The Silent Epidemic of Surgeon Burnout and Depression

 

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“A critical weekly review of important new research findings for health-conscious readers”


THE SILENT EPIDEMIC OF SURGEON

BURNOUT 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 burnout 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 burnout, 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 burnout 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 burnout.  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 burnout.  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, burnout, 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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For a groundbreaking overview of cancer risks, and evidence-based strategies to reduce your risk of developing cancer, order your copy of my new book, “A Cancer Prevention Guide for the Human Race,” from AmazonBarnes & NobleBooks-A-Million, Vroman’s Bookstore, and other fine bookstores!



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, a professor of surgery, a cancer researcher, an oncology consultant, and a widely published author


For a different perspective on Dr. Wascher, please click on the following YouTube link: 

Texas Blues Jam


I and the staff of Weekly Health Update would again like to take this opportunity to thank the more than 100,000 health-conscious people, from around the world, who visit this premier global health information website every month.  (As of 9/16/2010, more than 1,000,000 health-conscious people have logged onto Weekly Health Update so far this year!)  As always, I enjoy receiving your stimulating feedback and questions, and I will continue to try and personally answer as many of your inquiries as I possibly can.


 

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Gum Disease (Gingivitis) and Breast Cancer Risk

 

Welcome to Weekly Health Update



“A critical weekly review of important new research findings for health-conscious readers”


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OCTOBER IS NATIONAL BREAST CANCER

 

AWARENESS MONTH

 

 

 

GUM DISEASE (GINGIVITIS) AND BREAST CANCER RISK

Gum disease, also known as gingivitis, or periodontal disease, has been closely linked to an increased risk of heart disease.  Now, a newly published study from the renowned Karolinksa Institute in Sweden suggests that the risk of developing breast cancer may also be increased by chronic gum disease.  The results of this clinical research study appear in the current issue of Breast Cancer Research & Treatment.

In this prospective clinical research study, 3,273 women between the ages of 30 and 40 years were evaluated between 1985 and 2001.  Young women in this study who had documented chronic gum disease, or who had lost one or more molars due to gum disease, were more than twice as likely to be diagnosed with breast cancer when compared to women without periodontal disease (even after adjusting for known breast cancer risk factors in these young, healthy women).

Previous research has linked periodontal gum disease with an increased risk of other cancers, including cancers of the uterus, colon, rectum, prostate and pancreas.  However, up until now, there has been hardly any available research data linking gingivitis, or tooth loss due to periodontal disease, to breast cancer.

The exact mechanism whereby chronic gum disease increases cancer risk is unknown at this time.  (Some experts have proposed that bacteria from chronically inflamed gums may enter into the bloodstream, and induce an inflammatory response that, in turn, causes cancer formation.)  Irrespective of the true mechanism, however, certain cancers appear to be more common in people with chronic gum disease, even after adjusting for other known cancer risk factors.

If you experience red, swollen, sore, or bleeding gums, or premature tooth loss (or if your gums are retracting away from your teeth), then you may have periodontal disease (gingivitis).  Based upon recent research findings, this condition may not only increase your risk of heart disease, peripheral artery disease, stroke, and diabetes, but also cancer as well.  (Recent research has also linked periodontal disease in pregnant women with an increased risk of premature birth of their babies.)   If you notice any of these signs of periodontal disease, then please make an appointment to see your dentist for a complete check-up.

 

For a deeper discussion of known cancer risks, and evidence-based strategies to reduce your risk of developing cancer, order your copy of my new book, A Cancer Prevention Guide for the Human Race,” from Amazon, Barnes & Noble, Books-A-Million, Vroman’s Bookstore, and other fine bookstores! 



 

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, a professor of surgery, a cancer researcher, an oncology consultant, and a widely published author



For a different perspective on Dr. Wascher, please click on the following YouTube link: 

Texas Blues Jam



I and the staff of Weekly Health Update would again like to take this opportunity to thank the more than 100,000 health-conscious people, from around the world, who visit this premier global health information website every month.  (As of 9/16/2010, more than 1,000,000 health-conscious people have logged onto Weekly Health Update so far this year!)  As always, I enjoy receiving your stimulating feedback and questions, and I will continue to try and personally answer as many of your inquiries as I possibly can.



 

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Hormone Replacement Therapy (HRT) and Breast Cancer Risk

 

Welcome to Weekly Health Update



“A critical weekly review of important new research findings for health-conscious readers”



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OCTOBER IS NATIONAL BREAST CANCER

 

AWARENESS MONTH

 

 

 

HORMONE REPLACEMENT THERAPY (HRT)

AND BREAST CANCER RISK

The rising incidence of breast cancer, year-after-year, over the past 50 years in the United States (and in many other industrialized countries) has been attributed to a variety of factors, including environmental contaminants, rising obesity levels, and increased compliance with annual screening mammograms, among others.  However, one factor that has been given inadequate attention, in my view, is that of hormone replacement therapy (HRT), despite nearly a century of data showing a strong linkage between lifetime exposure to the female hormones estrogen and progesterone and the risk of developing breast cancer.

