No matter what career you choose, there will often be occupational risks that come along
with it.
Although it’s easy to see the dangers of being a high-voltage power line inspector,
even the most harmless appearing jobs have their risks – and medicine is no exception.
Dr. Jubbal, MedSchoolInsiders.com Although being a doctor may seem like a safe
job, there are some occupational risks that you should be aware of.
I’m not just talking about carpal tunnel syndrome from charting too much or UTIs from
holding your bladder too long either.
Here are the different occupational hazards that doctors face and which specialties are
most susceptible to them.
Needlesticks and other sharps injuries are some of the most common work-related injuries
among physicians.
They often occur during procedures or medication administration when a contaminated needle,
scalpel, suture, or other sharp object accidentally punctures the skin.
The problem with these injuries is not the wound itself, but rather the risk of contracting
a blood-borne illness – particularly HIV or hepatitis C.
The CDC estimates that approximately 385,000 needlesticks and other sharps-related injuries
occur each year; however, it is difficult to accurately estimate these numbers as many
of these incidents go unreported.
Many people feel ashamed or embarrassed when they stick themselves and worry that disclosing
the incident will make their peers and supervisors question their skills and competency or affect
their professional development.
Although the estimated risk of contracting a blood-borne illness after exposure to infected
blood is low, approximately 0.3% for HIV and 0.2% for HCV according to the CDC, there are
multiple factors that may increase your risk.
Exposure to large quantities of infected blood, exposure to blood from a patient with high
viral loads, and being stuck with a hollow-bore needle all increase your risk of infection.
That being said, there are safety precautions that further mitigate these risks such as
wearing two pairs of gloves.
Doing so has been shown to reduce the volume of blood transferred by almost a factor of
6.
Despite the low likelihood of transmission and the additional precautions, however, reporting
is still crucial given the lifelong consequences of an HIV or HCV diagnosis.
When these incidents occur, it is imperative that both the patient and physician are tested
to determine (1) whether exposure to a blood-borne pathogen has occurred and (2) whether the
physician should begin prophylactic treatment.
Surgical specialties are often at higher risk for these types of injuries due to their regular
exposure to bodily fluids and the use of sharp tools during surgery.
According to one study examining resident physicians, there was approximately twice
the number of needlestick injuries involving surgical residents as there were with non-surgical
residents at about one needlestick injury per year for each surgical resident.
Emergency medicine physicians also tend to be at higher risk for sharps injuries or exposure
to blood-borne illnesses given their regular exposure to blood and other bodily fluids.
They also perform a variety of procedures involving needles and other sharp tools including
central line placement and chest tubes, among others.
Exposure to pathogens through the air or respiratory droplets is another common occupational hazard
for physicians.
This has been of particular concern as of late due to the coronavirus pandemic.
Despite taking proper precautions, many physicians were still exposed to the virus and became
sick themselves – some even losing their lives due to the disease.
Even before COVID-19; however, there has always been a risk of contracting an airborne illness
for physicians.
This includes more common pathogens like flu and other respiratory viruses as well as more
dangerous pathogens such as tuberculosis and bacterial meningitis – both of which may
be transmitted through respiratory droplets when a patient coughs or sneezes.
Because physicians in most specialties regularly interact with patients, most physicians are
also susceptible to exposure to airborne pathogens.
That being said, some specialties are at higher risk than others.
To start, front-line specialties such as family medicine, pediatrics, emergency medicine,
and internal medicine are at higher risk given the fact that they are the first point of
contact for patients.
Other specialties at high risk for exposure to airborne pathogens are critical care, anesthesiology,
and pulmonology as they regularly work with patients’ airways and perform a variety
of procedures, such as endotracheal intubation, where they must be near the patient’s face.
Ear, nose, and throat doctors and ophthalmologists are also at higher risk for airborne exposures
for this same reason.
Lastly, infectious disease physicians would also fall into this category as they work
closely with patients with diseases that are transmissible through air and respiratory
droplets such as tuberculosis and bacterial meningitis, to name a few.
For some specialties, radiation exposure is another occupational hazard.
The x-rays, CT scans, and other imaging studies that doctors use to help diagnose patients
use ionizing radiation to produce images of the body.
