Running Head: PHYSICAL AND MENTAL HEALTH OF TRAUMA SURGEONS

Impact of Job Demands on the Physical and Mental Health of Trauma Surgeons
Bailey Porter
University of Kentucky

PHYSICAL AND MENTAL HEALTH OF TRAUMA SURGEONS

Impact of Job Demands on the Physical and Mental Health of Trauma Surgeons

As a trauma surgeon, you are expected to operate on those patients who are in critical
condition, which means that the patient has a high chance of dying within hours, or on patients
who have multiple injuries to different organ systems, such as the stomach or colon. Trauma
surgeons must be familiar with a large variety of surgical procedures, and must be able to make
difficult decisions with very little time and limited information. For trauma surgeons, work hours
are irregular, and there is a large amount of night, weekend, and holiday work. This can cause
the trauma surgeons to have extremely long work days and work weeks. On average, trauma
surgeons have 50-60 hour work weeks, and this does not include the time when they are
considered on call. A surgeon is considered on call when they are off the clock, and
something happens to a patient that falls into their field of work. When a surgeon is on call,
they can either be called in to help the patient or asked to relay information to those doctors
whom are already on the clock, depending on the severity of the situation. These long, intense,
and grueling work weeks can have a huge impact on both the physical and mental state of trauma
surgeons.
The formal education and training requirements for a surgeon is among the most
demanding of any occupation. In order to become a surgeon, one must complete four years of
undergraduate school, four
years of medical school, and
three to eight years of
internship and residency

PHYSICAL AND MENTAL HEALTH OF TRAUMA SURGEONS

(depending on the specialty selected). These students also volunteer or work at local hospitals or
clinics, while they are in school, in order to gain real-life experience in their desired health
profession. When the student is ready to apply to medical school, acceptance is extremely
competitive with thousands of applicants, and only a limited number of available spots for
students. In a typical application, a student must submit a transcript, scores from the Medical
College Admission Test (MCAT), and letters of recommendation. Most medical schools will
require a face-to-face interview, which the members of the colleges admissions committee will
use to judge the applicants character and personality. In the four years of medical school,
students will spend the first two years in laboratories and classrooms, and the last two years in
rotations. A rotation is when the student will work with patients under the direct supervision of
experienced surgeons, which can be seen in the photo to the right. These rotations are used so
that the student can gain experience in the diagnosis and treatment of an illness on a real person.
After completing medical school, the student must then enter a residency, which can last
anywhere from three to eight years (depending on the specialty selected). Residency is medical
education that takes the form of paid on-the-job training. This amount of schooling and training
can be extremely costly, causing 80 percent of medical school graduates to be in debt. On
average, a student coming out of medical school will owe over $200,000 in debt. This enormous
amount of debt can cause the surgeon to become stressed at a very early point in their career.
There are many risks that are posed by burned-out surgeons. A surgeon can become
burned out after they have just completed a long and difficult surgery, had multiple surgeries
back to back, or have worked a large amount of hours without an adequate, or enough, amount of
rest. Workers at all levels feel stressed out, insecure, misunderstood, and undervalued. In the
book, The Truth About Burnout by Christina Maslach and Michael Leiter, over 45 percent of the

PHYSICAL AND MENTAL HEALTH OF TRAUMA SURGEONS

7,200 doctors who were surveyed showed at least one symptom of burnout. Many doctors have
become stressed out, and have thus turned to drugs and alcohol as temporary fixes to cope with
their issues. Job burnout worries Tait Shanafelt, who is a Professor of Medicine at Mayo Clinic
in Minnesota, because burned-out physicians are more likely to make mistakes. Whenever a
surgeon is burned-out, there can be a failure in communication, or incorrect diagnoses and
treatment. William Norcross, who is an executive director of a physician wellness program
added, I look at burnout as being kind
of like a zombie: You lose your feeling,
you lose your empathy. You do not care
as much. In this study, emergency
doctors, which includes the field of
trauma surgery, has a burnout rate of
over 70 percent. It has never been easy
for surgeons to effectively balance work
and personal life. Surgeons, on average, work longer hours than any other profession. Shanafelt
said, The nature of the workabove the hoursseems to be a key factor. A surgeons feeling
of importance is undermined by the time that is spent doing endless paperwork or getting
approval to do certain treatments from the patients insurance company.
In an interview that was
conducted with Andrew C. Bernard,
who is the Associate Professor of
Surgery at the University of
Kentucky, Bernard said My weeks

