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  • Surgeon musculoskeletal risks similar to coal mining

    This article was sent around by my hospital's CMO today.  I believe it.

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

    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.

    For the meta-analysis, researchers at the Harvard T.H. Chan School of Public HealthBeth 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, F

  • #2
    Anecdotally dentists seem to have an even worse time of things. They do very similar movements in a very small space all day and likely have an even higher patient volume than most surgeons do. Every dentist I know has neck and wrist pain.

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    • #3
      Interesting article. It’s good to point out health risks like this that people might not be thinking of. Completely inappropriate for the authors to compare to the physical toll of coal mining though. Doubtful the life expectancy of a surgeon is 49 years as it is for an underground coal miner, so it is certainly not an appropriate comparison. Why not compare to auto mechanic, construction worker, or other physical laborer? Simple unfortunate answer - such comparisons are not as shocking. Clickbait titles with high shock value are fine for blogs, but bad for academic research and damage credibility.

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      • #4
        I dont think the intent of the article is to say that being a surgeon is as  physically demanding as digging coal.  It is however much more physically demanding than other "white collar" jobs.

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        • #5




          Anecdotally dentists seem to have an even worse time of things. They do very similar movements in a very small space all day and likely have an even higher patient volume than most surgeons do. Every dentist I know has neck and wrist pain.
          Click to expand...


          Think its the really awkwardness of the angles there, just no comfortable, ergonomic, or non intrusive way to really approach it. There are better ways for sure, and I notice dentists are starting to use their chairs more, but theres still the neck bending in best cases.

          Overall, I think its probably the most overlooked part of choosing a specialty, surgery is physical. I wish I had taken that into account before hand or even thought of it. I'd rather workout with a purpose and in beneficial ways rather than in awkward ways that put strain on you.

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          • #6
            I totally agree it is physically hard. I was not surprised to see that hand surgeons do their procedures while sitting. But even that doesn't always help- just take a look at the dentists.

            You know what else is hard? Interminable internal medicine rounding. I've never had my feet hurt so badly in my life. I'm amazed that 3 hours of rounding will give me a week of pain but I can hike 15 miles in a day without any. I didn't know if I was even going to get through medical school until I discovered Danskos.
            Helping those who wear the white coat get a fair shake on Wall Street since 2011

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            • #7




              I totally agree it is physically hard. I was not surprised to see that hand surgeons do their procedures while sitting. But even that doesn’t always help- just take a look at the dentists.

              You know what else is hard? Interminable internal medicine rounding. I’ve never had my feet hurt so badly in my life. I’m amazed that 3 hours of rounding will give me a week of pain but I can hike 15 miles in a day without any. I didn’t know if I was even going to get through medical school until I discovered Danskos.
              Click to expand...


              LOL, well I make sure to sit down after 2-3 patients and do my notes. No way would I just keep on rounding without taking intermittent physical and mental breaks.

              It is odd though that standing still for too long can cause more discomfort than walking long distances.  I guess it shows that our bodies are well suited for movement.

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              • #8
                I dont think ergonomics was even discussed when I trained.  Neck Issues will get you over time.

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                • #9
                  To me it’s the mental wear and tear in addition to the physical that makes it comparable to other jobs

                  Standing all day In the cath lab with lead all day is manageable but combining that with stress of high risk procedures/complications and the hundreds of distractions from interruptions, calls, staff requests just mentally wears you out. Combing that with the subsequent sleep deprivation from call and you can see how it wears you out.

                  Walking around on rounds is obviously not comparable and comparing it to the grind of some physical laborers or coal miners is silly too from a physical standpoint.

                  But the mental+physical wear and tear is real and often downplayed

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                  • #10




                    To me it’s the mental wear and tear in addition to the physical that makes it comparable to other jobs

                    Standing all day In the cath lab with lead all day is manageable but combining that with stress of high risk procedures/complications and the hundreds of distractions from interruptions, calls, staff requests just mentally wears you out. Combing that with the subsequent sleep deprivation from call and you can see how it wears you out.

                    Walking around on rounds is obviously not comparable and comparing it to the grind of some physical laborers or coal miners is silly too from a physical standpoint.

                    But the mental+physical wear and tear is real and often downplayed
                    Click to expand...


                    come back in 12 years and tell us how you feel.  what you say is obviously correct, but wow, aging makes it all worse.   especially call related sleep deprivation 

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                    • #11




                      I dont think the intent of the article is to say that being a surgeon is as  physically demanding as digging coal.  It is however much more physically demanding than other “white collar” jobs.
                      Click to expand...


                      I agree with your last sentence. Comparing coal mining to surgery is simply too ridiculous though.  Believe me, no coal miner is thinking, “man I’ve got it rough, but I really feel bad for those surgeons craning their necks awkwardly all day.”   Stuff like this exemplifies the reason for people’s disdain for ivory tower academics because they write things that sound good on paper but have no basis in the real world.  Many academics never work outside of the acadmic bubble, and it certainly shapes their world view.

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                      • #12







                        I dont think the intent of the article is to say that being a surgeon is as  physically demanding as digging coal.  It is however much more physically demanding than other “white collar” jobs.
                        Click to expand…


                        I agree with your last sentence. Comparing coal mining to surgery is simply too ridiculous though.  Believe me, no coal miner is thinking, “man I’ve got it rough, but I really feel bad for those surgeons craning their necks awkwardly all day.”   Stuff like this exemplifies the reason for people’s disdain for ivory tower academics because they write things that sound good on paper but have no basis in the real world.  Many academics never work outside of the acadmic bubble, and it certainly shapes their world view.
                        Click to expand...


                        Donnie at least the Ivory Tower people have recognized that the Docs who provide the care are wearing themselves out.

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                        • #13
                          And people wonder why disability insurance that protects a physician's specialty and not just an income is expensive, humm.....
                          Scott Nelson-Archer, CLU, ChFC
                          303-953-0263 Direct / [email protected]

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                          • #14










                            I dont think the intent of the article is to say that being a surgeon is as  physically demanding as digging coal.  It is however much more physically demanding than other “white collar” jobs.
                            Click to expand…


                            I agree with your last sentence. Comparing coal mining to surgery is simply too ridiculous though.  Believe me, no coal miner is thinking, “man I’ve got it rough, but I really feel bad for those surgeons craning their necks awkwardly all day.”   Stuff like this exemplifies the reason for people’s disdain for ivory tower academics because they write things that sound good on paper but have no basis in the real world.  Many academics never work outside of the acadmic bubble, and it certainly shapes their world view.
                            Click to expand…


                            Donnie at least the Ivory Tower people have recognized that the Docs who provide the care are wearing themselves out.
                            Click to expand...


                            I’m not saying this research is bad or flawed.  Many scientists (probably like these folks) devote their lives to research simply because they enjoy figuring things out that might help others.  They trade off large amounts of money many could earn working in the private sector to do this work. I am extremely supportive of science and research.  I spent 10 years in academic research myself.

                            Alienating working class America isn’t going to help anyone though.  We want everyone to be supportive of science and basic research, not just the wealthy or elite.

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                            • #15




                               

                              Walking around on rounds is obviously not comparable and comparing it to the grind of some physical laborers or coal miners is silly too from a physical standpoint.

                               
                              Click to expand...


                              My feet never hurt mowing lawns 10 hours a day like they did on IM rotations.
                              Helping those who wear the white coat get a fair shake on Wall Street since 2011

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