Cancer Mortality Rate Among Surgeons

The study “Mortality Among Surgeons in the United States,” published in JAMA Surgery, took a closer look at the leading causes of deaths among surgeons and other worker groups. In all, more than 1,000,000 death records were assessed, including that of 224 surgeons and 2,740 other physicians. After looking at the data and reviewing mortality rates, researchers uncovered:

• U.S. surgeons have a cancer mortality rate more than two times that of non-surgeon physicians.
• U.S. surgeons have a cancer mortality rate more about 20% higher than most non-physician workers.
• Cancer was the only category in which surgeons showed a higher mortality rate than all other surveyed workers.

Researchers say that it’s possible that workplace factors may be driving the excess cancer deaths, but they can’t say for certain. However, other factors could definitely be at play. For example, many surgeons may seek out a career in medicine due to a health-related hardship in the family. Many are called to medicine for a similar reason, and while it doesn’t totally explain the difference between surgeons and non-surgeon physicians, it’s possible that surgeons have a higher risk of cancer due to genetics and a family history of the disease. Until we learn more, we’re just guessing at the root cause.

While the cancer numbers are concerning, other numbers leave us a bit more optimistic. For example, surgeons were the least likely group studied to die from other health conditions like:

• Influenza
• Kidney disease
• Liver disease
• Septicemia
• Diabetes

There’s some good and bad with this study, but it does shine a light on a potential issue that surgeons should be aware of. Just like their patients, surgeons should make sure they are screened for cancers and other diseases at the recommended ages. Prevention and regular check-ups can go a long way in keeping cancer from becoming a fatal concern.

We do what we can to maintain optimal health as we age, but we know cancer is never fully preventable, so we’ll keep tabs on our health as we age, and you should too! And as always if you need help overcoming a health issue of your own – mainly a foot or ankle issue – reach out to Dr. Silverman by filling out this contact form.

The post Are Surgeons More Likely To Develop Deadly Cancers? appeared first on Lance Silverman, MD - Orthopedic Foot & Ankle Surgeon.

Many providers turn these patients away or simply try to appease them by offering them a script that will do more for their symptoms than their underlying issue. We welcome these patients because we know how to best help them, even if providing the right type of care won’t be easy. In today’s blog, we shine a light on how we work to help treat the overwhelmed and exhausted patient.

Helping The Exhausted Patient

If you’ve tried a number of different treatments or visited a few different doctors with no success, come visit Dr. Silverman. Here’s what sets his care apart:

1. We Give You The Time You Deserve – Too many medical centers force their doctors to see as many patients as possible, but that’s not how Dr. Silverman and his team operates. We strive to give every patient the time they need to have their needs met when they come in for care. We’re not going to rush you out of the exam room or kick you out because we have another patient to see in five minutes. Our consultations will take as long as they will take because in order to provide the best care, we need to truly understand what’s going on, and sometimes that can’t be uncovered in exactly 15 or 30 minutes.

2. We Listen – Another way that we work to connect with the fed up patient is by really sitting down and listening to their concerns. In medicine, it can be common for the doctor or the care team to do most of the talking. And while it’s important to be able to convey key information to the patient, it’s also incredibly helpful to stop talking and listen to what the patient has to say. Imaging results can tell a doctor a lot about the physical state a person is in, but they can’t do much to diagnosis the mental and emotional state. By listening to the patient, we can work to find a more comprehensive treatment plan that addresses all aspects of their injury. Oftentimes patients are exhausted and overwhelmed because they don’t feel like they are being heard by their physician.

3. We Won’t Choose The Easy Route – We’re not just going to write a script and hope that you’re happy with mild symptom relief. We’re going to work to find the best treatment path forward for your individual condition. Whether that means rest followed by physical therapy or a minimally invasive procedure and rehab exercises in a walking boot, we’re ready to get our hands dirty and help address the root cause of your discomfort. We don’t want to calm the symptoms, we want to treat the root cause of your pain so that it can be resolved once and for all.

4. Validation – Another reason that many patients feel frustrated with their care is because they don’t feel validated by their doctor. Pain is isolating enough without trying to treat the problem without having your feelings validated by your care provider. We believe you when you say your foot hurts or you’re struggling to walk normally, and we can empathize with how difficult that can make everyday activities. Connect with a provider who will validate your concerns.

