Slideshow: Occupational Injuries Among Orthopedic Surgeons

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Manish Sethi, M.D.

Study author Manish Sethi, M.D., is a member of the orthopaedic trauma team at Vanderbilt University Medical Center in Nashville, TN. Photo: Sethimk

By Cora Nucci, for HealthLeaders Media, December 2, 2013

Hospital and health system HR departments rarely receive injury reports from surgeons, but the financial consequences—specifically among orthopedic surgeons—are high, and the problem will only worsen as the workforce ages, a study shows.

Workplace injuries in healthcare are not uncommon among nursing staff, who are exposed to needlesticks, back injuries, and even acts of violence.

It's a big problem and it is financially draining. The cost of total workplace injuries in the United States reaches into the billions of dollars annually, when direct costs (medical care) and indirect costs (lost productivity) are factored.

But hospital and health system HR departments rarely receive injury reports from physicians and surgeons, who have an even higher financial impact than RNs. The lack of reporting isn't because physicians aren't getting hurt, though. A study of occupational injury among orthopedic surgeons published in the Journal of Bone and Joint Surgery demonstrates that injuries are not rare.

"Performing orthopaedic surgery requires many hours per week in body positions known to contribute to musculoskeletal injuries," the report states. Among the most physically demanding procedures are total joint replacement of the knee or hip, spine cases, and femur fractures in trauma patients, report author Manish K. Sethi, MD, told me in a phone interview.

The study, based on surveys sent electronically to every orthopedic surgeon in Tennessee (28% of 495 responded), found that:

  • 44% of surgeons had sustained at least one occupational injury in their career and 10% of respondents missed work due to their injuries
  • 25% reported an injury to the hand, followed in frequency by the lower back (19%), neck (10%) and shoulder (7%)
  • 38% of injured respondents reported no institutional resources available to support them as they recovered

"Some of these injuries were significant, having an impact on operating room performance and causing the surgeon to lose three or four weeks of work," Sethi says in a Vanderbilt University publication.

At 35, Sethi has been a surgeon for a decade, but he has so far evaded any "real injuries." A member of the orthopedic trauma team at Vanderbilt University Medical Center, he does acknowledge some occasional hand stiffness, however.

No Relief via Technology
Technologies to alleviate the strain on surgeons' bodies are scarce. Aside from OR tables that apply traction and minimize the physical force a surgeon must exert, there has been "no game-changer in over 50 years," says Sethi.

Somewhat counterintuitively, technological advances that have led to surgeries such as knee arthroscopy increase the risk of injury for surgeons. That's because these surgeries take a toll on the muscles that control fine motor movements, which can cramp and strain from positions such as "holding a camera all day" in the OR, Sethi explains.

Yet surgeons are not inclined to report injuries when they occur. Sethi says that's because surgeons often have independent employment contracts with hospitals that typically do not mention what happens with on-the-job injuries. Surgeons often don't know where to report such issues, he adds. "Most hospitals don't have anything set up" in the way of a formal reporting structure.

Cost Implications
I wonder if ego also comes into play. Known for their competitive spirit, surgeons as a group, and orthopedic surgeons in particular, project resilience. It's not hard to imagine that they would prefer to "play hurt" rather than bother with tracking down which OSHA forms to file. That can be costly. According to the report:

"Physician injury has substantial economic consequences as missed work can reduce the supply of orthopaedic care and result in large costs associated with the investments involving training personnel, and overhead in each surgeon."

Because the demand for orthopedic services is expected to grow at an exponential pace at the same time that the workforce is aging, Sethi views the matter as "very serious."

"How do we maintain the health of an aging workforce?" he asks. As surgeons, "we have to start thinking of issues of policy." The report calls on hospitals and health systems to establish occupational safety as an "institutional priority with support from high levels of management."

HR Readiness
The financial impact of workforce injuries is clear. Less clear is the reason for the apparent neglect of the matter by hospital and health system executives. Senior HR leaders who take heed of the coming confluence of aging workers and the growing demand for healthcare services have a chance to spare their organizations the negative financial consequences of injured healthcare providers.

They may even put themselves in a position to steal market share from competitors who have not prepared and can't meet the demand for services.