The top factors devastating doctors' health

Though physicians may make great health decisions daily, their career is inherently risky. A day at the office comes with unique mental and physical occupational hazards, from dangerous pathogens and hostile patients to demanding workloads and high-stakes decision making.

Hospitals are one of the most hazardous places to work, according to the Occupational Safety and Health Administration (OSHA). Hospital workers face injuries and illnesses at roughly double the rate of private industry, and at even higher rates than those seen in construction and manufacturing. Hazards in the workplace can lead to decreased productivity, lower job satisfaction, and missed workdays among hospital staff, which in turn can increase rates of medical errors and patient infection.

Here are the top seven health challenges that physicians face—plus key strategies to combat them.

Challenges

Workplace violence—According to OSHA, serious workplace violence is about 4 times more common in healthcare than in private industries. In fact, healthcare has nearly as many serious violent injuries as all other industries combined. Physicians tell horror stories about their patients and their patients’ families that validate this statistic—a 2018 poll conducted by the American College of Emergency Physicians found that nearly half of respondents reported being physically assaulted, with more than 60% saying the assault occurred within the previous 12 months. Historically, these assaults have been chalked up to an uncomfortable (and largely unspoken) part of the job, but awareness and concern are becoming more widespread. Healthcare workers and advocates are pushing for greater accountability among healthcare administrators and even lawmakers.

Burnout—Recognized by the World Health Organization as a legitimate syndrome, burnout results from chronic workplace stress and can lead to energy depletion, exhaustion, and reduced professional efficacy. Burnout is especially prevalent among doctors, who report its symptoms at twice the rate of US workers in other fields. For medical professionals, the most common drivers include spending too much time at work and increased focus on labor-intensive clerical tasks like paperwork and electronic documentation. Many physicians also work in high-stress environments and must make high-stakes decisions, which can intensify burnout and cause other disorders such as depression, insomnia, and anxiety.

Peripheral artery disease—Careers in high-pressure fields like medicine can place professionals at greater risk of atherosclerotic cardiovascular diseases, including hospitalization with peripheral artery disease (PAD), according to a recent study published in the Journal of the American Heart Association. In 11 cohorts from countries across Europe, participants who reported job strain had a 1.41-fold increased average risk for hospitalization with PAD, even when adjusted for potential confounders. Left undiagnosed, PAD can lead to health problems, including reduced mobility, leg cramps, slow wound healing, chronic pain, amputation, and even an increased risk of blockages in arteries that can cause stroke and heart attack. Given the prevalence of physician burnout and the high-pressure nature of the clinical setting, physicians and researchers must take the issue seriously.

Accidental injury—Workplace accidents that result in injury are common among physicians and other health professionals. These include burns from hot water used in sterilizing equipment, electrical shock from faulty equipment, and acute back and neck pain from long hours spent standing or in a single operating position. Sharp injuries, defined as accidental skin penetrating stab wounds caused by needles, are the most common occupational injuries reported by healthcare workers. They might seem innocuous at first, but the World Health Organization estimates that each year 10% of healthcare workers sustain sharp injuries. Beyond the physical injuries needles and instruments cause, they also can be contaminated by blood-borne pathogens and expose professionals to serious blood-borne diseases, including hepatitis B, hepatitis C, and HIV.

Radiation exposure—Medical imaging procedures, including mammograms, computed tomography scans, bone density tests, and more, have revolutionized medical diagnosis and treatment, but exposure to ionizing radiation from X-rays and other methods of nuclear imaging can cause cancer and cognitive dysfunction. Physicians are at a greater risk of exposure, as they complete hundreds to thousands of these procedures each year. A cohort study published in the American Journal of Epidemiology found that, when compared with other specialists, radiologists had the highest rates of cancer mortality—a potential correlation with their frequent exposure to radiation.

Chemical exposure—Allergic reactions to chemical agents and topical medications in clinical working environments, as well as exposure to surgical smoke and anesthetic gases, can seriously compromise a physician’s health. Surgical smoke, which contains contaminants like hydrocarbons, phenols, and carbon monoxide, poses potential long-term health risks to surgeons and surgical staff, including transmission of human papillomavirus and the development of asthma. Disinfectants used to sterilize medical facilities, along with strong soaps and detergents, are linked to skin irritation and lung injury when inhaled or if used excessively.

Pathogens—An inevitable risk for healthcare workers caring for sick patients is the possibility of acquiring a variety of contagious diseases. In a clinical setting, the primary routes of infectious disease transmission are contact, droplet, and airborne. Physicians can contract a disease through either direct or indirect physical contact: examining a wound or changing wound dressings, for example. Infectious agents can also contaminate objects, from food to medical supplies and drugs. An epidemiological study published in the Journal of Occupational Medicine and Toxicology found that the two most common infections spread to healthcare workers were scabies and tuberculosis.

Solutions

OSHA suggests that a first step for ensuring workplace safety is enforcing a system of record-keeping. Collecting data allows hospitals to analyze specific strengths and weaknesses for staff and to adopt effective solutions. OSHA also recommends that hospitals implement a comprehensive safety and health management system, which includes education on hazard prevention and control, and training for healthcare workers.

Accurate use of personal protective equipment (PPE) is essential for physicians and healthcare workers to avoid self-contamination, according to the CDC, but this challenge has been further complicated by the current pandemic and PPE shortage. Training and practice using a healthcare facility’s safety procedures is also critical. The most important infection prevention measure recommended by the International Society for Infectious Diseases is adequate hand hygiene. In the case of patients with signs and symptoms of transmissible infectious diseases, prompt evaluation is crucial, as is doctor immunization.

Operators of equipment that produces radiation can reduce their exposure by limiting time of exposure, keeping distance from the source, placing a shield between oneself and the source, and using proper protective clothing. Today, many cardiology imaging laboratories and radiology rooms require overhead radiation shields, thyroid shields, and leaded aprons to help reduce exposure to doctors.

To reduce the likelihood of burnout, efforts at individual and organizational levels can promote a better culture of self-care among physicians. Organizations can offer resources for confidential mental health treatment or rewards that aren’t productivity-based, which exacerbate burnout. In addition to financial rewards, organizations should consider providing more flexible schedules or increased vacation days.

It’s important to remember that when it comes to burnout, there’s only so much that’s within a physician’s control. That’s why, in addition to focusing on personal wellness, physicians might consider opening a dialogue with their administrators and advocating for better working conditions.

However, it’s always a good decision to make a concerted effort to maintain a strong work-life balance. A study published in the American Journal of Medicine measured the impact of imposing a work-hour limit on first-year resident physicians. For over 15,000 resident physicians who participated in the study, the work-hour limit was associated with positive improvements in physician safety and health.

Physicians can also spend more time on work tasks that they enjoy, from patient care to research. A study published in JAMA Internal Medicine found that physicians who spend at least 20% of their time on the part of work they find most fulfilling significantly lower their risk of burnout.

In a narrative review in the Cureus Journal of Medical Science, the authors concluded that “burnout has emerged as a major problem plaguing 21st-century American medicine. If not addressed, the burnout epidemic may continue to worsen, to the detriment of patients and physicians alike.”