The AAS Ethics Committee continues our 2023 blog series, presenting member’s submissions from this year’s essay contest. And a reminder: The 2024 Art and Essay Festival deadline is midnight, Monday, December 4. Click HERE to learn more and submit your work.
Authors: Rachael Essig, MD & Ariana Metchik-Gaddis, MD
Imagine completing a grueling — more than decade of surgical training — with long intense hours, countless procedures, and the weight of numerous medical decisions. Certainly not something that sounds stress free and wellness centric. Now with starting a new job, the necessity for disability insurance occurs with the financial stressors of residency lessening. The only positive of the COVID-19 pandemic is that wellness is now considered important as well as realizing it had been lacking in the healthcare field. Over 50% of surgical trainees that were redeployed to the intensive care units (ICU) in the pandemic described a deleterious effect on their wellbeing1. Since the start of the pandemic, research into healthcare worker wellness has uncovered disturbing but not surprising results. The rate of depression in surgical trainees is nearly 40%2. Surgeons are vulnerable due to the more than a quarter stating they have had suicidal ideations plus the decreased rate of mental health treatment sought3. During residency, the second highest reason for death is suicide at 21% and surgeons that die by suicide were 4.62 times more likely to be affected by a mental illness3. Mental health in both trainees and surgeons is a clear issue.
Returning to the vignette, it is probable, given the statistics, that this person experienced some mental health issues, potentially even overcoming the negative stigma and seeking treatment2. If this person received professional treatment with either medications or therapies, it would be considered a pre-existing condition4. If there was a recent exacerbation of any conditions, then the person could even be denied disability insurance4. There may be exclusions if the insurance is approved. This means that if this condition causes issues in their professional career, it will not be covered by the insurance4. The information regarding exclusions in disability insurance is quite shocking given the Affordable Care Act legislation that prevents health insurance companies from increasing premiums or refusing to cover individuals due to pre-existing conditions5. The actions of this person seeking appropriate medical treatment for a well-known and quite common medical condition now leads this young surgeon to lack full disability coverage. This, unfortunately, could be a reason for trainees and surgeons to not seek out treatment for any number of medical problems but especially including mental health issues given all the other barriers to care.
With the new focus on healthcare wellness there needs to be a shift in all aspects of hospital workers’ lives. Advocacy at all levels is necessary to accomplish this. At an institutional level, the negative stigma that can surround mental health needs to be rectified. This includes wellness programs for all surgeons that actually aid — not simply extra modules to complete. At the state and national level there needs to be policy changes to amend legislation in order to prevent potential bad outcomes including decreased productivity, job satisfaction, mental wellness and even the most egregious outcome, death by suicide.
Hopefully, this essay has highlighted an extremely important topic that has not been readily considered in the realm of surgical wellness. The concern is that trainees spend an incredibly significant amount of time and finances to become a surgeon in addition to balancing a personal life. These are highly motivated individuals with a passion for helping others. It is devastating for these individuals to feel such a lack of happiness and satisfaction in their profession. This perception must be changed. A policy surrounding mental health care to best support friends and colleagues would lead to a brighter future for the surgical profession.
References
- Payne, A., Rahman, R., Bullingham, R., Varnadeva, S., & Alfa-Wali, M. (2021) Redeployment of Surgical Trainees to Intensive Care During the COIVD-19 Pandemic: Evaluation of the Imapct on Training and Wellbeing. J Surg Educ. doi: 10.1016/j.jsurg.2020.09.009.
- Williford, M., Scarlet, S., Meyers, M., Luckett, D., Fine, J., Goettler, C., Green, J., Clancy, T., Hildreth, A., Meltzer-Brody, S., & Farrell, T. (2018) Multiple-Institution Comparison of Resident and Faculty Perceptions of Burnout and Depression During Surgical Training. JAMA Surg. doi: 10.1001/jamasurg.2018.0974.
- Elkbuli, A., Sutherland, M., Shepherd, A., Kinslow, K., Liu, H., Ang, D., & McKenny, M. (2022) Factors Influencing US Physician and Surgeon Suicide Rates 2003-2017. Annals of Surgery. DOI: 10.1097/SLA.0000000000004575
- Shih, A. Getting disability insurance with a pre-existing condition. Accessed on December 14, 2022. https://www.policygenius.com/disability-insurance/getting-disability-insurance-with-a-pre-existing-condition/
- https://www.hhs.gov/answers/health-insurance-reform/can-i-get-coverage-if-i-have-a-pre-existing-condition/index.html#:~:text=Under%20the%20Affordable%20Care%20Act,charge%20women%20more%20than%20men.
Dr. Rachael Essig is a PGY-5 General Surgery Resident at Georgetown University-Washington Hospital Center in Washington, DC. She completed professional development time at the University of Chicago Hospital including a Surgical Critical Care Fellowship, Pediatric ECMO Fellowship, and Ethics Fellowship. She will be starting fellowship at the University of Utah in cardiothoracic surgery in August 2024. Follow her journey on twitter @RachaelEssig.