Tuesday, July 8, 2014

Anesthesiology Residency Is One Of The Most Dangerous Jobs In America

Among medical professionals, it is widely believed that anesthesiologists are one of the most likely physicians to develop a drug addiction, now known as substance use disorder (SUD). But is that true? And how likely will a person who begins training in anesthesia develop SUD? The July 2014 issue of the ASA Newsletter shines some light on this common idea.

A collaborative study between the American Board of Anesthesiology and the Mayo Clinic examined the incidence of SUD in anesthesiology residents from 1975-2009. They looked at ABA training records, state medical board disciplinary actions, and the National Death Index, which describes causes of death. What they found was that there were 384 anesthesia residents found to have substance abuse out of a total of 44,612 residents during that 35 year time period, or 0.86%. The lowest incidence of SUD occurred in the years 1996-2002, which just happens to be the nadir of anesthesia residency training. Perhaps the residents who went into anesthesiology at that time were just more motivated to succeed. The highest incidence of SUD has been in the last few recent years. Currently about one in 87 residents will likely develop SUD.

During the study period, of the 384 residents who had SUD, 28, or 7%, died during training. Of those who survived, 56% completed residency training. But only 44% of SUD survivors eventually became board certified. Unfortunately 29% will relapse and death was the first indication of the relapse in 13%. Overall, of the 384 resident who developed substance abuse, 53 are now dead. The cause of death are known in 49 of them and SUD was the fatal factor in 44 of them, or 90%.

You may think that those numbers don't sound so threatening. After all, out of thousands of physicians who have successfully completed anesthesia training, only a few hundred have had problems with substance abuse. To get a better perspective on all this data, the study helpfully compared anesthesia residency mortality to other "dangerous" occupations using numbers from the Bureau of Labor Statistics. With 28 deaths found in 177,848 resident-years of training, that works out to an annual rate of 15.7 deaths per 100,000 anesthesia residents. According to the BLS, the most dangerous job in America is farming and fishing, with a mortality rate of 21.2 deaths per 100,000 workers. Policemen have a mortality of 18.6 per 100,000. Firefighters, though each of their deaths is considered a national tragedy, have a mortality of only 2.5 per 100,000. Among all healthcare workers, it is only 0.7 per 100,000. Think about that. You are more likely to die in anesthesia training than you are to get hit by lightening, die from a bee sting, or succumb in a plane crash. In fact, the odds of death among anesthesia residents is almost the same as getting shot with a firearm in America.

To all you CA1's starting your new careers, have a nice day. And be careful out there.

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