15% of surgeons struggle with alcohol problems

More than one in seven surgeons struggle with alcohol abuse or dependence, says a study in the February Archives of Surgery.

Researchers conducted an anonymous survey of 7,194 members of the American College of Surgeons and found that 15.4% of respondents had a score on the World Health Organization's Alcohol Use Disorders Identification Test that indicated alcohol abuse or dependence. The test originally was used to identify alcohol problems among Dept. of Veterans Affairs patients and is now used by institutions throughout the U.S.

The study found that rates of alcohol abuse or dependence were almost twice as high among female surgeons, at 25.6% compared with 13.9% for men. Rates also were higher among younger surgeons, those without children and those who reported being in an unhappy relationship, the study said (link).

The higher incidence among women may be due to greater societal expectations, said Michael Oreskovich, MD, lead study author and clinical professor of psychiatry at the University of Washington School of Medicine. There is more pressure on women than men to raise children and balance professional and family responsibilities.

"Female surgeons are more conflicted about the many obligations they have," he said. "They have more balls in the air at one time."

Alcohol problems also were more common among surgeons who reported feeling burned out or depressed, but less common among those who worked the most.

"The more hours worked and more nights on call are actually protective," said Dr. Oreskovich, psychiatric consultant to the ACS Board of Governors' Committee on Physician Competency and Health. "I think a lot of the younger surgeons starting out aren't as busy and probably have more time to drink."

Surgeons with alcohol abuse or dependence issues were "substantially more likely to report a major medical error in the past three months," the study said.

Overall, 10% of survey respondents said they made a major medical error in the previous three months, of which 77.7% had scores consistent with alcohol abuse or dependence. But the study did not identify the nature of the errors or determine cause and effect.

Dr. Oreskovich said there is no evidence that those rates correspond to patient injury, or that surgeons were impaired in the operating room. Most states require health professionals to report impaired colleagues, and the surgical profession is quick to intervene in cases that might threaten patient safety, he said.

"The likelihood of an impaired surgeon getting into the operating room is very low," Dr. Oreskovich said. "We have become sensitive enough to physician impairment that we are on the lookout for our colleagues who are impaired."

Other studies have estimated alcohol abuse or dependence among the general population to be 8% to 10%, but Dr. Oreskovich said it is difficult to measure and he suspects those estimates are low.

To address the issue among surgeons, the profession must work to destigmatize substance abuse to ensure that those who need help can get it.

"It really takes this kind of proactive approach and acknowledgement that this is a disease," Dr. Oreskovich said.

Physicians should know that there are services that can help them, John Fromson, MD, assistant clinical professor of psychiatry at Massachusetts General Hospital and Harvard Medical School in Boston, said in an invited critique.

"All surgeons should know that there is help for these problems," he said. "Physician health programs are found in almost every state and provide confidential referral to treatment, guidance and monitoring of the recovery process."