In 2002, the enormous, randomized, prospective, blinded Women’s Health Initiative (WHI) study published its preliminary results, and prematurely terminated its combination HRT study because of an alarming increase in the incidence of breast cancer in the group of women who had been secretly randomized to receive combination HRT medications for menopausal symptoms.

Despite subsequent updates from the WHI, which have shown, essentially, a doubling of breast cancer risk after more than 5 years of HRT use, there was initially a great deal of resistance to the WHI’s findings (and the findings of other similar clinical research trials) linking HRT use with an increased risk of developing breast cancer.

Now, a new national Canadian public health study offers additional powerful clinical research data linking HRT use with breast cancer risk, and reveals the equally strong link between declining HRT use and the declining breast cancer incidence in Canada.  This study appears in the current issue of the Journal of the National Cancer Institute.

In this study, 1,200 women between the ages of 50 and 69 participated in the National Population Health Survey between 1996 and 2006.  Just prior to the 2002 release of the WHI study’s results, 13 percent of these women regularly used combination HRT.  By December 2004, only 5 percent of the postmenopausal women participating in this study were still taking HRT medications.  During this same period, the incidence of breast cancer in this large group of Canadian women decreased by about 10 percent.  (Importantly, compliances rates with screening mammograms did not change during the course of this clinical research study.)

Thus, between 2002 and 2004, when HRT use significantly declined, the incidence of breast cancer decreased by about 10 percent in Canada.  Moreover, this significant decrease in breast cancer incidence occurred without any change in mammogram rates.

This study, as with other recent studies, adds to the overwhelming research data linking HRT use with an increased risk of developing breast cancer.  As I tell my own patients who are approaching menopause, it is best to avoid HRT altogether.  If you are already taking HRT medications, then ask your doctor to help you in weaning yourself off of these medications.

 

In recognition of Breast Cancer Awareness Month, I urge our tens of thousands of regular Weekly Health Update readers to join in the global fight against breast cancer.  There are numerous organizations and groups, in virtually every community, that are sponsoring fundraising activities throughout October, including the Susan G. Komen Race for the Cure.  Another opportunity to participate (and at no cost!) is to vote for the Dr. Susan Love Research Foundation Army of Women project in the Pepsi Refresh competition!  There are also many other worthwhile and deserving fundraising programs available for everyone to become involved in! 

 

For a deeper evidence-based discussion of the links between HRT and breast cancer risk, order your copy of my new book, A Cancer Prevention Guide for the Human Race,” from Amazon, Barnes & Noble, Books-A-Million, Vroman’s Bookstore, and other fine bookstores!


 


 

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, a professor of surgery, a cancer researcher, an oncology consultant, and a widely published author




For a different perspective on Dr. Wascher, please click on the following YouTube link: 

Texas Blues Jam



I and the staff of Weekly Health Update would again like to take this opportunity to thank the more than 100,000 health-conscious people, from around the world, who visit this premier global health information website every month.  (As of 9/16/2010, more than 1,000,000 health-conscious people have logged onto Weekly Health Update so far this year!)  As always, I enjoy receiving your stimulating feedback and questions, and I will continue to try and personally answer as many of your inquiries as I possibly can.



 

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Mammograms Between 40 and 49 Years of Age

 

Welcome to Weekly Health Update



“A critical weekly review of important new research findings for health-conscious readers”


pink-ribbon-image

   

 

OCTOBER IS NATIONAL BREAST CANCER

 

AWARENESS MONTH

 

 

 

MAMMOGRAMS BETWEEN 40 AND 49 YEARS OF AGE

Both patients and their physicians were stunned last year when the U.S. Department of Health and Human Services’ U.S. Preventive Services Task Force (USPSTF) recommended against routine annual screening mammograms in women between the age of40 and 49 years (as has been the standard recommendation in the United States, and in most countries around the world, for many years).  The USPSTF’s recommendations quickly set off a firestorm of debate regarding the calculations and public health considerations used by the USPSTF to arrive at this surprising recommendation.  Since the USPSTF released its recommendations in the fall of 2009, most breast cancer specialists and breast cancer advocacy groups have continued to recommend that women who are at average risk of developing breast cancer begin routine annual screening mammograms at age 40. 

As I extensively discuss in my new book, A Cancer Prevention Guide for the Human Race, there is ample available clinical research data showing that screening mammograms detect breast cancer at an earlier stage than other commonly available screening methods, and that survival is improved in women in whom breast cancer is first detected by a mammogram (as opposed to the detection of a palpable or visible breast mass).

Now, a newly published large-scale public health study from Sweden, which appears in the current issue of the journal Cancer, offers further important evidence that the routine use of annual screening mammograms among women between 40 and 49 years of age significantly reduces the risk of dying from breast cancer.

In this enormous study, women between the ages of 40 and 49 years were separated into two groups, depending upon whether or not they underwent annual screening mammograms between 1986 and 2005 (the average duration of patient follow-up in this study was a very impressive 16 years).  In this very powerful research study, young women who underwent annual mammograms accounted for 7.3 million “person-years” of observation, while the young women who did not undergo mammograms accounted for a similarly astonishing 8.8 million “person-years” of observation within this landmark public health study. 

