Posted by
Doctorwascher on Sunday, October 31, 2010 5:06:28 PM
Welcome to Weekly Health Update
"A critical weekly review of important new research findings for health-conscious readers..."
By, Robert A. Wascher, MD, FACS
Updated: 10/21/2010
The information in this column is intended for informational purposes only, and does not constitute medical advice or recommendations by the author. Please consult with your physician before making any lifestyle or medication changes, or if you have any other concerns regarding your health.
THE SILENT EPIDEMIC OF SURGEON BURN-OUT AND DEPRESSION
Here in the United States, we face momentous, and as yet unclear, changes in the delivery of health care. Approximately 46 million Americans lack any health insurance at this time, and tens of millions of others have grossly inadequate health insurance. Therefore, many millions of Americans are just one major illness away from a financial catastrophe.
In addition to the huge dilemma of how we go about making health care more efficient and more affordable for everyone, the United States, like most countries around the world, is in the midst of a dramatic shift in the average age of its population. As the graying of America continues (not to mention the ongoing epidemic of obesity across all age ranges, as well), the growing need for high quality, comprehensive health care will continue to present major challenges to our health care system here, and in many other countries around the world.
When I graduated from medical school in 1988, health care experts were predicting a huge surplus of physicians in this country, and in response to this concern, medical schools around the United States began cutting back their class sizes, and a de facto moratorium on opening new medical schools was initiated. Fast forward to 2010, and it has since become apparent that these dire predictions of an impending physician glut were absolutely incorrect. As our population grows older, and more diverse, the demand for physicians is increasingly in danger of outstripping the projected supply of doctors, including surgeons.
Aging patients have a higher incidence of illnesses and injuries that require the expertise of surgeons, and general surgeons in particular. Broadly trained and experienced general surgeons are the primary care doctors, and the workhorses, of the surgical world, and they manage an astonishing array of diseases and injuries. Unfortunately, and for a variety of reasons, comprehensive general surgeons are slowly withering in numbers, while the demand for their skills only continues to increase. Generational attitude shifts among recently graduating physicians have seen young new doctors gravitate towards less demanding “boutique” specialties, and away from the more challenging surgical specialties (like general surgery). Even among those young doctors who still elect to pursue residency training in general surgery, more than two-thirds will go on to train and practice in more restricted subspecialty surgery areas. (Disclaimer: As a surgical oncologist, I am one of those subspecialty surgeons. However, I still include a great deal of general surgery care in my practice, and I continue to take general surgery call in our medical center.) Another factor that discourages potential general surgeons is the enormous debt load that most newly minted doctors graduate from medical school with, and the resultant pressure that they feel to train in specialties that do not require the additional 5 to 10 years of training that general surgeons must complete. (Increasingly, new medical school graduates are, instead, seeking out specialties that are more financially lucrative, and require shorter durations of residency training, than general surgery.)
Yet another adverse factor that has harmed the recruitment of new general surgeons is the ongoing and progressive fragmentation of traditional general surgery practice into other subspecialty domains. For young doctors who are attracted to the diverse and clinically challenging sort of surgical practice that has historically made general surgery a highly desirable profession, the increasing practice restrictions imposed upon general surgeons have removed a major incentive to undergo the many years of training necessary to become a comprehensive general surgeon
Against the backdrop of these and other pressures that continue to dwindle the ranks of broadly trained and practicing general surgeons (as well as other critical core surgical specialists), the issue of surgeon burn-out has only recently started to receive its due attention. The comprehensive practice of general surgery, and other demanding surgical specialties, can be grueling and exhausting, particularly in the private practice setting where declining reimbursements compel surgeons to work ever longer hours to maintain their income and lifestyle. (Future threatened cuts in reimbursements to surgeons will likely only further exacerbate surgeon workload problems, and eventual surgeon shortages, as new health care reform initiatives begin to roll out in the coming years.)
A newly published research study, which appears in the current issue of the Journal of the American College of Surgeons, reveals a very disturbing picture of burn-out, exhaustion, and depression among surgeons, and the potentially adverse consequences of distressed surgeons on patient outcomes.
In this study, nearly 8,000 surgeon members of the American College of Surgeons responded to a detailed survey, which included self-assessments of their practice details, a validated depression screening tool, and validated assessments of both burn-out and overall quality of life. The results of these surgeon surveys were, in a word, depressing.
