No matter what career you choose, there will often be occupational risks that come along with it. Although it’s easy to see the dangers of being a high-voltage power line inspector, even the most harmless appearing jobs have their risks – and medicine is no exception.
Although being a doctor may seem like a safe job, there are some occupational risks that you should be aware of. I’m not just talking about carpal tunnel syndrome from charting too much or UTIs from holding your bladder too long either.
Here are 7 different occupational hazards that doctors face and which specialties are most susceptible to them.
- Sharps Injuries
- Exposure to Airborne Pathogens
- Radiation Exposure
- Back and Other Musculoskeletal Injuries
- Physically Combative Patients
- Substance Abuse
- Sleep Deprivation
1 | Sharps Injuries
Needlesticks and other sharps injuries are some of the most common work-related injuries among physicians. They often occur during procedures or medication administration when a contaminated needle, scalpel, suture, or another sharp object accidentally punctures the skin.
The problem with these injuries is not the wound itself, but rather the risk of contracting a blood-borne illness – particularly HIV or hepatitis C.
The CDC estimates that approximately 385,000 needlesticks and other sharps-related injuries occur each year; however, it is difficult to accurately estimate these numbers as many of these incidents go unreported. Many people feel ashamed or embarrassed when they stick themselves and worry that disclosing the incident will make their peers and supervisors question their skills and competency or affect their professional development.
Although the estimated risk of contracting a blood-borne illness after exposure to infected blood is low, approximately 0.3% for HIV and 0.2% for HCV according to the CDC, there are multiple factors that may increase your risk. Exposure to large quantities of infected blood, exposure to blood from a patient with high viral loads, and being stuck with a hollow-bore needle all increase your risk of infection. That being said, there are safety precautions that further mitigate these risks such as wearing two pairs of gloves. Doing so has been shown to reduce the volume of blood transferred by almost a factor of 6.
Despite the low likelihood of transmission and the additional precautions, however, reporting is still crucial given the lifelong consequences of an HIV or HCV diagnosis. When these incidents occur, it is imperative that both the patient and physician are tested to determine (1) whether exposure to a blood-borne pathogen has occurred and (2) whether the physician should begin prophylactic treatment.
Surgical specialties are often at higher risk for these types of injuries due to their regular exposure to bodily fluids and the use of sharp tools during surgery. According to one study examining resident physicians, there was approximately twice the number of needlestick injuries involving surgical residents as there were with non-surgical residents at about one needlestick injury per year for each surgical resident.
Emergency medicine physicians also tend to be at higher risk for sharps injuries or exposure to blood-borne illnesses given their regular exposure to blood and other bodily fluids. They also perform a variety of procedures involving needles and other sharp tools including central line placement and chest tubes, among others.
2 | Exposure to Airborne Pathogens
Exposure to pathogens through the air or respiratory droplets is another common occupational hazard for physicians. This has been of particular concern as of late due to the coronavirus pandemic. Despite taking proper precautions, many physicians were still exposed to the virus and became sick themselves – some even losing their lives due to the disease.
Even before COVID-19; however, there has always been a risk of contracting an airborne illness for physicians. This includes more common pathogens like flu and other respiratory viruses as well as more dangerous pathogens such as tuberculosis and bacterial meningitis – both of which may be transmitted through respiratory droplets when a patient coughs or sneezes.
Because physicians in most specialties regularly interact with patients, most physicians are also susceptible to exposure to airborne pathogens. That being said, some specialties are at higher risk than others.
To start, front-line specialties such as family medicine, pediatrics, emergency medicine, and internal medicine are at higher risk given the fact that they are the first point of contact for patients.
Other specialties at high risk for exposure to airborne pathogens are critical care, anesthesiology, and pulmonology as they regularly work with patients’ airways and perform a variety of procedures, such as endotracheal intubation, where they must be near the patient’s face. Ear, nose, and throat doctors and ophthalmologists are also at higher risk for airborne exposures for this same reason.