Although these tests use small doses of radiation and are unlikely to cause any damage in the
short term, long-term repeated exposure has the potential to cause cumulative damage to
DNA and subsequent adverse effects -– most notable of which is the increased risk of
cancer.
An increasingly common tool for physicians and surgeons is the fluoroscope.
These x-ray devices allow doctors to see into patients’ bodies in real-time to help guide
procedures.
The downside, however, is that they expose the physicians to small doses of radiation.
There are precautions that physicians take to minimize radiation exposure including wearing
lead vests to protect against radiation, maintaining appropriate distances to minimize exposure,
and keeping exposure times to a minimum.
Physicians that use these tools will typically also wear dosimeter badges which monitor their
exposure to ionizing radiation over time to ensure they are well within safe levels.
Although research largely suggests that the risk of an adverse health effect from radiation
is low for physicians, regularly being exposed to even low levels of radiation is likely
more harmful than not being exposed to radiation.
According to the Cleveland Clinic, as of 2012, there have been nine reported cases of left-sided
brain or head and neck tumors in interventional cardiologists which may suggest an increased
risk of brain tumors in doctors who use fluoroscopy.
Studies have also demonstrated an increase in chromosomal abnormalities in interventionalists,
compared with non-interventionists.
The specialties most at risk for radiation exposure are diagnostic radiology, cardiology,
interventional radiology, interventional cardiology, and certain surgical specialties due to the
use of real-time imaging in procedures.
Other occupational risks that we often don’t consider are neck pain, back pain, and other
musculoskeletal injuries.
These issues are especially common among surgeons due to the long hours spent standing and the
tendency to shift to poor, ergonomically limited positions to ensure proper exposure and accessibility
to the area of interest.
A 2020 study published in JAMA monitored the ergonomics of fifty-three surgeons from 12
different specialties while performing surgery.
They found that surgeons spent an average of 65% of procedure time in high-risk neck
positions, 30% in high-risk torso positions, and 11% in high-risk shoulder positions.
Other factors that contributed to increased time spent in high-risk positions included
longer case lengths, increased years in practice, and use of surgical loupes and headlights.
Additionally, a 2017 study of ENT residents found that 82% of residents experienced some
form of musculoskeletal pain, 16% reported having to scrub out of ongoing operating procedures
due to musculoskeletal symptoms, and 6% reported missing work due to their symptoms.
Lastly, a 2020 study surveying 685 orthopedic surgeons across 27 different states, found
that approximately 60% of respondents reported neck pain and approximately 23% reported issues
with cervical radiculopathy.
Of those surveyed, only six surgeons reported receiving ergonomic evaluations.
Surgeons aren’t the only physicians at risk for musculoskeletal issues either.
Any specialty that requires long hours standing or sitting at a computer also has the potential
for back pain, neck pain, and other musculoskeletal issues.
Gastroenterologists, for instance, have been shown to have high incidences of back and
neck issues as well as elbow, wrist, and hand injuries.
This is thought to be a result of the long hours spent performing scopes and endoscopic
ultrasounds and the repetitive motions associated with them.
Studies examining the prevalence of musculoskeletal pain and injuries among GI doctors range from
29% all the way up to 89%.
Although there is a lot of variation between studies, it is clear that many GI physicians
are being affected by this, which is problematic given that injury and pain can lead to loss
of productivity and shorten a physician’s career.
No matter what specialty you choose, it’s important that you remain cognizant of your
posture and movement patterns to minimize the risk of developing issues down the road.
Daily stretching and regular exercise are also great ways to prevent musculoskeletal
issues and improve your overall health.
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Insiders.
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Physically combative patients are another occupational hazard for some specialties – particularly
for psychiatrists and emergency medicine physicians.
In psychiatry, you are regularly treating patients with behavioral health issues including
anger management problems, personality disorders, and even homicidal ideation.
Although not all patients with mental illness are dangerous, the nature of these patient
populations does increase the risk for psychiatrists, which can be seen in the fact that psychiatrists
are the most common victims of physician homicide.
Emergency medicine physicians are also at higher risk of encountering physically combative
patients for several reasons.
