Longevity of Surgeons: Influencing Factors
M Al-Fallouji, PhD (London), FRCS (Ed), FRCS
Doctors may have a better longevity than general population (1). However, due to high stress level, suicide rates among doctors are higher than those in general population and among other academic occupations (2). In USA, 93 premature doctor deaths are reported yearly under age of 40 mainly due to suicide (3). A study of 34,439 British male smoking doctors over 40 years revealed a death rate ratios during 1971-91 (comparing continuing cigarette smokers with life-long non smokers) were threefold at ages 45-64 and twofold at ages 65-84 (4). Stress was higher among doctors of ethnic groups with shorter survival, but the study was based on BMJ obituaries over 6 months period only making it inadequate for general conclusion (5). There is no study devoted to surgeons’ longevity and causes of death. We have therefore conducted a detailed study of a cohort of 2013 dead doctors with 279 dead surgeons retrieved from obituary sections of consecutive BMJ issues over a longer period of 5 years (Feb 1992-Jan 1997) to smoothen inconsistencies and inadequacies of death reporting.
Longevity of Surgeons:
Influencing Factors
1. Specialties: In 279 surgeons, mean survival (MS) of 75.5 years (SD=12.5), fares well when compared to other medical professions (Fig.1). Among surgical specialties, ENT surgeons have the longest MS of 77.8 followed by Ophthalmologists 76.4, General Surgeons 76.3 (including paediatric, plastic, urologists, cardiac and neurosurgeons, since such specialties are not always clear in obituaries), Dental/Faciomaxillary 73.5, Orthopaedics 71.1, and Accident/Emergency surgeons have the shortest MS of 67.5.
2. Timing of Retirement: Out of 279 surgeons, 52 (19%) died in post while working with MS of 54; 21 retired before 65 with late survival (LS) of 14.5; 22 continued work beyond 65 with LS of 9.1. However, 184 surgeon retired at 65 with LS of 15.5 resulting in a double impact of optimal age of retirement and better LS; this may indicate that working to age of 65 may be therapeutic, provided that such doctors control their stress level.
3. Nationality: MS was 75.8 for British surgeons (n=226), followed by Irish MS of 74.6 (n=15) then other Anglo-Saxons MS of 73.5 (n=38). No Asian/African surgeons.
4. Academic Interests: Two degrees (MBChB and FRCS) signify a non-academic interest; those with 3 degrees or more (MBChB, FRCS and e.g. MS or PhD) are academic. Surgeons with academic interests (n=108) live slightly longer than those without (n=173) with MS of 76.2 and 74.7 respectively.
5. Outside Activities: Surgeons with dynamic activities (sports, travel and gardening, n=137) may live longer than surgeons with static activities (reading literature, listening to Music, playing Piano, n=55) with MS of 75.8 and 74.1 respectively.
6. Place of Work: Contrary to expectations, surgeons working in the Cities have MS of 72 (n=168) followed by surgeons working in the Countryside MS of 71.7 (n=80) and finally surgeons working in the Seaside MS of 70.4 (n=31).
7. Other factors may include personal habits such as smoking, alcoholism, faith, sex, wife and diet (see below).
DEATH OF SURGEONS:
Causes, Pattern, and Precautionary Measures
Causes of death were identified in 153 surgeons. Causes include: cancer, the leading cause of surgeons death (43.7%), then ischaemic heart disease (22.5%), stroke (11.3%), chronic illness (8.6%), pulmonary disease (4%), accidents (4%), infections (2.6%), ruptured aortic aneurysm (2%), and suicide (1.3%). Such high cancer mortality may indicate that cancer is a transmissible disease or a stress-related illness. Among 53 known cancers, they were in the order of frequency: 11 bladder/prostate, 9 pancreatic, 7 colorectal, 7 lymphomas, 5 leukaemias, 3 lung, 2 myelomas, 2 oesophageal, 2 gastric, 2 kidneys, 1 hepatic, 1 nasopharyngeal, and 1 sarcoma. Findings confirmed literature report that smoking-associated diseases result in excess doctors’ mortality. Such diseases include: cancers of upper GI, lung, pancreas, and urinary bladder; from chronic obstructive pulmonary disease; from vascular diseases; from peptic ulcer; and (when confounding by personality and alcohol use) from cirrhosis, suicide, and poisoning (4). Furthermore, data revealed an inverse association between weekly fish consumption and death from coronary heart disease (6). Also, mortality risk was 50% lower in those with high orgasmic frequency (twice a week or more) than in those with low frequency (less than monthly). However, priests and nuns though celibate have lower overall mortality than in general population (7) presumably due to low rates of smoking. Attending cultural events may have a positive influence on survival (8).
There are 2 peaks of death: at MS of 54 (in 19% of surgeons) and at MS of 75 (in 81%). There seems to be a crescendo pattern in the build-up of career-related stress from juniors to registrars to consultants at which stage must control their stress level (to prevent workaholism death). Clinical stress must be curtailed at the other end of career spectrum by a build-down of clinical stress (mirror-imaging initial build-up) and planned 5 years prior to retirement (by becoming part-time clinician or a manager to prevent acute stress incurred by sharp transition from an important consultant position to no-status retired person).
From this study and others one may recommend precautionary measures (Table 1).
Table 1. Precautionary Measures
1. Balance your life: work/home sharp demarcation (never make your home an extension base of hospital, don’t carry a brief case, avoid bringing hospital work home), maximise home privacy (phone ex-directory, no private practice at home, cultivate relations with friends from outside hospital environment, enjoy your time at home- time spent on your relaxation is not time wasted- no time management at home).
2. Destress yourself regularly (strong faith, caring partner, spoil yourself like a child, time management at work, delegation and evolving extramural activities (something to look for when you come home). There is always another life to enjoy beyond hospital. Work to live and don’t live to work.
3. Agenda for life:
-
- Daily: Anti-cancer diet / using stairs instead of lifts (daily exercise)
- Weekly: Fish / attending theatre
- Monthly: Sex (at least once monthly to once every 2 weeks (medium frequency)
- Bimonthly/Quarterly: Holiday
- Yearly: Health check / maintain normal body mass index
References
1. Goodman LJ. The longevity and mortality of American physicians. Milbank Mem Fund Q Health Soc 1975;53(3):353-75.
2. Lindeman S, Laara E, Hakko H et al. A systematic review on gender-specific suicide mortality in medical doctors. British Journal of Psychiatry 1996;168(3):274-9.
3. Samkoff JS, Hockenberry S, Simon LJ et al. Mortality of young physicians in the United States 1980-1988. Academic Medicine 1995;70(3):242-4..
4. Imperial cancer research fund cancer studies unit, nuffield, oxford. Mortality in relation to smoking: 40 years’ observation on male British doctors. BMJ 1994; 309(6959):901-11.
5. Wright DJM and Roberts AP. Which doctors die first? BMJ 1996;313:1581-2.
6. Daviglus ML, Stamler J, Orencia AJ et al. Fish consumption and the 30-year risk of fatal myocardial infarction. New England Journal of Medicine 1997;336(15):1046-53.
7. Smith GD, Frankel S, Yarnell J. Sex and death. BMJ 1997;315:1641-4.
8. Bygren L O, Konlaan B B, and Johansson S-E. Attendance at cultural events, reading books or periodicals, and making music or singing in a choir as determinants for survival. BMJ 1996;313:1577-80.
