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Alcohol Dependence Among Surgeons a 'Significant Problem'

 |  By John Commins  
   February 23, 2012

Alcohol abuse is a "significant problem" for surgeons in the United States, with more than 15% of respondents in a nationwide survey signaling that they may have dependency issues, the American College of Surgeons reports.

The survey in the February issue of Archives of Surgery found that the rate of alcohol use disorders among the 7,197 responding surgeons is slightly higher than that of the general U.S. population.

For surgeons reporting dependency issues, the survey found there was a "strong association" with problems in personal and professional relationships that included burnout, depression, and medical errors. In fact, the study found that nearly 78% of surgeons reporting a medical error in the previous three months also had issues with alcohol abuse or dependence.

"Our goal is not to scare the public. That is the last thing we want to do. But we also want to say that people are paying a really high price," says Krista L. Kaups, MD, a coauthor of the survey, Prevalence of Alcohol Use Disorders Among American Surgeons.

The study recommends that healthcare organizations and professional associations, including the American College of Surgeons, develop early warning and intervention programs that identify problem drinkers and provide treatment and therapy options. "These findings should also decrease the shame and stigma associated with alcohol abuse or dependence and encourage surgeons to pursue treatment and rehabilitation to promote patient safety and personal well-being," the study said.

"We want people to be aware of this because we want to be able to honestly look at ourselves and say here is the issue we need to support people," said Kaups, chair of the American College of Surgeons Governors Committee on Physician Competency and Health.

Kaups says substance abuse problems may be particularly insidious and difficult for surgeons to admit. "There is the idea that ‘I can take care of crazies and disasters, so I am in control. The alcohol is just to take the edge off because I deal with enough things,'" she says. "We also know that in general, the characteristics we value in our professional lives, things like perfectionism, commitment to patients, those things put people at risk of burnout as well." 

Alcohol disorders target female surgeons particularly hard. The survey found that 25.6% of female surgeons indicated that they have alcohol use issues, compared with 13.9% of their male colleagues. By contrast, in the general population, 9.4% meet the criteria for alcohol and substance abuse, including 10.5% of men and 5.1% of women.

"Part of it is that female surgeons on the whole are less likely to be married or in a supportive relationship," Kaups says. "It is changing as we look at the younger surgeons. But the lack of personal and social support is a really key thing when you are dealing with difficult and challenging issues."

The anonymous online survey is the latest in a series of studies the American College of Surgeons has undertaken recently to assess members' stress, burnout, and other job pressures. Kaups says failure to address these problems could have significant repercussions for patient safety and access.

"We have people who are not functioning at their best in terms of taking care of patients optimally," she says. "We find people who are struggling with these issues are less likely to stay in practice. We have a workforce shortage already so we have to figure out how to allow people to function at their best and continue in practice."

The survey was sent to 25,073 surgeons, and the 7,197 surgeons who responded represent a sampling of less than 29%. A critique of the study that also appears in the February issue of Archives echoes the survey authors' concerns that the low response rate could skew the findings. 

Edward Livingston, MD, a professor of surgery at the University of Texas Southwestern Medical Center in Dallas, wrote that the response rate was about half the 60% minimum required by some medical journals. Thus, he wrote that it is impossible to say if the problem is being over-reported or underreported.

"Surgeons who abuse alcohol are at risk for livelihood-threatening sanctions should this behavior be exposed. Despite reassurances of confidentiality, questionnaire responses may still be considered risky by surgeons with much to lose," Livingstone wrote.

Livingstone said that several types of bias and error may be at play in any survey, but the most obvious one is nonresponse. "Nonresponse bias is particularly salient when the topic is considered sensitive," he wrote.

Kaups concedes that the accuracy of the survey could be questioned because of the low response rate, but she's standing by the findings.

"This is a huge group of people who we studied. What we don't know and what we can theorize about is a possible sampling bias," she says. "Did we get people who respond who are having issues and feel like they can express themselves, or are these people who feel pretty good about themselves? We don't know but we think it is a reasonable survey. It was anonymous online. People are honest about what they say."

John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.

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