Surgeons Twice as Likely to Miscarry

[Tim]

Another vote for chronic stress. There’s NOTHING more stressful than the responsibility knowing that the actions of ones hands can hurt or kill another human being.

it’s just a thing that no one can fully grasp.. even doctors who aren’t surgeons

even in the cardiology world where it’s technically the same specialty, I’ve yet to meet a general cardiologist who truly understands what high risk interventions are like to the primary operator.

Probably why the choice of specialty is surgical or non-surgical as the first decision point.

[FIREshrink]

Surgeries start at 730a. Long cases can be hours and surgeons rarely scrub out to do human-things like eat and drink. Lack of sleep, the physical stress, and the physical deprivation could increase complications are my guess. I would be interested to see if there are significant differentiators by field of surgery. I almost fainted during a c-section in the late 3rd trimester and that was only an hour long. I wonder how transplant surgeons fare.

Also makes me wonder what kind of long-term
health consequences surgeons in general carry that non-surgeons might not carry. For example, do male surgeons have higher rates of illness compared to male non-surgeon counterparts. I bet female surgeons aren’t ‘weak’. There probably is something underlying that is just not optimal for humans, male and female alike- something about surgery that is bad for ones health. That awful smelling bovie burn comes to mind.

That bovie burn and the suction slurp talked me out of any surgical specialty day 1 of my first clinical rotation (which was general surgery).

[VentAlarm]

Another vote for chronic stress. There’s NOTHING more stressful than the responsibility knowing that the actions of ones hands can hurt or kill another human being.

it’s just a thing that no one can fully grasp.. even doctors who aren’t surgeons

even in the cardiology world where it’s technically the same specialty, I’ve yet to meet a general cardiologist who truly understands what high risk interventions are like to the primary operator.

I don’t think that’s accurate at all. I think this is one of those things surgeons tell themselves, but I just don’t believe it. I think people conflate surgery with managing ill patients. There are plenty of surgeons who don’t do anything remotely life-threatening. Conversely, I’m an Intensivist and EM doc at one of the highest acuity hospitals in the country. I make life and death split second decisions all the time. You wouldn’t believe some of the stuff I’ve seen this week (seriously, it’s been nuts). I had to intubate a term pregnant woman with covid who had sats of 80 on high-flow and a non-rebreather. You think my hands not being quick and facile enough or a mental mistake wouldn’t have resulted in the death of two patients? I had about no time flat to get a chest tube in a patient last night who’s sat was in the 70s with tension physiology. I had three patients code this week. Admitted a septic shock patient with lactic of 15. Cardiogenic shock with new EF<15. I had to massively transfuse two patients not to mention the attendant cordis needed for both that had to be put in super fast. Had one patient with an undetectable bicarb (labs lower limit is 2). AIDS patient with shock and MSOF with CD4<5. I don’t see how this is any less stressful than a hand surgeon doing a carpal tunnel release or a orthopod doing a femur nail, especially when procedures are involved.

Seriously, it’s been a week….

[Lordosis]

I don’t think that’s accurate at all. I think this is one of those things surgeons tell themselves, but I just don’t believe it. I think people conflate surgery with managing ill patients. There are plenty of surgeons who don’t do anything remotely life-threatening. Conversely, I’m an Intensivist and EM doc at one of the highest acuity hospitals in the country. I make life and death split second decisions all the time. You wouldn’t believe some of the stuff I’ve seen this week (seriously, it’s been nuts). I had to intubate a term pregnant woman with covid who had sats of 80 on high-flow and a non-rebreather. You think my hands not being quick and facile enough or a mental mistake wouldn’t have resulted in the death of two patients? I had about no time flat to get a chest tube in a patient last night who’s sat was in the 70s with tension physiology. I had three patients code this week. Admitted a septic shock patient with lactic of 15. Cardiogenic shock with new EF<15. I had to massively transfuse two patients not to mention the attendant cordis needed for both that had to be put in super fast. Had one patient with an undetectable bicarb (labs lower limit is 2). AIDS patient with shock and MSOF with CD4<5. I don’t see how this is any less stressful than a hand surgeon doing a carpal tunnel release or a orthopod doing a femur nail, especially when procedures are involved.

Seriously, it’s been a week….

Well I had to argue with someone about taking a statin!