Among the surgeons who reported working less than 60 hours per week, 30 percent described themselves as burned-out with their profession. Among surgeons who worked 60 to 80 hours per week, 44 percent felt burned-out, and among those surgeons who put more than 80 hours per week, 50 percent experienced significant feelings of burn-out. In addition to the number of hours spent in clinical practice per week, the number of nights spent performing overnight surgery call was a highly significant predictor of surgeon burn-out. These two surgeon workload factors were also highly statistically significantly linked to clinical depression, difficulties in finding a reasonable home-work balance, and increased conflicts at both home and at work. Additionally, the rates of both personal emotional exhaustion and feelings of depersonalization towards patients were directly associated with working more than 80 hours per week, and with performing 2 or more night calls per week.
Excessive hours spent in clinical practice, as well as performing 2 or more overnight calls per week, also correlated with a significant increase in the number of self-reported medical and surgical errors committed by exhausted and burned-out surgeons. Nearly 11 percent of surgeons who worked more than 80 hours per week admitted to committing medical or surgical errors, compared to about 7 percent of surgeons who worked less than 60 hours per week.
Surgeons who either worked more than 80 hours per week, or who took more than 2 night calls per week, were also significantly more likely to express regret regarding their choice of specialty, and more likely to indicate that they would not choose to become surgeons if they had an opportunity to choose their specialty all over again.
The results of this survey of surgeons across the United States have been generally confirmed by other similar studies, recently. These disturbing findings, as reported by surgeons themselves, paints a picture of a large population of highly essential physician specialists who are, increasingly, feeling burned-out, depressed, emotionally exhausted, regretful of their career choices, and progressively more prone to both depersonalizing their relationships with their patients and to committing more medical and surgical errors. In short, my chosen profession appears to be a profession that is, frankly, approaching a state of crisis.
Because of these enormous (and growing) pressures and stresses that are being experienced by many surgeons, including general surgeons, many public health experts are viewing the current and future surgical workforce with considerable consternation. As more and more surgeons hang up their white coats and put away their scalpels early in their careers, and as more and more newly graduated doctors shy away from the more demanding surgical specialties, our country appears to be headed for a potentially catastrophic mismatch between the demands of an aging population for surgical care and the diminishing pool of physicians who are willing to shoulder the heavy responsibilities, and significant stresses, of surgical practice.
It is my hope that the governmental agencies responsible for implementing current and future health reforms will pay close attention to this study, and others like it. If hard-working surgeons cannot sustain reasonable income levels (against the decades of grueling training required, and the hundreds of thousands of dollars in educational loans that most young doctors acquire) without working themselves into a state of exhaustion, burn-out, and divorce, the ranks of general surgeons, and other core surgical specialists, will continue to become thinner and thinner. Ultimately, if things do not change, and soon, you and I might find it difficult to obtain access to high quality surgical care, particularly for emergency illnesses and injuries….
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Disclaimer: As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity
Dr. Wascher is an oncologic surgeon, professor of surgery, cancer researcher, oncology consultant, and a widely published author
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Robert A. Wascher, MD, FACS
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Dr. Wascher's Archives:
10-21-2010: The Silent Epidemic of Surgeon Burn-Out and Depression
10-14-2010: Gum Disease (Gingivitis) and Breast Cancer Risk
10-7-2010: Hormone Replacement Therapy (HRT) and Breast Cancer Risk
10-3-2010: Mammograms Between 40 and 49 Years of Age
9-26-2010: Vitamin D, Cardiovascular Disease, Cancer, and Death
9-19-2010: Fruits and Vegetables Improve Memory
9-12-2010: Low-Carb Diet and Risk of Death
9-5-2010: Non-Compliance with Hormonal Therapy for Breast Cancer and Risk of Death
8-29-2010: New Treatment for Irritable Bowel Syndrome (IBS)
8-22-2010: Lactoferrin Reduces Abdominal (Visceral) Obesity
8-15-2010: Blueberries, Obesity, Diabetes and Metabolic Syndrome
8-8-2010: High LDL Cholesterol in Young Adults and Heart Disease Risk in Middle Age
8-1-2010: Physician Error
7-25-2010: Obesity and Cancer Risk
7-18-2010: Vitamin D Reduces Risk of Cognitive Decline & Dementia
7-11-2010: All Forms of Hormone Replacement Therapy (HRT) Increase Breast Cancer Risk
7-4-2010: Irritable Bowel Syndrome: Cause Discovered?
