He lost a colleague and friend.
Samir Mehta, M.D., an orthopedic surgeon at the University of Pennsylvania in Philadelphia, experienced this loss, knew that surgeon suicide is claiming many of his orthopedic colleagues, and decided to investigate further. He and his colleagues have published a new study looking at what exactly is associated with depression and suicidal ideation in orthopedic surgeons.
Their work, “Objects in Mirror Are Closer Than They Appear: Symptoms of Depression and Suicidality in Orthopaedic Surgeons,” appears in the June 1, 2022 edition of The Journal of Bone and Joint Surgery.
Part of the issue, said Dr. Mehta, to OTW, is that historically, orthopedic surgery has been a major revenue generator for health systems. “It’s a high-volume specialty that involves a lot of throughput in a relatively elective field. Orthopedic surgeons are driven and are naturally competitive and, in some cases, are running their own businesses.”
Using the Beck Depression Inventory and the Columbia-Suicide Severity Rating Scale, the authors sent surveys to the orthopedic subspecialties of trauma, adult reconstruction, hand and upper extremity, shoulder and elbow, foot and ankle, spine, pediatrics, sports medicine, and oncology.
A total of 661 board-certified, practicing orthopedic surgeons completed this survey. The authors found that 156 surgeons (23.6%) revealed some level of active suicidal ideation in their lifetime, 200 surgeons (30.3%) reported having either active or passive suicidal ideation at some point in their lifetime, and 33 surgeons (5%) reported that, on at least one occasion in their lifetime, they had experienced active suicidal ideation with a specific plan and intention to harm themselves.
“We found,” said Dr. Mehta, “that younger age, divorce, adult reconstruction, and foot and ankle subspecialties were associated with a higher risk of suicidal ideation and/or depression. “Regarding age, we might potentially be dealing with a generational issue of resiliency. We have transitioned from ‘helicopter’ parents to ‘snowplow’ parents who attempt to foster a clear path forward for their children, with the results being that when the children do encounter difficulties, they are at a loss for what to do. Mentoring would help these individuals so that they can learn how to manage failure—so the first time they fail is not their first years in practice.”
While the authors had assumed that those in the orthopedic trauma were most at risk for depression or suicidality, the study found that adult reconstruction and foot and ankle surgeons were the most at risk. “Perhaps,” stated Dr. Mehta to OTW, “it is due to pressure on the elective surgeon, with volume and throughput being important. There may be differences in approach to practice or dealing with complications that are specialty specific.”
West Coast Surgeons More Chill?
“We found that attending an orthopedic residency in the Western U.S. was associated with less risk of depression. There may be cultural differences on the West Coast, where the environment may be potentially more ‘laid back’ compared to the East Coast. As an example, one of the students ranked for our program chose to go to the West Coast because he wanted to be somewhere with great weather and a beach.”
Little League or the OR?
“You have surgeons thinking, ‘Should I go to my son’s baseball game or handle this open tibia?’ The reality of our profession is that we sign up for the frontlines and we take the Hippocratic Oath. The niceties of the real world are not present in the OR or in a trauma bay…there are no do-overs. It is critical that we as a profession be able to identify who is going to be able to handle this level of stress and who is not. The concept of critical communication is essential in a high-pressure environment.”
System Overhaul Needed
Dr. Mehta: “The Orthopaedic Trauma Association (OTA) has created a wellness working group and is gathering data from members and developing programming for their upcoming national meeting. Jeff Smith, M.D. of Orthopaedic Trauma & Fracture Specialists in San Diego has dedicated a huge amount of time identifying and describing surgeon behavior and characterizing it.”
“The question is, ‘Will health systems provide the resources needed in order to address these challenges?’ How much of the stress and misbehavior that we are seeing is a reflection of the system—and not of the individual? Instead of telling me I need a midday yoga class, fix the Electronic Medical Record system! And surgeons need hospitals to hire more staff so that they are not working until 2am!”
See No Depression, Hear No Depression?
“I was surprised by the amount of resistance we encountered in administering the survey,” continued Dr. Mehta. “The data gathered is concerning and with this much information at hand, it can be overwhelming…and maybe the field has a more serious problem than we thought.”
But, says Dr. Mehta, the sheer number of emails he and his colleagues have received is evidence that there is indeed a huge problem. “Faculty across the world have told us they are thrilled that we are addressing this issue more closely,” said Dr. Mehta to OTW.
Dr. Mehta says that the next steps could be partnering with the OTA (and other speciality societies) or the American Osteopathic Association (AOA) or the American Academy of Orthopaedic Surgeons (AAOS) to get more data and/or moving towards the implementation of suicide prevention programming.
His message? “We are fairly certain that there is someone around you going through this…look for those people and start a conversation with them. We need to create an environment where imperfection is not shameful. To make progress, we must normalize discussions surrounding emotional well-being, depression, and suicidal ideation. This is imperative.”
If you are considering suicide, reach out to the National Suicide Hotline (24 hours a day…simply dial 988.