To start, there are a lot of strong emotions that come along with emergencies as these
situations are often incredibly stressful for the patients and families, as well as
for the medical staff.
Anytime strong emotions get involved, people often experience less control over their actions
leading them to say and do things that they normally would not.
In addition, common presentations including intoxication, hypoxia, stroke, and infection
can lead to altered mental status and agitation.
As a result, patients experiencing these conditions may unknowingly lash out against the physician
due to their altered mental status.
It is also common for EM physicians to encounter patients who are malingering, or in other
words, trying to abuse the hospital system for their own gain.
As an example, patients who are addicted to narcotics will often feign illnesses to receive
pain medications.
Although various prescription monitoring programs exist to help physicians detect drug-seeking
behavior, these patients tend to become aggressive towards providers when they don’t get what
they want.
I discuss these issues in more detail in my Why I Didn’t…
Emergency Medicine video on my second channel Kevin Jubbal, M.D.
– link in the description.
Substance abuse is another surprisingly common issue among physicians.
According to the American Addiction Centers, approximately 10-15% of physicians will develop
a problem with substance abuse during their careers.
The type of substance abuse; however, often varies between specialties.
Among anesthesiologists, for instance, the most commonly abused substances are opioids.
This is thought to be a result of their proximity to large quantities of highly addictive drugs,
the relative ease at which they can divert small quantities of these drugs for personal
use, the high-stress environment in which they work, and the continuous exposure to
these drugs in the workplace which can promote substance abuse.
Although the exact prevalence of substance abuse among anesthesiologists is not known,
between 1991 and 2001, four out of five U.S. anesthesiology residency programs reported
experiences with impaired residents, and one in five reported at least one pretreatment
fatality.
This is especially concerning given that substance abuse increases your risk of suicide and anesthesiologists
are known to have some of the highest rates of suicide out of any medical specialty.
Anesthesiologists are not the only physicians with substance abuse issues.
According to the American Addiction Centers, male surgeons are over two times as likely
to experience alcohol dependence or abuse than the general population and female physicians
are over four times as likely.
In addition, a 2014 study of emergency medicine physicians treated by a Physician Health Program
showed that nearly half were treated for alcohol abuse, 38% for opioid abuse, and almost 10%
for stimulant abuse.
Lastly, sleep deprivation is another common workplace hazard that is present across a
variety of specialties.
It’s common knowledge that many physicians work long and unpredictable hours – especially
during training.
It’s so common in fact that it is pretty much expected that you will experience many
sleepless nights on your path to becoming a physician.
That being said, sleep deprivation, both acute and chronic, can have significant negative
effects on a physician’s health.
Acute sleep deprivation has been shown to decrease cognitive function, attention, and
memory – all of which can negatively affect a physician’s performance.
Additionally, driving when sleep deprived has been compared to driving intoxicated and
can greatly increase your risk of getting into an accident.
Anecdotally, I have known multiple physicians who have gotten into car accidents when driving
home tired after work and have even had a close call myself after working a 34-hour
shift without any sleep.
In addition to the acute dangers of sleep deprivation, chronic sleep deprivation has
also been linked to higher rates of diabetes, high blood pressure, depression, heart attack,
and stroke.
Although most specialties carry at least some risk for sleep deprivation, especially during
residency training, surgical specialties are at particular risk due to the long, irregular
hours as well as their on-call responsibilities.
In a 2004 study of sleep deprivation among residents, general surgery, neurosurgery,
urology, and orthopedic surgery had the highest percentages of residents who slept fewer than
five hours per night.
Regardless of the specialty, however, sleep deprivation is an issue that affects many
physicians.
Although these occupational risks are important to be aware of, you shouldn’t let them dissuade
you from pursuing your dream specialty.
By understanding the risks associated with each specialty ahead of time, you can better
take steps to mitigate them in your own life.
But no matter what specialty, or even career, you choose to pursue, you should always be
cognizant of your own health.
We only get one body in this life, so make sure you’re doing what you can to take care
of it.
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Thank you all so much for watching.
If you enjoyed this video, be sure to check out the Top 5 Riskiest Doctor Specialties
or this other video.
Much love, and I’ll see you guys there.