Surgeons and Alcohol Use

The public is becoming increasingly aware of the risk of burnout in physicians, as seen in this Nov 30th NBC news segment. This report gets into the demands on time that many physicians experience, balancing patient care, paperwork, and schedules with their at-home demands of family and self-care. This leads to physical and mental health issues among providers, as well as an increase in medical mistakes.

Unhealthy Coping Mechanisms

Another contribution to the burnout discussion is using unhealthy coping mechanisms, such as alcohol. There are few studies that look at the rate of alcohol use among practicing physicians who have finished their training. One such study, by Oreskovich et al., looked at alcohol use among surgeons. These medical professionals are on call and often must be ready to practice surgery in a matter of hours.  Alcohol use by surgeons holds risks not only to themselves but also their patients. As such, this issue is obviously worthy of investigation.

Oreskovich Michael R, Kaups Krista L, Balch Charles M, et al. Prevalence of Alcohol Use Disorders among American Surgeons. Arch Surg. February 2012;147(2):168-174. doi:10.1001/archsurg.2011.1481.

The study used the AUDIT-C and found rates of alcohol abuse or dependence for male surgeons was 13.9%. For female surgeons, it was significantly higher at 25.6%. The actual rates are likely to be much higher. Why? There are 4 possible explanations

1. Individuals underreport their rate of alcohol use. Underreporting is likely to be even higher among skilled professionals unwilling to admit to a behavior that could alter their function, challenge their professionalism, or require acknowledgment in a required annual registration with the state board of medicine. Underreporting for this population would further raise the rate of risky alcohol use.
2. They found very large differences between men and women. The study showed a significant and very large difference between men and women surgeons that is not seen in the general population. Although this may certainly be a real finding, it may also be evidence that men are less willing to report risky drinking than women. This would drive the actual numbers for men closer to the number for women and increase the potential severity of the problem.
3. The authors chose to utilize a more stringent bar that decreased the sensitivity of the instrument they used. The goal was to ensure that specificity of their evaluation instrument was high with the subsequent drop in the sensitivity of the instrument. The choice was based on the fact that the AUDIT-C, the metric used in this study, has relatively low specificity and sensitivity. This choice may have further weakened the value of the scale to detect important amounts of alcohol use.
4. Since that study, NIAAA definitions of risky use have gone down. This is the opposite direction of this study’s designers and this change would have raised the actual figure even higher.

Although the first two concerns cannot be easily investigated, the latter two could if the actual data were available for inspection. If it were, one could assess the impact that reanalysis based on different cut off numbers would have on rates and determine the extent of the bias based on the cutoff point. The missed potential value is yet another argument for a requirement that studies publish their raw data along with their results.

Overall, it is clear that patterns of alcohol use that develop early in life and persist during medical training do not suddenly go away as physicians practice medicine. Intervention must start early, limiting or fully eliminating the habitual use of alcohol in medical school, in order to stop the pattern. For physicians who have completed medical training, we need to help them identify problems with alcohol use and assist them in decreasing or eliminating their alcohol use for the betterment of themselves and their patients.

Potential Interventions For Change

Potential interventions to address the significant use of alcohol in the population of medical students can address burnout or instill better coping mechanism than alcohol use. We are focusing on both. Our BurntOut experiences prepare students for the challenges that await them in clinical care.

We are also creating case-based studies with medical students or practicing physicians as the patient. Such cases reflect reality and may alter misperceptions that alcohol is not an issue for students and physicians, or that providers cannot be patients as well.

Other cases can also teach the process of alcohol use screening. By showing the value of screening for alcohol use, we equip students with the skills to self-assess and to assess colleagues and as well. This may be an indirect, yet useful way to help students identify alcohol drinking problems and to seek assistance and treatment.