January 5, 2018

Surgeons face as much risk as coal miners of musculoskeletal disorders, study finds

Daily Briefing

    Surgeons and medical interventionalists are about as likely as coal miners, construction workers, and others working in physically demanding occupations to develop musculoskeletal disorders, according to a research review published in JAMA Surgery.

    Learn 4 key strategies to mitigate physician burnout

    For the meta-analysis, researchers at the Harvard T.H. Chan School of Public Health, Beth Israel Deaconess Medical Center, and Northeastern University reviewed 21 studies published between 1974 and 2016, from 23 different countries that together included data on 5,828 physicians.

    Key findings

    The researchers found that surgeons and medical interventionalists experienced a high rate of work-related musculoskeletal disorders, largely stemming from the professions' long hours, repetitive movements, and long periods of standing in awkward positions. According to the researchers, the most common musculoskeletal disorder reported among those providers was lumbar spine disease, with an overall career prevalence of 19%. Other disorders included:

    • Rotator cuff pathology, with an overall career prevalence of 18%;
    • Degenerative cervical spine disease, with an overall career prevalence of 17%; and
    • Carpal tunnel syndrome, with an overall career prevalence of 9%.

    The researchers also found that the prevalence of pain in the back, neck, shoulder, or upper extremities within the past year among surgeons and medical interventionalists ranged from 21% to 60%. The researchers said the estimates varied based on how individual studies assessed pain.

    Overall, the researchers found surgeons and medical interventionalists have a risk of musculoskeletal disorders comparable to coal miners, physical therapists, manufacturing laborers, and other high-risk jobs. And according to the study, such disorders often led physicians to take time off work, with 12% needing to take a leave of absence, modify or restrict their practice, or retire early.

    Discussion

    Bernard Lee, a plastic surgeon at Harvard Medical School and the lead author on the study, said the results were surprising. "These are common symptoms and common disorders that we discuss with our colleagues all the time," he said. "When we pulled all the data together, it was alarming and surprising to us that this was pervasive."

    In fact, according to industry experts, the problem is so prevalent that it may contribute to the shortage of physicians projected to occur within the coming years. The Association of American Medical Colleges projects that the physician shortage could reach somewhere between 40,800 and 104,900 physicians by the year 2030.

    According to the researchers, the study emphasizes the need to develop evidence-based ergonomics programs for surgeons and interventionalists to prevent musculoskeletal disorders from developing. And while those programs might be effectively combined with other wellness programs—such as those aimed at preventing physician burnout—they should focus first on awareness, the researchers said.

    "The number one thing we need to do is improve awareness. We need to know that this is a problem. We need to improve awareness from the earliest levels, whether in residency or even in medical school," Lee said. "[Ergonomics] could be as simple as standing up straight, or making sure that your neck is in the right position, or making sure that you're not bending halfway over the table to do something" (Finnegan, FierceHealthcare, 1/2; Hackethal, Medscape, 12/28/17).

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