Lastly, infectious disease physicians would also fall into this category as they work closely with patients with diseases that are transmissible through air and respiratory droplets such as tuberculosis and bacterial meningitis, to name a few.
3 | Radiation Exposure
For some specialties, radiation exposure is another occupational hazard. The x-rays, CAT scans, and other imaging studies that doctors use to help diagnose patients use ionizing radiation to produce images of the body. Although these tests use small doses of radiation and are unlikely to cause any damage in the short term, long-term repeated exposure has the potential to cause cumulative damage to DNA and subsequent adverse effects -– most notable of which is the increased risk of cancer.
An increasingly common tool for physicians and surgeons is the fluoroscope. These x-ray devices allow doctors to see into patients’ bodies in real-time to help guide procedures. The downside, however, is that they expose the physicians to small doses of radiation.
There are precautions that physicians take to minimize radiation exposure including wearing lead vests to protect against radiation, maintaining appropriate distances to minimize exposure, and keeping exposure times to a minimum. Physicians that use these tools will typically also wear dosimeter badges which monitor their exposure to ionizing radiation over time to ensure they are well within safe levels. Although research largely suggests that the risk of an adverse health effect from radiation is low for physicians, regularly being exposed to even low levels of radiation is likely more harmful than not being exposed to radiation.
According to the Cleveland Clinic, as of 2012, there have been nine reported cases of left-sided brain or head and neck tumors in interventional cardiologists which may suggest an increased risk of brain tumors in doctors who use fluoroscopy. Studies have also demonstrated an increase in chromosomal abnormalities in interventionalists, compared with non-interventionists.
The specialties most at risk for radiation exposure are diagnostic radiology, cardiology, interventional radiology, interventional cardiology, and certain surgical specialties due to the use of real-time imaging in procedures.
4 | Back and Other Musculoskeletal Injuries
Other occupational risks that we often don’t consider are neck pain, back pain, and other musculoskeletal injuries. These issues are especially common among surgeons due to the long hours spent standing and the tendency to shift to poor, ergonomically limited positions to ensure proper exposure and accessibility to the area of interest.
A 2020 study published in JAMA monitored the ergonomics of fifty-three surgeons from 12 different specialties while performing surgery. They found that surgeons spent an average of 65% of procedure time in high-risk neck positions, 30% in high-risk torso positions, and 11% in high-risk shoulder positions. Other factors that contributed to increased time spent in high-risk positions included longer case lengths, increased years in practice, and use of surgical loupes and headlights.
Additionally, a 2017 study of ENT residents found that 82% of residents experienced some form of musculoskeletal pain, 16% reported having to scrub out of ongoing operating procedures due to musculoskeletal symptoms, and 6% reported missing work due to their symptoms.
Lastly, a 2020 study surveying 685 orthopedic surgeons across 27 different states, found that approximately 60% of respondents reported neck pain and approximately 23% reported issues with cervical radiculopathy. Of those surveyed, only six surgeons reported receiving ergonomic evaluations.
Surgeons aren’t the only physicians at risk for musculoskeletal issues either. Any specialty that requires long hours standing or sitting at a computer also has the potential for back pain, neck pain, and other musculoskeletal issues.
Gastroenterologists, for instance, have been shown to have high incidences of back and neck issues as well as elbow, wrist, and hand injuries. This is thought to be a result of the long hours spent performing scopes and endoscopic ultrasounds and the repetitive motions associated with them.
Studies examining the prevalence of musculoskeletal pain and injuries among GI doctors range from 29% all the way up to 89%. Although there is a lot of variation between studies, it is clear that many GI physicians are being affected by this, which is problematic given that injury and pain can lead to loss of productivity and shorten a physician’s career.
No matter what specialty you choose, it’s important that you remain cognizant of your posture and movement patterns to minimize the risk of developing issues down the road. Daily stretching and regular exercise are also great ways to prevent musculoskeletal issues and improve your overall health.