PHYSICAL AND MENTAL HEALTH OF TRAUMA SURGEONS

are 60 hours on average, some weeks a little less or a little more. I still have 80-90 hour weeks
sometimes. They are harder once you are older. I am 46, and at my age you cannot go all night
and keep going the next day like you used to. In a regular seven-day week, there is a total of
168 hours. This means that Bernards average work week of 60 hours, is nearly one-third of the
total amount of hours in a single week. In the remaining time (when they are not on call), a
surgeon must find time to get enough rest, so they can perform at the highest level possible. If a
surgeon does not get enough rest, they can become tired, which is evident in the photo to the
right. Once a surgeon does not get enough rest, it can lead to a development of sleep
deprivation, which can pose a huge threat to the life of both the surgeon and the patient. A study
found that the effects of 24 hours without sleep, corresponds to a Blood Alcohol Content (BAC)
of 0.10%. At this level of BAC, one begins to lack coordination and balance, judgment, memory,
and vision is impaired, or effected. In surgery, coordination, balance, judgment, memory, and
vision are all important. If just one of these is impaired, the outcome of the surgery can be at risk.
A study, which was conducted by Martijn Ruitenburg from the Coronel Institute of
Occupational Health in Netherlands, wanted to find the impact that a surgeons poor physical
health and high physical job demands would have on the quality
of care given. In this study, a total of 958 medical doctors were
asked to complete an online survey, which was used to assess the
physical work ability and the commonness of complaints. Then a
total of 126 medical doctors, 44 surgeons and 82 other hospital
physicians, were observed to better understand the physical job
demands that are in an average work day. In the sample of 44
surgeons, Ruitenburg found that 41 percent of the sample found

PHYSICAL AND MENTAL HEALTH OF TRAUMA SURGEONS

their work to be physically strenuous, and 73 percent of the sample was bothered by working in
uncomfortable or exhausting positions. High physical job demands is a potential threat to overall
health of a surgeon. Surgeons are most likely to develop musculoskeletal complaints (photo to
left), which can include awkward body postures (region 8), pain or stiffness in the neck (region
1), lower back (region 7), arms (regions 4, 5, and 6), and legs (regions 9, 10, and 11). Of the 44
surgeons observed, 39 percent reported pain the neck area (80 percent work related/17 percent
work impairing), 24 percent reported pain in the lower back area (59 percent work related/18
percent work impairing), 36 percent reported pain in the arm area (61 percent work related/42
percent work impairing), and 10 percent reported pain in the leg area (56 percent work related/22
percent work impairing).
For surgeons to remain healthy on the job, it is important to provide a work environment
which minimizes the risk of developing physical health complaints. Performing specific types of
surgery can put physical strain on surgeons, since they have fixed work positions. As a surgeon,
you are required to have fixed low-back postures, over a long period of time, while performing
precise movements, which will result in the awkward positioning of arms and hands. However, a
surgeons normal workday consists of more than just performing surgeries. A normal day can
also include ward rounds, meetings, patient consultations, and report writing. In order for
surgeons to stay healthy while on the job and to keep the quality of care high, it is important to
reduce the physical strain on surgeons. Physical strain can be reduced by providing more
recovering time during the day for surgeons, for example, all that could be needed is a change in
body posture. However, currently, there is a lack in the amount of recovery opportunities for
surgeons. As a result, a surgeon can experience increased levels of stress and fatigue throughout
an operation, which will have an effect on the surgeons accuracy and the overall outcome of the

PHYSICAL AND MENTAL HEALTH OF TRAUMA SURGEONS

surgery. However, as a surgeon, awkward body positions is almost completely unavoidable. In

order to gain more recovery opportunities a surgeon should circulate between different tasks,
such as going from a high physically demanding task to a low physically demanding task.

WORKS CITED

A.C. Bernard, personal communication, October 7, 2014

Maslach, C., & Leiter, M. (2000). The Truth About Burnout How Organizations Cause Personal
Stress and What to Do About It. Wiley: Jossey-Bass.

Ruitenburg, M., Frings-Dresen, M., & Sluiter, J. (2013). Physical job demands and related health
complaints among surgeons.. International Archives of Occupational & Environmental

PHYSICAL AND MENTAL HEALTH OF TRAUMA SURGEONS

Health,86(3), 271-279. Retrieved October 29, 2014, from the University of Kentucky Library
database.
.
Ruitenburg, M., Frings-Dresen, M., & Sluiter, J. (2013). Physical job demands and related
health complaints among surgeons.. International Archives of Occupational & Environmental
Health,86(3), 271-279. [Chart] Retrieved November 23, 2014, from the University of Kentucky
Library database.