5. Adaptive – Finally, we’re always ready to adapt if a first course of treatment fails to yield the expected results. If you’re frustrated with your care, there’s a good chance you’re not dealing with a simple issue, so don’t get overwhelmed if your initial treatment isn’t a rousing success. We’re willing to pivot as we see fit, and we hope you will too.

Let us help bring relief to your exhausting situation. For more information, reach out to Dr. Silverman by filling out this contact form.

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Dr. Goldman is an AMA member, president-elect of the American College of Physicians and represents that medical association in the AMA House of Delegates, so he is clearly a very knowledgeable and trusted physician, and even he is having a hard time keeping his head above water with his solo practice. The piece highlights a few key metrics that show just how tough it continues to get for solo practitioners:

• Physicians stand to see  a 2.83% cut for 2025 in the Medicare payments that help them support their practices and their care teams.
• The Centers for Medicare & Medicaid Services (CMS) projects another 3.5% rise in the Medicare Economic Index, which measures the cost of running a medical practice.
• This year marks the fifth straight year of cuts in Medicare pay.
• AMA research shows that Medicare physician payment, when adjusted for inflation, has dropped by 33% since 2001.

“Sometimes you can only squeeze so much blood from a stone before there’s nothing left and the practice has to close,” Dr. Goldman said, noting that all of these financial pressures on physicians who just want to care for patients also leads to burnout and decreased wellness for doctors.

Dr. Silverman Comments

After 20 years of providing the unique care that has come to define the Silverman difference, my wife and I faced the tough decision to close Silverman Ankle & Foot. The realization hit me hard a year ago, especially after losing my best friend to cancer. It was a moment of profound loss both personally and professionally. The challenges were clear, even before the pandemic, but the recovery afterward was beyond our reach.

Eventually, my road led me to Resurgens Orthopaedics. While I’ve had to give up some autonomy, joining this exceptional team has been rewarding. It’s certainly a better alternative than the path many doctors have had to take by completely giving up their practice.

Much of what Dr. Scott touched on in the AMA blog hit home with our practice. Medicare cuts and rising costs are making it harder and harder for smaller practices to survive. Private practices only get a fraction of what is billed to Medicare, and after rent, staff wages and other overhead expenses are accounted for, it’s getting harder for it to make financial sense to take the risk to make it as a solo practitioner, no matter your skill or experience.

But don’t get me wrong, I am incredibly excited about the new opportunity. As they say, “A rising tide lifts all ships,” and I think being around some of the best and brightest minds in the industry will only bring out the best in me. Working together to solve complex problems and being able to provide patients with more on-site diagnostic and treatment options will only make it easier to ensure patients get the care they deserve. Here’s to new beginnings and continuing to make a difference in foot and ankle care.

~ Dr. Lance Silverman

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Today, when I went to find the same article, I noticed it was no longer available on the site. Had it been removed because of professional outcry? Whatever the reason for its disappearance, I found another site that published a similar piece on how spinal fusion and knee/shoulder arthroscopy surgeries may be doing more harm than good. Below, I share my thoughts on those claims.

Spinal Fusion Surgery

While none of these procedures are commonly recommended in my office as I specialize in troubles below the knee, the data cited and recommendations for and against are so poorly presented that they will cause massive confusion for patients. It is almost as if they are claiming that surgeons do things without evidence to support. In the article, they state that surgeons oftentimes move forward with spinal fusion procedures “despite evidence that spinal fusion is not more effective than non-surgical treatments (such as an exercise program) and often results in complications.”

For the treatment of back pain, it is clear that non-surgical management is extraordinarily successful. But when non-surgical management fails and there are distinct painful conditions that correspond to both X-ray, MRI and even discogram, surgery can be highly successful and relieving. Can you imagine showing this article to a patient who has spent the last six months trying physical therapy, has significant signs of lumbar spine instability on flexion and extension radiographs, whose MRI shows significant end plate edema and has a positive discogram which correlates to the site of arthritis in the back?

