A recent study published in JAMA Network Open highlights a significant issue in the professional landscape: the risk of burnout among female physicians and workers in the United States. The study surveyed 25,248 physicians and 20,283 workers over 12 years. Female physicians consistently faced higher burnout risks than their male counterparts at four out of five survey time points, with odds ratios ranging from 1.26 to 1.34. Similarly, female workers across various industries showed elevated burnout risks at three out of five measurement points, with odds ratios between 1.24 and 1.45.
Here’s the irony: excellence doesn’t necessarily equate to endurance.
Sustained performance over decades hinges on structural factors that make career longevity more accessible to some than others. Two key disciplines prove essential for maintaining long-term professional engagement: perpetual technical renewal and adaptive career architecture. But here’s what matters more – who actually gets to use these strategies successfully.
This article examines both individual strategies that professionals deploy to extend their careers and the systemic constraints that determine their success. Personal excellence and institutional barriers operate as co-determinants of professional longevity across fields like neurosurgery, aerospace manufacturing, and medical device development.
The Expertise Paradox
We’ve all heard the story: you start your career learning everything, then spend your middle years mastering it all. By the time you’re senior, experience trumps everything else. But here’s the problem with that neat little narrative – it falls apart completely when entire technological platforms get replaced every few years.
High-stakes professions don’t care about your feelings. They’re ruthless about maintaining standards.
Your decades of hard-earned expertise? It can become dead weight overnight. Technology keeps evolving throughout your entire career while your body and mind face increasing demands. You’re not just accumulating knowledge anymore – you’re watching chunks of it become irrelevant at the same time.
So how do some professionals actually survive decades in these fields? The answer isn’t just about staying current with tech. It’s about how they structure their entire careers from the ground up. These aren’t just individual choices – they’re responses to structural realities that most people never see coming.
Platform Adoption at Year Twenty-Four
The first mechanism – technical renewal – shows up when surgeons actively engage with systems introduced long after their initial training. Your accumulated experience doesn’t exempt you from this renewal discipline. It requires integrating digital surgical platforms that consolidate multiple workflow functions.
Dr Timothy Steel, a Sydney-based neurosurgeon and minimally invasive spine surgeon at St Vincent’s Private and Public Hospitals, provides one example of this approach. In September 2022, he integrated the NuVasive Pulse digital surgery platform at St Vincent’s Private Hospital – 24 years after his consultant appointment in 1998. This platform combines neuromonitoring, imaging, navigation, planning, and rod bending into a single workflow to reduce variability and radiation exposure during spine procedures. At the time of this integration, Dr Steel had performed over 2,000 brain surgeries and 8,000 minimally invasive spine procedures.
Those numbers don’t buy you a pass on learning new systems.
Actually, they make the stakes higher. The timing of this platform integration shows that expertise accumulation doesn’t create independence from knowledge renewal but requires continuous engagement with emerging systems. Late-career practitioners face the same imperative to adopt new technologies as their early-career counterparts.
This pattern of late-career technical adoption underscores that sustained performance relies on ongoing engagement with systems that enhance workflow efficiency and patient safety.
The Institutional Evolution Model
Career architecture is distinct from technical renewal; it involves maintaining institutional continuity while engaging with emerging knowledge frameworks. This model demands that executive responsibilities coexist with technical currency rather than replace it. This requires a leadership approach that integrates ongoing technical engagement within organisational tenure.
Dig Howitt provides one example of this leadership approach. As CEO and President of Cochlear Limited, an Australian company specialising in cochlear implants, his tenure at Cochlear began in 2000, marking a 25-year commitment to the organisation. That’s long enough to become a walking museum of outdated practices without constant renewal. Howitt has been actively involved in initiatives like the ANZ Living Guidelines for Cochlear Implantation. This long-term involvement supports the claim that sustained evolution requires continuous technical engagement despite holding an executive role.
The ANZ Living Guidelines initiative requires ongoing leadership input rather than a one-time strategic endorsement. Most executives delegate technical work while maintaining they’re still technically current – it’s professional theatre. Howitt’s participation as CEO indicates that an executive perspective must remain informed by continuous engagement with clinical and technological frameworks.
This pattern demonstrates that longevity within a single organisational context depends on maintaining technical currency alongside executive responsibilities, treating these roles as complementary rather than sequential career phases within institutional frameworks that permit depth while demanding continuous knowledge renewal.
