Are we OK?

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Lately, I’ve been thinking a lot about you and me. No, not being creepy. I meant all of us, vascular surgeons. Something might be wrong. I credit my concern to Dawn Coleman. Last spring, I was attending a session at the SVS and Dr. Coleman’s presentation was running over. The red light signal began to flash and she quickly covered the content of her last few slides. As she finished her talk I thought I heard her say, almost under her breath, that vascular surgeons lead all medical specialists in suicidal ideation. “Did she just say suicidal ideation?”, I asked the person next to me. It was an odd statement and certainly a fact I had never heard.

For the next few weeks, the thought stuck with me. Why us? It turns out the study she was quoting from 1 was an American College of Surgeons survey that found that suicidal ideation (SI) was 6.4% among American surgeons, compared with 3.3% of the general population. And yes, the highest incidence of suicidal ideation was found in vascular surgeons (7.7%). The study also found that 50% of those with SI will make an attempt but only 26% will seek psychiatric treatment. The most commonly stated deterrent to seeking professional help was fear of a negative impact on their licensure. While SI and suicide rates are disproportionately higher in physicians, clinical depression is not. Therefore there are other factors in play. So we must look at burnout and quality of life (QOL) issues.

Dr. Malachi Sheahan III

Dr. Malachi Sheahan III

A second study based on this same ACS survey2 looked at career satisfaction among 14 surgical specialties. Vascular surgeons again performed miserably with 36% stating they would not be a surgeon again (rank, 1st) and 54% would not recommend a medical career to their children (rank, 1st). A look at the demographics of this survey show that the 463 vascular surgeons who responded were 94% male with a mean age of 52.9 years. Burnout was reported in 44% of vascular surgeons, second only to trauma surgeons (51.6%).

Unfortunately, there are other markers of a problem in our field. A study3 based on the 2004-2005 Community Tracking Survey (CTS) looked at 6,381 physicians who reported working between 20 and 100 hours per week. The respondents comprised 41 medical specialties. Mean annual hours worked were 2,524, and accounting for a 48-week work-year, this would extrapolate to 52.6 hours per week among all specialties. The authors devised an interesting (arbitrary?) “hours above or below family practice” metric and here vascular surgery is once again the unfortunate winner. Our adjusted mean work hours were 888 above family practice, worst of any specialty.

Recently, Samuel Money, MD, former president of the Society for Clinical Vascular Surgery, sent a survey on physical discomfort to vascular surgeons on behalf of the SCVS. I wonder about the power of suggestion with these types of studies. While filling it out, I found myself thinking, “Now that you mentioned it, my back DOES kind of hurt, Sam, thanks for asking!” I am reminded of the pain scale questions our clinic patients fill out each visit. If these were accurate our waiting room would look like the aftermath of the Battle of Gettysburg. I realize our periodical selection is suboptimal but I don’t think it should cause true agony.

None of this is to disparage the validity of surveys. Vascular surgeons face real health risks related to radiation exposure, repetitive movements, and long surgical times. Spine issues and cataracts have been closely correlated to our vocation, and I do look forward to the results of this study from the SCVS.

So what do we do? Michael Sosin, MD, and his colleagues recently published an extensive review of quality of life and burnout rates across surgical specialties.4

I’ll paraphrase some of their recommendations here:

• Streamline specialty training.

• Optimize reimbursement.

• Reevaluate training paradigms.

• Examine department cultures.

• Look carefully at tort reform.

• Examine the medical education dept.

The good news is that the ACS survey was performed 8 years ago and the work hours report from the Community Tracking Survey is nearly 12 years old. Looking at the recommendations from Dr. Sosin, we have made a massive move to streamline our training with the advent of the 0+5 integrated vascular residencies. Work hours correlate closely to caring for acutely ill patients who require intensive monitoring. The widespread adoption of endovascular options has likely had a positive impact on our work hours with shorter lengths of stay and fewer ICU patients.

Nevertheless, being the lead specialty in several of these surveys should be eye opening, to say the least. We need to take a closer look at burnout, depression, and suicidal ideation in our field. We need to fight with the SVS for serious reform in reimbursements and malpractice legislation. We need to identify and transform malignant department cultures where they exist. Finally, removing the stigma of psychiatric assistance may be the most important goal of all.

References

1. Arch Surg. 2011;146(1):54-62.

2. Ann Surg. 2011;254:558-68.

3. Arch Intern Med. 2011;171(13):1211-3.

4. JAMA Surg. 2016;151(10):970-8.

Dr. Malachi Sheahan III, from the Louisiana State University Health Sciences Center, New Orleans, is the Associate Medical Editor of Vascular Specialist.

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