Surgeons don’t just move forward with a procedure for anyone who walks in their door. Specific conditions need to be met, and months of conservative care will be pursued first because surgeons know if they can fix the problem without an operation, that is what’s best for the patient. To suggest otherwise is a disservice to patients and providers.

Next, they suggest that shoulder arthroscopy to debride inflamed or thickened bone and that knee arthroscopy for knee osteoarthritis is no better than placebo. We know that shoulder arthroscopy is performed to treat rotator cuff tears and shoulder instability, and these clear mechanical conditions can significantly benefit from an arthroscopic procedure. As for knee arthroscopy, it has been shown to successfully treat conditions such as meniscus tears with mechanical symptoms with incredible results. Again, for the right patient who has failed to find relief with conservative care, an arthroscopic procedure can get them back to the activities they love.

To suggest that these operations are harmful to the patient and a money grab by doctors is doing a huge disservice to the industry. Again, we can’t just paint with broad brushstrokes and fit one narrative to every single patient. It’s absolutely true that conservative measures like physical therapy, posture changes, weight loss, dietary changes, controlled exercise, medications and stretching routines can yield great results, but that doesn’t mean everyone will experience this type of recovery, and for these patients and those with a more severe injury, we may need to consider these surgeries that do in fact have a high rate of success for the right type of patient. Not all meniscus tears need surgery, but when specific issues are present, it can be the perfect solution if non-operative treatment fails.

It’s ironic that the article finishes by saying be wary of misinformation, because that’s exactly what they are spreading by grouping all patients with a specific condition into one category. To suggest that the right patient should not consider these procedures is borderline unethical.

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Video Chatting With A Doctor

The OCR announced that it will exercise its right to “enforcement discretion” and to waive potential penalties for HIPAA violations against health care provides that serve patients through everyday electronic communications during the COVID-19 global pandemic. This means doctors can now reach patients through numerous electronic communication methods like:

• Facetime
• Skype
• Google Hangouts
• Facebook Messenger Video Chat

These are just a few of the ways that doctors can connect with patients as we try to navigate the COVID-19 outbreak. The key here is that doctors can connect with patients and share health information through means that might normally constitute a potential HIPAA violation so long as the efforts are in “good faith.” So for example, a patient with COVID-19 symptoms can use a video chat application to connect with a provider in an effort to help relay critical healthcare information without putting other patients and hospital staff at risk of virus transmission. These video chats are not limited to COVID-19 related cases, and can be used for conditions like ankle sprains, bunions or other non-foot related healthcare issues.

“We are empowering medical providers to serve patients wherever they are during this national public health emergency,” said Roger Severino, OCR Director. “We are especially concerned about reaching those most at risk, including older persons and persons with disabilities,” Severino added.

More information, including a list of electronic services that should not be used to connect with a physician, can be found here on the Health and Human Services website.

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In many instances, doctors can’t win. And as attention spans get shorter and headlines become more bombastic in hopes of grabbing that attention, sometimes writers go for the low hanging fruit, which is outrage. They write the headline “Seven doctors arrested in massive opioid prescription scheme,” or “Felony charges for doctor accused of groping patient” in order to get the masses riled up. A good story makes you feel something, and sometimes misplaced anger and outrage is preferred to a well-written, thoroughly sourced informative piece that really dives into the specifics of the ordeal. Outrage and website clicks can do more for the bottom line than the boring truth.

Why Doctors?

We’re not defending every single doctor or medical worker that you read about in these stories. We know there are bad apples in our industry, but find us an industry that doesn’t have some. There are plumbers that overcharge, non-profit employees who embezzle and managers that cross the line with sexual harassment in the office. No profession is perfectly good, so why are doctors consistently taking the heat in the media?

There’s little hard evidence as to why, but it doesn’t seem that hard to reason why there seems to be a media bias. We have this picture in our head of what it’s like to be a doctor. They make a lot of money, they get to play the hero and save lives, and they probably drive a flashy sports car. There’s a certain draw to reading stories about the downfall of the rich and successful, and that seems to be what the media is going for.

However, that perfect picture of what it’s like to be a physician couldn’t be further from the truth. For starters, doctors are often overburdened by their caseload, as evidenced by the increasing rates of doctor burnout. That’s a big reason why cases of depression continue to rise among doctors and medical professionals. However, physicians rarely seek treatment for their mental health. After all, they are a physician, they should know how to care for themselves.

