One in five surgeons set to retire early due to physical toll


16-09-2019
Surgical strain - ergonomics in surgery - report image

Survey exposes the physical impact on surgeons of conducting minimal access/keyhole procedures that threaten to shorten surgical careers and put further pressure on health systems.

  • Nearly 20% of surgeons in the UK and the U.S, and 15% of surgeons surveyed in Germany think they may need to retire early due to physical impact of conducting laparoscopic surgery.
  • Approximately three in four UK surgeons (76%) have experienced back pain while performing laparoscopic surgery;[1]
  • 78% of surgeons in the United States[2] and 61% of surgeons in Germany have experienced muscular or back pain while performing laparoscopic surgery[3]
  • 16% of surgeons in the UK, 13% of surgeons in the U.S, and 10% of surgeons in Germany, have had to consult with a healthcare professional due to musculoskeletal injuries
  • 37% of UK surgeons believe they reach the peak of their operating ability after 50.[4]

Up to a fifth of surgeons in the UK (19%), U.S (20%) and Germany (15%) predict they are likely to retire early because of the physical strain of conducting minimal access/keyhole surgical procedures,[5] according to a survey of over 450 surgeons across Europe and the U.S. The survey, commissioned by CMR Surgical, recruited general, gynaecological and colorectal surgeons who regularly perform laparoscopic surgery,[6] which is proven to reduce pain, scarring and patient recovery time.[7]

Despite having proven benefits, minimal access techniques are not used in almost half of all cases worldwide with up to 6 million patients globally not receiving the benefits of this type of surgery.[8] The technique can be difficult to conduct and physically gruelling for a surgeon to do, where the surgeon stands in physically difficult positions to conduct procedures including hysterectomy, hernia-repair and colectomy.[9] The survey has revealed that 30% of surgeons experienced discomfort during surgery due to the awkward positions undertaken, with three in four surgeons having experienced back pain when performing laparoscopic surgery. In addition, up to 16% of surgeons have had to consult with a healthcare professional as a result of musculoskeletal injuries from conducting minimal access/keyhole procedures.

The physical strain of conducting minimal access procedures is further adding to an existing workforce crisis. Many health systems, including in the UK and the U.S, are facing chronic workforce shortages so prolonging the working life of a surgeon is pivotal to the continued delivery of sustainable healthcare.[10][11] A recent study found that when it comes to the National Health Service, the biggest employer in Europe, over half (53%) of senior doctors (consultants) said that there was frequently gaps in hospital medical cover that raises significant patient safety issues.[12] The picture is similar in the U.S, with a study showing that by 2050 there will be a deficit of over 7,000 general surgeons.[13]

There is a common misconception about what the peak working age is for a surgeon. The survey has revealed that 90% of surgeons surveyed believe surgeons reach the peak of their operating ability by the age of 54. However, studies have shown that the peak age for a surgeon is actually 55-60 years old.[14]  

According to the survey, one in five surgeons believe they will have to retire early, the equivalent to over 3,000 surgeons in the UK losing key experienced surgeons from health systems that are already stretched.

Commenting on the survey’s findings Adrian Park, MD, Professor of Surgery and Chairman at Anne Arundel Health System, Johns Hopkins University School of Medicine said: “Surgeons of all stripes are reporting musculoskeletal pain and injuries as a result of going to work every day. It is hard to imagine that those responsible for any other workplace, let alone one where the stakes are so high, such as in surgery, would tolerate rates of “worker injury” such as are now being reported by surgeons. Surgeons need to be supported to conduct minimal access procedures sustainably in order to protect the future of the surgical workforce, for the benefit of surgeons, hospitals and most importantly, patients.” 

“It is unacceptable that to conduct laparoscopic surgery and offer its benefits to patients and healthcare providers, we neglect the impact this is having on the surgical workforce. Surgical robotics can play a role in extending surgical careers, by allowing surgeons to perform laparoscopic surgery with a choice of ergonomic solutions more typically found in offices across the world.  With a workforce crisis facing health systems around the world, now is the time to act in order to protect our surgical workforce of the future.” commented Mark Slack, Chief Medical Officer at CMR Surgical.

The survey also revealed:

  • The most common areas of discomfort are the back, neck and shoulders for surgeons.[15]
  • Surgeons who perform colorectal surgery are significantly more likely to consider early retirement than those who perform gynaecological surgery.[16]
  • Over a quarter of surgeons surveyed frequently experience muscular or back pain as a result of surgery.[17]
  • Surgeons who are under 5 ft 3” or over 6 ft 1” are most likely to experience muscular or back pain during, or as a result of, surgery.[18]

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References


[1] Bryter. (2019). Surgeons and back pain, slide 12.

[2] Bryter. (2019). Surgeons and back pain, slide 13.

[3] Bryter. (2019). Surgeons and back pain, slide 13.

[4] Bryter. (2019). Surgeons and back pain, slide 20.

[5] Bryter. (2019). Surgeons and back pain, slide 17.

[6] Bryter. (2019). Surgeons and back pain, slide 23.

[7] Cole, A., O’Neill, P., Sampson, C. and Lorgelly, P. (2018). Barriers to Uptake of Minimal Access Surgery in the United Kingdom. OHE Consulting Report, London: Office of Health Economics. p.6.

[8] McWilliams, Andrew. (2009, March). The Market for Minimally Invasive Medical Devices. BCC Research, p.14

[9] Park, A (2017). “Physician Heal Thyself” Isn’t Working. Annals of Surgery, Volume 266, Issue 6, 921–922.

[10] Rolewicz, L., Palmer, B. (08/05/2019). What do the shortages look like within hospital services?, The NHS workforce in numbers. https://www.nuffieldtrust.org.uk/resource/the-nhs-workforce-in-numbers#3..., accessed 22/07/2019.

[11] Ellison, E. Christopher et al. (2018). Ten-year reassessment of the shortage of general surgeons: Increases in graduation numbers of general surgery residents are insufficient to meet the future demand for general surgeons. Surgery, Volume 164, Issue 4, 726–732.

[12] Rolewicz, L., Palmer, B. (08/05/2019).

[13] Ellison, E. Christopher et al. (2018).

[14] Yusuke Tsugawa, Anupam B Jena, Ruth L Newhous E John Orav, et al (2018) Age and sex of surgeons and mortality of older surgical patients: observational study BMJ 2018;361:k1343

[15] Bryter. (2019). Surgeons and back pain, slide 9.

[16] Bryter. (2019). Surgeons and back pain, slide 18.

[17] Bryter. (2019). Surgeons and back pain, slide 13.

[18] Bryter. (2019). Surgeons and back pain, slide 14.

 

 

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