When the number of breast cancer deaths were assessed in both of these huge groups of young women, the women who underwent routine annual mammograms were found to be 29 percent less likely to die of breast cancer when compared to the young women who did not undergo annual mammograms!  (In public health terms, this 29 percent observed reduction in the death rate due to breast cancer is highly clinically significant!)

 

This public health study, which encompassed the entire country of Sweden, is the largest mammography study of its kind, and its findings are both powerful and persuasive in defense of beginning routine annual screening mammograms at the age of 40 in women who are at average risk of developing breast cancer.  It is my hope that the dramatic findings of this huge clinical study will now lay to rest any lingering doubts regarding the effectiveness of screening mammograms, beginning at 40 years of age, in reducing the risk of death due to breast cancer.

 

 

In recognition of Breast Cancer Awareness Month, I urge our tens of thousands of regular Weekly Health Update readers to join in the global fight against breast cancer.  There are numerous organizations and groups, in virtually every community, that are sponsoring fundraising activities throughout October, including the Susan G. Komen Race for the Cure.  Another opportunity to participate (and at no cost!) is to vote for the Dr. Susan Love Research Foundation Army of Women project in the Pepsi Refresh competition!  There are also many other worthwhile and deserving fundraising programs available for everyone to become involved in! 

 

For an evidence-based discussion of the critical importance of breast cancer screening, including mammograms, in a cancer prevention lifestyle, order your copy of my new landmark book, “A Cancer Prevention Guide for the Human Race,” from Amazon or Barnes & Noble, Books-A-Million, Vroman’s Bookstore, and other fine bookstores! 


 


 

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, a professor of surgery, a cancer researcher, an oncology consultant, and a widely published author



For a different perspective on Dr. Wascher, please click on the following YouTube link: 

Texas Blues Jam


I and the staff of Weekly Health Update would again like to take this opportunity to thank the more than 100,000 health-conscious people, from around the world, who visit this premier global health information website every month.  (As of 9/16/2010, more than 1,000,000 health-conscious people have logged onto Weekly Health Update so far this year!)  As always, I enjoy receiving your stimulating feedback and questions, and I will continue to try and personally answer as many of your inquiries as I possibly can.



 

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Vitamin D, Cardiovascular Disease, Cancer, and Death

 

Welcome to Weekly Health Update


“A critical weekly review of important new research findings for health-conscious readers”



VITAMIN D, CARDIOVASCULAR DISEASE, CANCER AND DEATH

Among all of the vitamins, only Vitamin D appears to have clinically significant health benefits in reducing the risk of death associated with cardiovascular disease, fractures, and cancer, based upon numerous recent clinical research study findings (for a comprehensive update on the role of Vitamin D as part of a cancer prevention lifestyle, please see my new book, A Cancer Prevention Guide for the Human Race, which is now available from Amazon and Barnes & Noble). 

A newly-published clinical research study, which appears in the current issue of the American Journal of Clinical Nutrition, prospectively evaluated 1,194 elderly men (average age was 71 years) over a period of nearly 13 years.   Blood levels of Vitamin D were measured in these elderly male men, and the results of these blood tests were then correlated with subsequent health outcomes. 

In this prospective public health study, with extensive long-term follow-up, very low and very high blood levels of Vitamin D were associated with a significantly increased risk of death.  In fact, a whopping 50 percent increase in the risk of death was associated with both very low (<46 nmol/L) and very high (>98 nmol/L) concentrations of Vitamin D in the blood.  Death due to cancer was two times more common with very low Vitamin D levels, while very high levels of Vitamin D increased the risk of death due to cancer by almost three-fold.  At the same time, death due to cardiovascular disease was nearly twice as likely in elderly men with very low Vitamin D levels, but not in men with very high levels of this hormone-like vitamin.

The findings of this prospective public health study add to the enormous volume of previously published clinical research data on the health effects of Vitamin D.  As this study suggests, there may be an optimal concentration of Vitamin D in the blood that is associated with a decreased risk of death from both cardiovascular disease and cancer.  Meanwhile, a healthy diet that emphasizes fresh fruits, brightly-colored fresh vegetables, whole grains, and fatty fish (and minimal red meat and other animal-based foods) is your best bet for a long and healthy life! 

For a comprehensive, evidence-based review of the importance of Vitamin D and diet in a cancer prevention lifestyle, order your copy of my new landmark book, A Cancer Prevention Guide for the Human Race, from Amazon or Barnes & Noble! 



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, a professor of surgery, a cancer researcher, an oncology consultant, and a widely published author


For a different perspective on Dr. Wascher, please click on the following YouTube link: 
Texas Blues Jam


I and the staff of Weekly Health Update would again like to take this opportunity to thank the more than 100,000 health-conscious people, from around the world, who visit this premier global health information website every month.  (As of 9/16/2010, more than 1,000,000 health-conscious people have logged onto Weekly Health Update so far this year!)  As always, I enjoy receiving your stimulating feedback and questions, and I will continue to try and personally answer as many of your inquiries as I possibly can.



 

Bookmark and Share



 

Post to Twitter

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