The prevalence of substance use disorders in the United States has been well documented in published research. Nearly 8% to 12% of Americans aged 12 and older meet criteria for alcohol abuse or dependence, with men being twice as likely to depend upon or abuse alcohol as women. The prevalence of substance use disorders among U.S. physicians has been estimated to range from 10% to 15%, but less is known about alcohol dependence and abuse in particular. “Although actual injury to patients from impaired physicians is incredibly rare, alcohol abuse and dependence are important factors to consider when thinking about patient safety in surgery,” says Michael R. Oreskovich, MD. “These disorders can play a major role in causing clinically significant impairment or distress in social, occupational, and other areas of functioning.”

Alcohol Use Disorder: A Problem for Surgeons Nationwide

Dr. Oreskovich and colleagues conducted a study, published in the February 2012 Archives of Surgery, in which American surgeons completed online surveys anonymously. “We wanted to gain a better picture of the actual prevalence of alcohol dependence and abuse,” he says. “We also wanted to explore personal and professional characteristics, surgeon distress, and recent self-reported events.”

According to the results, about 15% of respondents overall appeared to suffer from alcohol abuse or dependence, a figure that exceeds what has typically been cited for the general public. “Surprisingly, male surgeons were less likely to have these disorders than female surgeons,” Dr. Oreskovich says. “About 14% of male surgeons reported having alcohol issues, compared with a 26% rate that was observed for female surgeons.” In addition, the study found that alcohol issues were less prevalent among surgeons who were older, had children, worked longer hours, were more often “on call,” or were employed by the U.S. Department of Veterans Affairs (Table 1).

Respondents who reported having made a major medical mistake over the previous 3 months were more likely to struggle with alcohol abuse or dependence. So too were surgeons who were either depressed, emotionally exhausted, suicidal, distressed, or burned out. Burnout was more frequent in surgeons with alcohol misuse and in those with alcohol abuse or dependence. Suicidal ideation in the preceding year was present in about 6% of surgeons with alcohol misuse and about 8% of surgeons with alcohol abuse or dependence. Career satisfaction and quality of life were rated lower in surgeons with alcohol abuse or dependence (Table 2).

Increased Awareness on Alcohol Dependence Is Warranted

Although the prevalence of alcohol dependence and abuse in surgeons does not appear to be much different from what is found in the general population, the repercussions of using alcohol may be more consequential in physicians. In previous research, studies have shown that direct patient harm associated with impairment due to chemical dependency is extremely rare. However, these occurrences can be catastrophic for surgeons and patients alike.

“The most significant finding our study illustrates is that physicians are not immune to these kinds of problems,” adds Dr. Oreskovich. “Few studies look at this phenomenon because physicians oftentimes don’t want to participate in such analyses, perhaps because of the shame, guilt, and fear associated with it.” Because less than one-third of the 25,073 surgeons who received surveys for Dr. Oreskovich’s study actually responded to it, the problem of alcohol disorders may be even bigger than the numbers indicate. “Increasing awareness may help reduce the stigma surrounding it and elicit more honest, forthright conversations about these problems,” he adds. “It’s also important to identify and recognize factors and stressors that contribute to dependence and abuse in surgeons.”

The study by Dr. Oreskovich and colleagues was supported by the American College of Surgeons (ACS), a point he says is very important. “The fact that the ACS supported this study demonstrates why the organization should serve as a model for other groups,” he says. “The ACS has taken a leadership role in identifying alcohol abuse and dependence among its members. In doing so, they’re helping destigmatize these disorders. They’re also proactively promoting appropriate interventions and treatments. Our findings should encourage surgeons to pursue treatment and rehabilitation so that patient safety and personal well-being are kept at the forefront.”

Previous investigations have shown that alcohol abuse and dependence are treatable and reversible. Dr. Oreskovich says the prognosis is excellent when physicians are identified early and receive appropriate interventions and treatments. “Just like people from the public sector, surgeons are not infallible, but they can recover. With adequate monitoring, surgeons can be safely returned to the operating room after treatment for these problems. The key is to provide surgeons with a safe forum so that they can get the help and support they need.”

References

Oreskovich MR, Kaups KL, Balch CM, et al. Prevalence of alcohol use disorders among American surgeons. Arch Surg. 2012;147:168-174. Available at: http://archsurg.ama-assn.org/cgi/content/full/147/2/168.

Buhl A, Oreskovich MR, Meredith CW. Prognosis for the recovery of surgeons from chemical dependency: a 5-year outcome study. Arch Surg. 2011;146:1286-1291.

Gallagher AG, Boyle E, Toner P; et al. Persistent next-day effects of excessive alcohol consumption on laparoscopic surgical performance. Arch Surg. 2011;146:419-426.

McLellan AT, Skipper GS, Campbell M, DuPont RL. Five year outcomes in a cohort study of physicians treated for substance use disorders in the United States. BMJ. 2008;337:a2038.

Balch CM, Freischlag JA, Shanafelt TD. Stress and burnout among surgeons: understanding and managing the syndrome and avoiding the adverse consequences. Arch Surg. 2009;144:371-376.

Balch CM, Shanafelt TD. Burnout among surgeons: whether specialty makes a difference. Arch Surg. 2011;146:385-386.

Bertges Yost W, Eshelman A, Raoufi M, Abouljoud MS. A national study of burnout among American transplant surgeons. Transplant Proc. 2005;37:1399-1401.