6-27-2010: Soy, Curcumin & Prostate Cancer Risk
6-20-2010: Green Tea Epicatechin Reduces Heart Damage & CHF
6-13-2010: Diacylglycerol (Diglyceride) Oil Reduces Obesity
6-6-2010: Important New Advance in the Breast Cancer Treatment: Intraoperative Radiation Therapy
5-30-2010: Medical Research Studies & “Spin”
5-23-2010: Soy & Curcumin Reduce Prostate-Specific Antigen (PSA)
5-16-2010: Coffee & the Risk of Death from Heart Disease & Cancer
5-9-2010: Soy Foods & Stomach Cancer Risk
5-2-2010: Chemotherapy for Breast Cancer & Memory Loss
4-25-2010: Smoking, Teenagers & Tobacco Company Advertising
4-18-2010: Coffee Improves HDL Cholesterol Levels
4-11-2010: Cruciferous Vegetables, Soy & Breast Cancer Risk
4-4-2010: Avodart (Dutasteride) & Prostate Cancer Prevention
3-28-2010: Aspirin & Breast Cancer Survival
3-21-2010: Obesity, Alcohol & Liver Disease
3-14-2010: Nuts, Diet & Obesity
3-7-2010: Walnuts, Cholesterol, LDL & Triglycerides
2-28-2010: Soy Isoflavones & Recurrent Prostate Cancer
2-21-2010: Testosterone Supplements in Frail Elderly Men
2-14-2010: Pancreatic Cancer Risk, Sodas & Juice
2-7-2010: Vitamin D, Cardiovascular Disease & Death
1-31-2010: Concord Grape Juice Improves Memory
1-24-2010: Mozart, Music, Babies & Health
1-17-2010: Breast Cancer, Physical Therapy & Lymphedema
1-10-2010: Prevention of Surgical Site Infections (SSIs) after Surgery
1-3-2010: Ginkgo Biloba, Memory & Cognitive Health
12-20-2009: CT Scans & Cancer Risk
12-13-2009: Soy Isoflavones Decrease Breast Cancer Recurrence Risk
12-6-2009: Salt (Sodium) Intake, Stroke & Cardiovascular Disease
11-29-2009: Exercise & Prostate Cancer Risk
11-22-2009: Genistein (Soy Isoflavone) & Prostate Cancer
11-15-2009: Breast Cancer Treatment & Chronic Pain
1-8-2009: Vitamin D & Breast Cancer Risk
11-1-2009: Exercise & Prostate Cancer Risk
10-25-2009: HPV Virus & Risk of Breast Cancer
10-18-2009: Post-Cholecystectomy Syndrome (Symptoms after Gallbladder Surgery)
10-11-2009: Vitamin D & Falls in the Elderly
10-4-2009: Surgery, NSQIP, Complications & Death
9-27-2009 Stress, Heart Disease, Exercise & Death
9-20-2009: Vitamin D & Colorectal Cancer Survival
9-13-2009: H1N1 Swine Flu Update
9-7-2009: Green Tea, Aging & Lifespan
8-30-2009: Irritable Bowel Syndrome (IBS), Diet & Fiber
8-23-2009: Update on Prostate Cancer and Cryotherapy
8-16-2009: Exercise Improves Lymphedema Symptoms in Breast Cancer Survivors
8-9-2009: Breast Cancer Recurrence, Death & Vitamin D
8-2-2009: Honesty, Dishonesty & Brain Function
7-26-2009: Coronary Artery CT Scans & Cancer Risk
7-19-2009: Hormone Replacement Therapy (HRT) & Ovarian Cancer
7-12-2009: Breast Cancer & Metformin (Glucophage)
7-5-2009: Prostate Cancer & Green Tea
6-28-2009: Air Pollution & the Risk of Deep Venous Thrombosis (DVT)
6-21-2009: Red Yeast Rice, Statins & Cholesterol
6-14-2009: Bone Marrow Stem Cell Transplant & Congestive Heart Failure (CHF)
6-7-2009: Diet, Soy & Breast Cancer Risk
5-31-2009: Diet and Prostate Cancer Risk
5-24-2009: Diabetes, Glucose Control & Death
5-17-2009: Drug Company Marketing & Physician Prescribing Bias
5-10-2009: Hemorrhoids & Surgery
5-3-2009: Statin Drugs & Blood Clots (Thromboembolism)
4-26-2009: Are We Really Losing the War on Cancer?
4-19-2009: Exercise in Middle Age & Risk of Death
4-12-2009: Can Chronic Stress Harm Your Heart?
4-5-2009: Does PSA Testing for Prostate Cancer Save Lives?