5 | Physically Combative Patients
In psychiatry, you are regularly treating patients with behavioral health issues including anger management problems, personality disorders, and even homicidal ideation. Although not all patients with mental illness are dangerous, the nature of these patient populations does increase the risk for psychiatrists, which can be seen in the fact that psychiatrists are the most common victims of physician homicide.
Emergency medicine physicians are also at higher risk of encountering physically combative patients for several reasons. To start, there are a lot of strong emotions that come along with emergencies as these situations are often incredibly stressful for the patients and families, as well as for the medical staff. Anytime strong emotions get involved, people often experience less control over their actions leading them to say and do things that they normally would not.
In addition, common presentations including intoxication, hypoxia, stroke, and infection can lead to altered mental status and agitation. As a result, patients experiencing these conditions may unknowingly lash out against the physician due to their altered mental status.
It is also common for EM physicians to encounter patients who are malingering, or in other words, trying to abuse the hospital system for their own gain. As an example, patients who are addicted to narcotics will often feign illnesses to receive pain medications. Although various prescription monitoring programs exist to help physicians detect drug-seeking behavior, these patients tend to become aggressive towards providers when they don’t get what they want.
6 | Substance Abuse
Substance abuse is another surprisingly common issue among physicians.
According to the American Addiction Centers, approximately 10-15% of physicians will develop a problem with substance abuse during their careers. The type of substance abuse; however, often varies between specialties.
Among anesthesiologists, for instance, the most commonly abused substances are opioids. This is thought to be a result of their proximity to large quantities of highly addictive drugs, the relative ease at which they can divert small quantities of these drugs for personal use, the high-stress environment in which they work, and the continuous exposure to these drugs in the workplace which can promote substance abuse.
Although the exact prevalence of substance abuse among anesthesiologists is not known, between 1991 and 2001, four out of five U.S. anesthesiology residency programs reported experiences with impaired residents, and one in five reported at least one pretreatment fatality. This is especially concerning given that substance abuse increases your risk of suicide and anesthesiologists are known to have some of the highest rates of suicide out of any medical specialty.
Anesthesiologists are not the only physicians with substance abuse issues. According to the American Addiction Centers, male surgeons are over two times as likely to experience alcohol dependence or abuse than the general population and female physicians are over four times as likely. In addition, a 2014 study of emergency medicine physicians treated by a Physician Health Program showed that nearly half were treated for alcohol abuse, 38% for opioid abuse, and almost 10% for stimulant abuse.
7 | Sleep Deprivation
Lastly, sleep deprivation is another common workplace hazard that is present across a variety of specialties. It’s common knowledge that many physicians work long and unpredictable hours – especially during training. It’s so common in fact that it is pretty much expected that you will experience many sleepless nights on your path to becoming a physician. That being said, sleep deprivation, both acute and chronic, can have significant negative effects on a physician’s health.
Acute sleep deprivation has been shown to decrease cognitive function, attention, and memory – all of which can negatively affect a physician’s performance. Additionally, driving when sleep deprived has been compared to driving intoxicated and can greatly increase your risk of getting into an accident.
Anecdotally, I have known multiple physicians who have gotten into car accidents when driving home tired after work and have even had a close call myself after working a 34-hour shift without any sleep. In addition to the acute dangers of sleep deprivation, chronic sleep deprivation has also been linked to higher rates of diabetes, high blood pressure, depression, heart attack, and stroke.
Although most specialties carry at least some risk for sleep deprivation, especially during residency training, surgical specialties are at particular risk due to the long, irregular hours as well as their on-call responsibilities. In a 2004 study of sleep deprivation among residents, general surgery, neurosurgery, urology, and orthopedic surgery had the highest percentages of residents who slept fewer than five hours per night. Regardless of the specialty, however, sleep deprivation is an issue that affects many physicians.
Although these occupational risks are important to be aware of, you shouldn’t let them dissuade you from pursuing your dream specialty. By understanding the risks associated with each specialty ahead of time, you can better take steps to mitigate them in your own life. But no matter what specialty, or even career, you choose to pursue, you should always be cognizant of your own health.
We only get one body in this life, so make sure you’re doing what you can to take care of it.