No seriously I appreciate there are folk out there willing to do this hard work.

[Hatton]

I don’t think that’s accurate at all. I think this is one of those things surgeons tell themselves, but I just don’t believe it. I think people conflate surgery with managing ill patients. There are plenty of surgeons who don’t do anything remotely life-threatening. Conversely, I’m an Intensivist and EM doc at one of the highest acuity hospitals in the country. I make life and death split second decisions all the time. You wouldn’t believe some of the stuff I’ve seen this week (seriously, it’s been nuts). I had to intubate a term pregnant woman with covid who had sats of 80 on high-flow and a non-rebreather. You think my hands not being quick and facile enough or a mental mistake wouldn’t have resulted in the death of two patients? I had about no time flat to get a chest tube in a patient last night who’s sat was in the 70s with tension physiology. I had three patients code this week. Admitted a septic shock patient with lactic of 15. Cardiogenic shock with new EF<15. I had to massively transfuse two patients not to mention the attendant cordis needed for both that had to be put in super fast. Had one patient with an undetectable bicarb (labs lower limit is 2). AIDS patient with shock and MSOF with CD4<5. I don’t see how this is any less stressful than a hand surgeon doing a carpal tunnel release or a orthopod doing a femur nail, especially when procedures are involved.

Seriously, it’s been a week….

Thanks for your good work. As a now retired OB/GYN I can agree that not every case is saving a life. The ones that are become life-long memories. Intensivists may have a high miscarriage rate also. Who knows?

[CordMcNally]

There’s NOTHING more stressful than the responsibility knowing that the actions of ones hands can hurt or kill another human being.

it’s just a thing that no one can fully grasp.. even doctors who aren’t surgeons

Stress is an individual thing. There are things about an office job that I would find much more stressful than my job. It's rare that a surgery needs to happen right that second for a life-saving intervention for most surgical subspecialties. OB probably has the most common emergent surgeries. For many cases, the most dangerous part of the case is done by the anesthesiologist. Non-surgeon physicians certainly know about the stress you're talking about so hopefully you don't go around the hospital saying the bolded out loud. I'm assuming you don't because chances are you would have run into someone that would have corrected you.

[CM]

i have this ongoing convo w/ several friends and family who are non-medical. i think the non-medical workplace has lots of screwing around baked into the workday. even a family member i talked to lately who is a very highly paid design professional was telling me that he really only works about 3 hours a day. my med school roommate did some entry level software sales gig in our big city and he freely admitted that his day was usually about 2 hours of calls and about 6 hours of "staff meetings" which were mostly planning social events, long lunches, and wandering around the office BS'ing. if he made $1k in sales or whatever his quota was by 11am he was pretty much done for the day and even his boss didn't expect more. he wasn't supposed to leave but he was done.

medicine is hard... save early so you have options.

I have personal experience. Shortly after I started as an equity analyst, the Spitzer settlement tripled our coverage list as the company positioned itself as a major research shop. We were typically working 12 hours a day trying to keep up. The bitching and moaning from my colleagues was amazing to me.

The standard day was spent quietly reading 10-Ks and building financial models in Excel. We regularly walked across the street for a Starbucks, took our time with lunch, had group email conversations about investing topics, shot the breeze in the break room, etc. There were no emergencies, no constant interruptions, no one's life on the line, no urgent push every second of the day trying to keep up with an avalanche of work -- and everyone slept peacefully every night. I thought it was a sweet, sweet vacation after my hellish experience as a solo cardiologist.

What I found most remarkable was the attitude of my colleagues. In medicine, everyone just sucked it up and did the work. It didn't matter what was demanded; everyone just did the job.

[burritos]

I don’t think that’s accurate at all. I think this is one of those things surgeons tell themselves, but I just don’t believe it. I think people conflate surgery with managing ill patients. There are plenty of surgeons who don’t do anything remotely life-threatening. Conversely, I’m an Intensivist and EM doc at one of the highest acuity hospitals in the country. I make life and death split second decisions all the time. You wouldn’t believe some of the stuff I’ve seen this week (seriously, it’s been nuts). I had to intubate a term pregnant woman with covid who had sats of 80 on high-flow and a non-rebreather. You think my hands not being quick and facile enough or a mental mistake wouldn’t have resulted in the death of two patients? I had about no time flat to get a chest tube in a patient last night who’s sat was in the 70s with tension physiology. I had three patients code this week. Admitted a septic shock patient with lactic of 15. Cardiogenic shock with new EF<15. I had to massively transfuse two patients not to mention the attendant cordis needed for both that had to be put in super fast. Had one patient with an undetectable bicarb (labs lower limit is 2). AIDS patient with shock and MSOF with CD4<5. I don’t see how this is any less stressful than a hand surgeon doing a carpal tunnel release or a orthopod doing a femur nail, especially when procedures are involved.

