Majority of doctors are at greater risk for this dangerous disease

By John James
Published June 1, 2020

Key Takeaways

Being a physician may be one of the most rewarding careers, but it’s also one of the most demanding. Many physicians experience job strain and, consequently, burnout at some point in their careers. In fact, some researchers have found that as many as 50% of clinicians suffer from burnout, defined as a long-term stress reaction causing emotional exhaustion, depersonalization, and other symptoms that affect quality of life. Physicians who experience burnout are likely to encounter a lack of focus, poor memory, impaired executive function, poor bedside manner, and even more errors at work. But physician burnout doesn’t only affect mental health, quality of life, and work performance. The condition can also negatively impact physical health. Most notably, careers in high-pressure fields like medicine can place professionals at greater risk of atherosclerotic cardiovascular diseases, including hospitalization with peripheral artery disease (PAD), according to a new study published in the Journal of the American Heart Association.

Job strain and peripheral artery disease

In a multicohort study, researchers investigated the link between job strain—meaning high demands and low control at work—and PAD by using hospital records. Specifically, they analyzed individual-level data and self-reported job strain at baseline (1985-2008) from 11 cohorts from Finland, Sweden, Denmark, and the United Kingdom. Overall, participants who reported job strain had a 1.41-fold increased average risk for hospitalization with PAD. Importantly, participants reported job strain at baseline rather than exclusively during high-stress periods, meaning that these individuals experienced job strain as the norm, not the exception. The results of the study were consistent across various demographics, including sex and socioeconomic background, and no matter whether the participant had diabetes or a history of smoking. Furthermore, the relative risk of job strain-induced PAD was in line with similar risks of developing coronary artery disease and ischemic stroke.

Why peripheral artery disease is dangerous

PAD, of course, is a serious disease caused by a buildup of plaque in the walls of blood vessels serving the legs, arms, stomach, and head. This buildup can cause the arteries to harden and narrow, restricting blood flow. Left undiagnosed and untreated, PAD can lead to a host of health problems, including reduced mobility, leg cramps, slow wound healing, chronic pain, amputation, and even an increased risk of blockages in arteries throughout the body that can cause stroke and heart attack.

While about 18 million people in the United States have PAD, as many as 50% are asymptomatic, so it’s not uncommon for the disease to go undiagnosed. However, serious complications are likely preventable: 95% of clinicians who responded to a 2017 survey reported the belief that diagnosis and appropriate intervention could prevent atraumatic primary amputation.

Other risk factors

Perhaps more concerning, many physicians have additional risk factors for PAD, whether due to lifestyle or genetics. When combined with the occupational hazard of physician burnout, these threats increase the risk of greater physician suffering and hospitalization from PAD. Consider that roughly 20% of people over the age of 70 have PAD—with additional factors like smoking history, ethnicity, diabetes, the presence of other cardiovascular conditions, and family history all further increasing the risk of a PAD. What’s more, up to 80% of patients who experience critical limb ischemia—the most severe form of PAD—are diabetic, while between 15% and 20% of patients with end-stage renal failure also have critical limb ischemia.

Physician burnout and peripheral artery disease

Given the prevalence of physician burnout and its relationship with PAD, physicians and researchers alike must take the issue seriously. Physicians should keep a careful eye on symptoms that can be attributed to job strain and stress. But how can doctors mitigate the effects of burnout? A survey conducted by the Agency for Healthcare Research and Quality determined that moving toward a patient-centered approach to medicine could help minimize the prevalence of physician burnout. Conducted across 26 clinics, the study found that reducing patient load, allowing for longer patient visits, reducing the number of in-person visits per day, and increased staffing all led to lower burnout rates. Essentially, an improved work environment and workplace culture can help cut the risk of physicians experiencing burnout—and that just might lower the risk of developing PAD.

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