3-22-2009: CABG Surgery vs. PCI in Diabetics with Coronary Artery Disease; Sweetened Beverages and Coronary Artery Disease
3-15-2009: Depression, Stress, Anger & Heart Disease
3-8-2009: Coronary Artery Disease: CABG vs. Stents?; Swimming Lessons & Drowning Risk in Children
3-1-2009: Aspirin & Colorectal Cancer Prevention; Fish Oil & Respiratory Infections in Children
2-22-2009: Health Differences Between Americans & Europeans; Lycopene & Prostate Cancer
2-15-2009: Statin Drugs & Death Rates; Physical Activity, Breast Cancer & Sex Hormones
2-8-2009: Hormone Replacement Therapy (HRT) & Breast Cancer; Stool DNA Testing & Cancer of the Colon & Rectum
2-1-2009: Obesity and the Complications of Diverticulosis (Diverticulitis & Bleeding); Obesity, Weight Loss & Urinary Incontinence
1-25-2009: Prostate Cancer, Fatigue & Exercise; Does your Surgeon “Warm-up” Before Surgery?
1-18-2009: Cancer and Vitamins; Teenagers, MySpace and Risky Behaviors
1-11-2009: Exercise Reverses Some Effects of Fatty Meals; Vitamin C and Blood Pressure
1-4-2009: Secondhand Smoke & Heart Attack Risk; Poor Physical Fitness During Childhood & Heart Disease Risk During Adulthood
12-28-2008: Stress & Your Risk of Heart Attack; Vitamin D & the Prevention of Colon & Rectal Polyps
12-21-2008: Breast Cancer Incidence & Hormone Replacement Therapy; Circumcision & the Risk of HPV & HIV Infection
12-14-2008: Vitamin E, Vitamin C and Selenium Do Not Prevent Cancer; Postscript: A Possible Cure for Down’s Syndrome
12-7-2008: Generic vs. Brand-Name Drugs, Stress & Breast Cancer Survival
11-30-2008: A Possible Cure for Down’s Syndrome?; Smoking & Cognitive Decline; Calcium & Vitamin D & Breast Cancer Risk
11-23-2008: Breast Cancer & Fish Oil; Lymphedema after Breast Cancer Treatment; Vasectomy & Prostate Cancer Risk
11-16-2008: Vitamin E & Vitamin C: No Impact on Cardiovascular Disease Risk; Does Lack of Sleep Increase Stroke & Heart Attack Risk in Hypertensive Patients?
11-9-2008: Statins Cut Heart Attack Risk Even with Normal Cholesterol Levels; Statins & PSA Level
11-2-2008: Radiation Treatment of Prostate Cancer & Second Cancers; Sexual Content on TV & Teen Pregnancy Risk
10-26-2008: Smoking & Quality of Life
10-19-2008: Agent Orange & Prostate Cancer
10-12-2008: Pomegranate Juice & Prostate Cancer
10-5-2008: Central Obesity & Dementia; Diet, Vitamin D, Calcium, & Colon Cancer
9-28-2008: Publication & Citation Bias in Favor of Industry-Funded Research?
9-21-2008: Does Tylenol® (Acetaminophen) Cause Asthma?
9-14-208: Arthroscopic Knee Surgery- No Better than Placebo?; A Healthy Lifestyle Prevents Stroke
8-23-2008: Alcohol Abuse Before & After Military Deployment; Running & Age; Running & Your Testicles
8-12-2008: Green Tea & Diabetes; Breastfeeding & Adult Cholesterol Levels; Fish Oil & Senile Macular Degeneration
8-3-2008: Exercise & Weight Loss; Green Tea, Folic Acid & Breast Cancer Risk; Foreign Language Interpreters & ICU Patients
7-26-2008: Viagra & Sexual Function in Women; Patient-Reported Adverse Hospital Events; Curcumin & Pancreatic Cancer
7-13-2008: Erectile Dysfunction & Frequency of Sex; Muscle Strength & Mortality in Men; Cryoablation for Prostate Cancer
7-6-2008: Sleep, Melatonin & Breast Cancer Risk; Mediterranean Diet & Cancer Risk; New Treatment for Varicose Veins
6-29-2008: Bone Marrow Stem Cells & Liver Failure; Vitamin D & Colorectal Cancer Survival; Green Tea & Colorectal Cancer
6-22-2008: Obesity, Lifestyle & Heart Disease; Effects of Lifestyle & Nutrition on Prostate Cancer; Ginkgo Biloba, Ulcerative Colitis & Colorectal Cancer
6-15-2008: Preventable Deaths after Coronary Artery Bypass Graft (CABG) Surgery; Green Tea & Colorectal Cancer; Attention-Deficit/Hyperactivity Disorder (ADHD) & St. John’s Wort
6-8-2008: Vitamin D & Prostate Cancer Risk; Radiofrequency Ablation (RFA) of Kidney (Renal) Cancer; Antisense Telomerase & Cancer