Seriously, it’s been a week….

Yup that's why the "not taking the vaccine" is messed up.

[burritos]

Thanks for your good work. As a now retired OB/GYN I can agree that not every case is saving a life. The ones that are become life-long memories. Intensivists may have a high miscarriage rate also. Who knows?

I wonder if there is a correlation between Obstetrician morbidity and the advent of the fetal heart rate machine.

[Lordosis]

I wonder if there is a correlation between Obstetrician morbidity and the advent of the fetal heart rate machine.

I remember seeing a study at one point that showed that the fetal heart tracing is actually increased interventions which led to poor outcomes. However the alternative was intermittent monitoring which was too labor intensive so the fetal heart monitoring has become standard of care. Not sure if there's been further research to flesh this out any more but this is the way I remember it from about a decade ago.

[Max Power]

You guys are overthinking it. It is AGE, pure and simple... "but-but-but it says age was standardized out."

Physiologic age, no chronological. There is no comparison between some female 35 year old housewife or hairdresser and a surgeon. Surgery residency is stressful both psychologically and physically... the sleep is bad, the patient care hours are bad, the boards and studying hours are bad, the nutrition is subpar and the stimulant use to various extents is a part of the game. Even a general surgeon who comes out of med school 26 and out of residency 31 is basically 35 or 40 years old physiologically.

You can see it in almost all of the surgery residents, of both genders, at one time or another - even the ones who are quite attractive or well-kept normally... the common puffy face or cortisol, the hairline suffering and disheveled and overdue for some TLC, the skin greasy or pale, the muffin top, the droopy bloodshot eyes, etc. I see it every dang day on rounds or in M&M. Some recover and right the ship after training, and some never do.

It is definitely double bad for women in surgery since they get to watch most of their female friends get married, start families, etc while they are sitting by their beeper or in a library. They know their time is slipping away and they are trading peak dating and reproductive years for possible stability and academic/financial payoff later... yet the body won't be the same later. The female surgery residents who get pregnant and have a kid during residency almost always drop out to do something easier with less call... like FP or IM or ER.

Again, don't overthink it. It is what it is. Women who work hard on their careers in their 20s with medical residency, travel sales, military, PhD or JD or other tough grad school, etc etc know they're making a tradeoff. The tradeoff is probably won't land as high quality man as they may have to attain not "needing" a man. It is what it is. Everyone makes their own choices.

[Tim]

You guys are overthinking it. It is AGE, pure and simple... "but-but-but it says age was standardized out."

Physiologic age, no chronological. There is no comparison between some female 35 year old housewife or hairdresser and a surgeon. Surgery residency is stressful both psychologically and physically... the sleep is bad, the patient care hours are bad, the boards and studying hours are bad, the nutrition is subpar and the stimulant use to various extents is a part of the game. Even a general surgeon who comes out of med school 26 and out of residency 31 is basically 35 or 40 years old physiologically.

You can see it in almost all of the surgery residents, of both genders, at one time or another - even the ones who are quite attractive or well-kept normally... the common puffy face or cortisol, the hairline suffering and disheveled and overdue for some TLC, the skin greasy or pale, the muffin top, the droopy bloodshot eyes, etc. I see it every dang day on rounds or in M&M. Some recover and right the ship after training, and some never do.

It is definitely double bad for women in surgery since they get to watch most of their female friends get married, start families, etc while they are sitting by their beeper or in a library. They know their time is slipping away and they are trading peak dating and reproductive years for possible stability and academic/financial payoff later... yet the body won't be the same later. The female surgery residents who get pregnant and have a kid during residency almost always drop out to do something easier with less call... like FP or IM or ER.

Again, don't overthink it. It is what it is. Women who work hard on their careers in their 20s with medical residency, travel sales, military, PhD or JD or other tough grad school, etc etc know they're making a tradeoff. The tradeoff is probably won't land as high quality man as they may have to attain not "needing" a man. It is what it is. Everyone makes their own choices.