The Return From Retirement
You don’t have to stay in the game forever. There’s another approach: strategic withdrawal and return. This preserves your capacity for high-stakes leadership through selective deployment rather than being constantly available. You step back, then return when crisis hits.
Kelly Ortberg’s recent appointment as President and CEO of Boeing in August 2024 shows this model in action. Boeing tasked him with addressing critical challenges in their commercial and defence sectors. Ortberg returned to leadership following his retirement in 2021. That’s a three-year gap in his active career.
Modern retirement often looks more like strategic positioning than actual withdrawal. But what happens to professional relevance during those gap years? It requires deliberate maintenance rather than passive preservation. With 35 years of aerospace experience beginning in 1983 at Texas Instruments and later at Rockwell Collins, Ortberg’s episodic engagement demonstrates how career value can be preserved through strategic withdrawal.
Ortberg’s transition to leadership at Boeing addresses production defects, delivery timelines, and financial stabilisation following his strategic withdrawal from active leadership.
This model proves something important. Career longevity can operate through episodic reinvention rather than sustained institutional presence. It creates a different risk-reward profile that allows recovery periods between high-intensity engagements. The catch? You’ve got to maintain relevance during withdrawal phases.
The Demographic Differential
Individual strategies for technical renewal and adaptive career architecture operate within systemic contexts that distribute access to longevity unequally. Sustained excellence depends partially on institutional factors beyond personal adaptation.
The JAMA Network Open study revealed consistent burnout risk differentials among female physicians compared to their male counterparts across multiple measurement points. This pattern suggests structural rather than episodic factors at play.
These consistent differentials indicate that demographic groups face systematically different probabilities of sustaining engagement across decades, regardless of individual technical renewal strategies or career architecture choices.
These demographic patterns establish that access to longevity depends partially on factors operating at the institutional and cultural level rather than through individual decision-making alone. Technical renewal and adaptive career architecture are necessary but not sufficient for sustained excellence.
When Systems Fail
What happens when support systems can’t keep up with mounting pressure? We get a stark answer from the construction industry. In 2021, male construction workers in the United States killed themselves at a rate of 56 per 100,000 – nearly double the 32 per 100,000 rate for male workers overall. That’s not just a statistic. It’s what systemic neglect looks like at its worst.
Construction and surgery don’t share much on the surface. But dig deeper and you’ll find troubling similarities. Both demand physical endurance that doesn’t let up. Both punish mistakes without mercy. Both pile cognitive load on workers without offering systematic ways to decompress.
Here’s the brutal truth: experience doesn’t protect you from error-induced stress.
The jump from burnout risk to mental health crisis shows us something important. When systems fail people, individual grit isn’t enough. Doesn’t matter how much technical training you get or how you structure your career. If the underlying pressures stay unaddressed, resilience has its limits. This structural reality shapes how long careers can actually last.
The Institutional Question
Career longevity depends partially on whether institutions design systems that distribute access to sustained engagement equitably or simply reward those whom existing structures already favour.
Organisations face a choice in structuring support for career longevity: whether to design systems for equitable access or continue favouring certain demographic groups by default. Most prefer to rename the problem rather than solve it.
Burnout data suggests most institutions haven’t resolved whether to design for equitable access. Suicide rates indicate some have stopped asking the question altogether.
Understanding career longevity requires acknowledging both individual disciplines and structural contexts. Technical renewal and adaptive career architecture represent necessary individual strategies, yet burnout differentials and inadequate support systems reveal that structural constraints determine who can successfully deploy these strategies over decades. Without institutional change that addresses these systemic barriers, even optimal individual approaches will continue to produce unequal outcomes across demographic groups.
Rethinking Endurance
Career longevity operates through mechanisms contradicting standard expertise narratives. Perpetual technical renewal remains essential regardless of accumulated experience; platform adoption at year 24 carries the same urgency as year one. Adaptive career architecture permits either sustained evolution or episodic reinvention as legitimate models.
Practitioners examined – spanning 25 to 35 years in neurosurgery, aerospace manufacturing, and medical device development – demonstrate that the ‘long game’ isn’t about endurance but continuous reinvention within structural constraints. Reinvention is more feasible for some professionals than others based on systemic factors.
Those JAMA burnout differentials from the opening? They’re not just statistics – they’re a reminder that professional longevity isn’t equally accessible despite equal effort. Institutions must decide whether they design systems distributing access to longevity equitably or reward those existing structures already favour. The uncomfortable truth is that whose careers get to last often depends less on individual excellence than on which side of the structural divide you started from.
