fit as many patients in, because you may be able to fit more patients in, but are you giving the quality of care that you need to give? more isn’t always better, and i think we always try to do more. sometimes you want better patient outcomes, not just more patients that are seen.”
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dr. fedak brings an honest perspective to the crippling workload and culture because of his own lived experience. one of his closest surgeon colleagues committed suicide, and he had no inclination there was anything wrong. another two surgeons he worked with also took their own lives in that same dark year.
“i don’t have all the answers, but i do think that largely we need a change in culture, in the health-care system about how we show up to work, our relationship with our work, our identities at work, you know, the mask we wear and what we suppress and what we don’t say because of the culture,” he emphasizes of what is ingrained during training and reinforced by society.
“it’s this archetype in society that we talk about things with ‘cold surgical precision,’ and you certainly identify with that, and then it harms you. because things happen to everybody, we’re just human. you’re just trained to do a tough job, but you’re just as vulnerable as anybody else.”
from all this, dr. fedak recognizes that he has a wound that needs to heal by figuring out who he was before he went to medical school, before he became a “fixer.” he lives with lasting chronic pain from nerve damage and can’t cycle like he used to, so everything on the inside and out has been forced to slow down and reflect. he can still bike and travel and enjoy time with his family. as well, he’s planning retreats for practicing physicians to “unpack” the narratives that are making them ill and have safe, open conversations.
in december, he’s starting a new leadership position at the university of alberta as chair of the department of surgery, so that he can influence the culture of next-generation physicians. “i think it’s really going to amplify the message. i think it’s going to empower me to really work with surgeons, probably across north america, and really try to shape this culture.”
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as well, he’s spending “more time at home and in the normal rhythm of life, which i’ve been absent from for so long.”
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