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Today's Practice | Sep 2016

Elite Surgeons Should Strive to Become Elite Athletes

The benefits in terms of surgical performance make the time commitment to fitness worthwhile.

There is no doubt that the busy and demanding lifestyle of a microsurgeon makes getting or staying in shape a demanding goal. However, I genuinely believe that the benefits in terms of surgical performance make the time commitments worthwhile.

Allon Barsam, MD, MA, FRCOphth

I will not focus on the increased longevity associated with fitness or the reduced risk of developing back and neck problems so common in microsurgeons, nor the role model that physicians should play for their patients. Those are clearly also benefits of fitness. This article focuses on how physical fitness can improve surgical performance.


Many things contribute to surgical skill and performance. In no particular order, these include:

Training. How well has the surgeon been taught what to do and what not to do?

Experience. How much surgery has the surgeon done, and how much does he or she do on a weekly or monthly basis?

Natural ability. Is the surgeon equally comfortable operating with both hands (bearing in mind that microsurgery is bimanual surgery), and does the surgeon have so-called good hands?

Physical fitness. Does the surgeon have well-honed and quick reactions? Physical stamina? Quick thinking and a sharp mind? Does the surgeon’s body habitus allow her or him to sit comfortably with good posture when perfoming surgery?

Although microsurgery is the most delicate of activities, it is nonetheless a physical task. Operations can last from a few minutes to more than 90 minutes depending on the complexity, and a surgical list can last all day for busy surgeons. That is all day spent operating, sometimes several times per week. This not only involves performing the surgery itself but also comfortably positioning ourselves and our patients for each surgery.

In the past decade, precision sports such as Formula 1 racing and golf have seen universal acceptance of punishing workout regimes for drivers and players, respectively. I believe that, in the next decade, the same recommendations will apply to surgeons.


Fitness not only gives us the ability to be more in tune with how we coordinate our bodies, it also acts to sharpen the mind. The effects on the mind mostly pertain to better and more normal hormone control. However, surgery has more in common with fitness and sport than just these elements. Surgery also involves the planning and psychological preparations that are so common in sports.

Many elite athletes now use visualization techniques prior to sport, whereby they envision themselves carrying out certain tasks before they actually do them.1 This same technique can and should be applied to surgery, especially complex surgery. The reverse applies to learning and progressing after surgery. Athletes review video footage of their performances, and so should we. This coordination of mind and body is what allows us to function at the highest level as surgeons.

Fitness results in improvements in movement, positioning, reactions, planning, learning, and energy levels. Physical fitness benefits not only the surgeon but also his or her patients, as surgical outcomes can improve due to these factors.


As a fellow in the United States, I was fortunate to be trained by Henry D. Perry, MD, and Eric D. Donnenfeld, MD, who, to varying degrees, have each spent much of their adult lives combining elite fitness regimes with world-class surgical skill. Henry’s son Marc Perry, who contributed to this article, has also had a tremendous influence on me. He founded the company BuiltLean, which is dedicated to showing individuals how to combine fitness with their busy lifestyles. All of these men have been enormous inspirations to me.

1. Bailey M. Sports visualisation: how to imagine your way to success. The Telegraph. January 22, 2014. http://www.telegraph.co.uk/men/active/10568898/Sports-visualisation-how-to-imagine-your-way-to-success.html. Accessed August 1, 2016.

Allon Barsam, MD, MA, FRCOphth
• Medical Director, AB Vision, London
• Member, CRST Europe Editorial Board
• Financial interest: None acknowledged