Physiologic AND chronological. Work/life self selection has consequences. Time goes on regardless of the choices made.

[Hatton]

You guys are overthinking it. It is AGE, pure and simple... "but-but-but it says age was standardized out."

Physiologic age, no chronological. There is no comparison between some female 35 year old housewife or hairdresser and a surgeon. Surgery residency is stressful both psychologically and physically... the sleep is bad, the patient care hours are bad, the boards and studying hours are bad, the nutrition is subpar and the stimulant use to various extents is a part of the game. Even a general surgeon who comes out of med school 26 and out of residency 31 is basically 35 or 40 years old physiologically.

You can see it in almost all of the surgery residents, of both genders, at one time or another - even the ones who are quite attractive or well-kept normally... the common puffy face or cortisol, the hairline suffering and disheveled and overdue for some TLC, the skin greasy or pale, the muffin top, the droopy bloodshot eyes, etc. I see it every dang day on rounds or in M&M. Some recover and right the ship after training, and some never do.

It is definitely double bad for women in surgery since they get to watch most of their female friends get married, start families, etc while they are sitting by their beeper or in a library. They know their time is slipping away and they are trading peak dating and reproductive years for possible stability and academic/financial payoff later... yet the body won't be the same later. The female surgery residents who get pregnant and have a kid during residency almost always drop out to do something easier with less call... like FP or IM or ER.

Again, don't overthink it. It is what it is. Women who work hard on their careers in their 20s with medical residency, travel sales, military, PhD or JD or other tough grad school, etc etc know they're making a tradeoff. The tradeoff is probably won't land as high quality man as they may have to attain not "needing" a man. It is what it is. Everyone makes their own choices.

This is the most offensive post you have made.

[ObgynMD]

You guys are overthinking it. It is AGE, pure and simple... "but-but-but it says age was standardized out."

Physiologic age, no chronological. There is no comparison between some female 35 year old housewife or hairdresser and a surgeon. Surgery residency is stressful both psychologically and physically... the sleep is bad, the patient care hours are bad, the boards and studying hours are bad, the nutrition is subpar and the stimulant use to various extents is a part of the game. Even a general surgeon who comes out of med school 26 and out of residency 31 is basically 35 or 40 years old physiologically.

You can see it in almost all of the surgery residents, of both genders, at one time or another - even the ones who are quite attractive or well-kept normally... the common puffy face or cortisol, the hairline suffering and disheveled and overdue for some TLC, the skin greasy or pale, the muffin top, the droopy bloodshot eyes, etc. I see it every dang day on rounds or in M&M. Some recover and right the ship after training, and some never do.

It is definitely double bad for women in surgery since they get to watch most of their female friends get married, start families, etc while they are sitting by their beeper or in a library. They know their time is slipping away and they are trading peak dating and reproductive years for possible stability and academic/financial payoff later... yet the body won't be the same later. The female surgery residents who get pregnant and have a kid during residency almost always drop out to do something easier with less call... like FP or IM or ER.

Again, don't overthink it. It is what it is. Women who work hard on their careers in their 20s with medical residency, travel sales, military, PhD or JD or other tough grad school, etc etc know they're making a tradeoff. The tradeoff is probably won't land as high quality man as they may have to attain not "needing" a man. It is what it is. Everyone makes their own choices.

Female surgeons marry lower quality men?

Seriously?

[Max Power]

Female surgeons marry lower quality men?

Seriously?

Yes, seriously. Not just female surgeons specifically but any women who delay marriage/LTR in general for whatever reason. Most will have to "settle" for a guy who is older/chubby/uglier/etc when they are 35 than they probably would have at 25... it is a tradeoff if they choose to party or travel or do career in the prime dating years and find a partner after that.

Women's prime dating years are 20s (aka busy years of school/residency for a surgeon) since their looks and fertility are peaking. For men, it tends to be mid 30s or even later since their career/provider ability is materializing yet they still have good looks/fitness. It is just the way of human attraction, partnering, and reproduction (you should know that as well as anybody). That is why Julia Roberts and Richard Gere were so good in Pretty Woman even though she was 22 and he was 40. They were both at their peaks. I don't make the rules.