Moreover, there’s a stigma that comes with being a physician that is receiving mental health treatment. The doctor doesn’t want to be judged by fellow employees or patients if word gets out he’s seeking treatment for depression. Even if the doctor is one of the few who do seek mental health treatment, oftentimes it’s not enough. Did you know that doctors have the highest suicide rate of any profession, and it’s not even close?

And then there’s the money. What a doctor bills for isn’t what he or she collects, and while there often is a push from management to log more billable time, that again circles back to fatigue and doctor burnout. With the rising cost of medical school and the commitment it takes to become a doctor, many medical professionals enter the workforce with boatloads of debt, as the 4-year tuition average for medical school at a public institution is roughly a quarter of a million dollars, and that doesn’t even factor in undergrad costs. It’s not uncommon for a physician to enter the workforce with upwards of half a million dollars in debt. And because of the high cost of medical school, fewer students are working to get into medical school. This is leading to a doctor shortage, and who has to pick up the slack? The overworked and mentally fatigued physician who can’t take time off work to address his burnout because he needs the money to keep paying off his loans.

These stories about the true lives of physicians rarely get told because they don’t won’t sell newspapers or garner clicks. It’s easier to read a story about one bad pill pusher than it is to dive into the complexities of physician burnout or mental health issues. It’s uncertain how we can stop the spread of misinformation and media bias, but it starts with blogs like this and being as transparent as possible. Physicians and patients need to hold media companies responsible for these half truths and pushed agendas. Creating outrage from misinformation does nothing to move us forward as a society.

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Improving the quality of care doctors provide to their patients was the focus of a recent study published in the Journal of Bone and Joint Surgery. For the study, the authors were interested in seeing how time spent with or without the patient affected that patient’s perception of empathy. For example, if a patient waited in the waiting room for 20 minutes and then saw the doctor for 10 minutes, would they be more likely or less likely to rate their doctor as empathetic compared to someone who waited for 5 minutes in the lobby and saw the doctor for a half an hour.

Quality Time With Patients

After looking at the data, researchers were a little surprised with the results. They found that neither variable – time spent in the waiting room and time spent with the doctor – had an impact on their perception of the doctor’s empathy towards their situation. This is interesting, because a lot of doctors believe that patients want to wait less and have more time with the doctor. While this sentiment may be true, study authors found that those factors had no impact on the patient’s perception of empathy from the doctor.

However, researchers did find that there was a direct, inverse relationship between the doctor’s self-reported stress level and the patient-perceived empathy. For every 1-point increase in a surgeon’s self-reported stress (measured by the Perceived Stress Scale), there was a 0.87 decrease in perceived empathy (measured with the Jefferson Scale of Patient’s Perceptions of Physician Empathy).

Essentially, a quality interaction is more important than a short wait time or more time spent with the doctor, and a physician’s stress level appears to have a direct effect on their ability to provide their patient with a quality interaction. So if doctors can work to lower their stress levels, which admittedly is easier said than done, we may be able to provide our patients with a more meaningful visit.

Helping each patient is important, but letting them know that they are important to us is just as crucial during the care process. When we’re stressed, our patients suffer, so doctors need to work on lowering their stress levels for their sake and for the sake of their patients.

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Recently, I read a piece that spoke about orthopedic surgeon suicides and how it’s a growing trend, and I wanted to share some of the highlights from the article. However, if you have some time, please check out the moving piece and learn more about this concerning trend.

Suicide Trends Among Surgeons

About a third of the way through the piece, the author begins to talk about some trends when it comes to physician suicides. Some of these statistics were very surprising, while some others, sadly, weren’t surprising at all. Here are some of each.