6-2-2008: Acute Coronary Syndrome- Do You Know the Symptoms?; Green Tea & Lung Cancer; Episiotomy & Subsequent Deliveries- An Unkind Cut
5-25-2008: Early Childhood Screening Predicts Later Behavioral Problems; Psychiatric Disorders Among Parents of Autistic Children; Social & Psychiatric Profiles of Young Adults Born Prematurely
5-18-2008: Can Statins Reverse Coronary Artery Disease?; Does Breast Ultrasound Improve Breast Cancer Detection?; Preventive Care Services at Veterans Administration (VA) Medical Centers
5-11-2008: Smoking Cessation & Risk of Death; Childhood Traumas & Adult Suicide Risk; “White Coat Hypertension” & Risk of Cardiovascular Disease
5-4-2008: Super-Size Me: Fast Food’s Effects on Your Liver; Exercise, Weight & Coronary Artery Disease; Contamination of Surgical Instruments in the Operating Room
4-27-2008: Stents vs. Bypass Surgery for Coronary Artery Disease; The “DASH” Hypertension Diet & Cardiovascular Disease Prevention; Testosterone Therapy for Women with Decreased Sexual Desire & Function
4-20-2008: BRCA Breast Cancer Mutations & MRI Scans; Bladder Cancer Prevention with Broccoli?; Diabetes: Risk of Death Due to Heart Attack & Stroke
4-13-2008: Breast Cancer Recurrence & Hormone Replacement Therapy (HRT); Carotid Artery Disease: Surgery vs. Stents?; Statin Drugs & Cancer Prevention
4-6-2008: Human Papilloma Virus (HPV), Pap Smear Results & Cervical Cancer; Human Papilloma Virus (HPV) Infection & Oral Cancer; Hormone Replacement Therapy (HRT) & the Risk of Gastroesophageal Reflux Disorder (GERD)
3-30-2008: Abdominal Obesity & the Risk of Death in Women; Folic Acid Pretreatment & Heart Attacks; Pancreatic Cancer Regression after Injections of Bacteria
3-23-2008: Age of Transfused Blood & Risk of Complications after Surgery; Obesity, Blood Pressure & Heart Size in Children
3-16-2008: Benefits of a Full Drug Coverage Plan for Medicare Patients?; Parent-Teen Conversations about Sex; Soy (Genistein) & Prostate Cancer
3-9-2008: Flat Colorectal Adenomas & Cancer; Health Risks after Stopping Hormone Replacement Therapy (HRT); Television, Children & Obesity
3-2-2008: Medication & Risk of Death After Heart Attack; Hormone Replacement Therapy (HRT) & Mammogram Results; Selenium: Cancer, Heart Disease & Death
2-23-2008: Universal Healthcare Insurance Study; Glucosamine & Arthritis
2-17-2008: Exceptional Longevity in Men; Testosterone & Risk of Prostate Cancer; Smoking & Pre-malignant Colorectal Polyps
2-10-2008: Thrombus Aspiration from Coronary Arteries; Intensive Management of Diabetes & Death; Possible Cure for Down's Syndrome?
2-3-2008: Vitamin D & Cardiovascular Health; Vitamin D & Breast Cancer; Green Tea & Colorectal Cancer
1-27-2008: Colorectal Cancer, Esophageal Cancer & Pancreatic Cancer: Update from the 2008 American Society of Clinical Oncology's Gastrointestinal Cancers Symposium
1-20-2008: Testosterone Levels & Risk of Fractures in Elderly Men; Air Pollution & DNA Damage in Sperm; Statins & Trauma Survival in the Elderly
1-12-2008: Statins, Diabetes & Stroke and Obesity; GERD & Esophageal Cancer
1-7-2008: Testosterone Supplements in Elderly Men; Colorectal Cancer-- Reasons for Poor Compliance with Screening Recommendations
12-31-2007: Minority Women, Hormone Replacement Therapy & Breast Cancer; Does Health Insurance Improve Health?
12-23-2007: Is Coffee Safe After a Heart Attack?; Impact of Divorce on the Environment; Hypertension & the Risk of Dementia; Emotional Vitality & the Risk of Heart Disease
12-16-2007: Honey vs. Dextromethorphan vs. No Treatment for Kids with Night-Time Cough, Acupuncture & Hot Flashes in Women with Breast Cancer, Physical Activity & the Risk of Death, Mediterranean Diet & Mortality
12-11-2007: Bias in Medical Research; Carbon Nanotubes & Radiofrequency: A New Weapon Against Cancer?; Childhood Obesity & Risk of Adult Heart Disease
12-2-2007: Obesity & Risk of Cancer; Testosterone Level & Risk of Death; Drug Company Funding of Research & Results; Smoking & the Risk of Colon & Rectal Cancer