• One million patients lose their doctor to suicide each year.
• Most doctors know at least one colleague who has died by suicide.
• For every female physician who commits suicide, four male physicians die by suicide.
• Women prefer to overdose, while men oftentimes choose firearms.
• Sensitive doctors, those who care most about their patients, are at the greatest risk, as they are sometimes overburdened by trying to help everyone or are punished for not choosing more expensive treatment options.
• Many doctors cite inhumane working conditions in their suicide notes.
• Bullying, hazing and sleep deprivation all increase suicide risk.
• Doctors fear lack of confidentiality if they seek mental health care, so oftentimes they don’t seek out help.
• Ignoring doctor suicides leads to more doctor suicides.
• Surgeons have the highest rate of suicide.

Suicide is a sad reality that many of us in the medical community have to face on a regular basis. As noted above, many doctors have a colleague or know someone in their professional circles who has ended their life by suicide. And when you look at that list above, it’s pretty clear why. Doctors want to help everyone, and when they can’t, they start down a path that discourages them to get help, which only makes it harder to break free from the cycle.

Clearly we need to rethink the whole system and work toward shifting towards a society that doesn’t stigmatize getting mental health counseling or putting the bottom line ahead of the doctors and patients. If you or someone you know is struggling, help them get help. If the warning signs are there, even if you just suspect they are there, help that person get counseling or support.

We lose about one physician a day to suicide. We need that to change, and we need it to change soon.

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The findings come on the heels of a systematic review of suicide rates in America. According to the data, the suicide rate among physicians is 28 to 40 per 100,000, while for the general public, it’s 12.3 per 100,000. That rate is higher than suicides among current and former military members, which some argue is the most stressful occupation in America. Some of the main conditions that these physicians experience are untreated depression and mental illness.

Physician Suicide Rates

Other findings from the national review include:

• Although female physicians attempt suicide far less often than women in the general population, the completion rate for female physicians is more than 2.5-4 times higher than the general population, and is equal to the completion rate of male physicians.

• One study found that depression affects roughly 12 percent of male physicians and up to 19.5 percent of female physicians.

• Between 15 and 30 percent of medical students express depressive symptoms on screening tests.

• The biggest issue may be the obstacle of seeking treatment. 50 percent of female physician respondents met a criteria for a mental disorder, but were reluctant to seek professional help because of fear of stigma.

• Poisoning and hanging are the two most common means of physician suicide in America.

• Psychiatrists had the highest rate of suicides among specialties.

The healthcare industry is very demanding, and it doesn’t help that the majority of doctors are overburdened. Bureaucratic red tape makes it harder to see patients can get them the help they need in a timely manner, which stresses both the patient and provider. We are so focused on helping fix everyone else and making them healthy that it’s easy to overlook our mental and physical health.

Working in healthcare is truly a rewarding experience, but it takes a heavy toll on healthcare workers. That’s why I always stress the importance of maintaining a healthy balance outside of work where the stresses of the day can be put on the back burner. Whether you find that stress relief in the form of exercise, playing in a band or going fishing, find something that you enjoy doing that takes you away from the stresses of work.

If you find yourself struggling with any aspect of this, or if life is becoming too stressful, please reach out for help.

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What A Doctor Wants

Whether you’re seeing a foot specialist or a general practitioner, they are going to want these three things from you.

1. Details – When it comes to explaining what’s going on with your health to your doctor, oversharing is always preferred to undersharing. The more information you give your doctor about your ailment and your overall health, the better idea they’ll be able to get about what might be wrong and the best ways to treat it. Your doctor is not going to judge you, so don’t be embarrassed or feel that you need to hide important details about your health or your symptoms from your doctor.

2. Questions – Believe it or not, questions help to show that the patient actually understands what’s going on with their health and that they are listening to the doctor. By asking questions, it shows the doctor that you want to understand whats going on with your body and what you can do to help it recover. Questions like “What can I do to help my recovery?” or “What would you recommend if you or your child were dealing with this condition?” can help get the conversation going and provide you with some helpful answers. Patients who ask questions also tend to have a healthier mindset about their condition and treatment, which can help you immensely during your rehab.

3. Commitment – Finally, your doctor is going to want you to commit to the care plan they prescribe. As we always say, there is no magical pill that will solve all your problems, so you are going to have to put in some work on your end to make a full recovery. Doctors love patients who are committed to their care plan and willing to put in the work on their end. You will be better off by following your doctor’s instructions when it comes to taking your prescriptions, attending physical therapy sessions and following a healthy lifestyle.

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