Health Care Workforce and Musculoskeletal Disorders in Surgery

Health Care Workforce and Musculoskeletal Disorders in Surgery

The U.S. health care industry employs an estimated 12,143,080 workers according

to the Bureau of Labor Statistics (BLS) May 2014 report. This population includes

medical and health services managers, licensed health care practitioners and technical

occupations, health care support occupations, and community health workers. This

overall employment rate for health care workers makes up nearly 9% of the employed

population in the United States.25 As currently defined by the BLS Standard

Occupational Classification System self-employed medical workers are not accounted for

in the 12 million health workforce. Although the number of surgeons in private practice

technologies and techniques are increasing the workload on the surgeons17, 28, 29 and surgical

team members.21, 30-32 This increased workload exposes medical providers to a known risk

factor of musculoskeletal injury or illness.33 The BLS reports a high number of injuries and

illnesses that result in time off work occurring at rates of over 150/10,000 workers for both

hospitals and general medical and surgical hospitals (Figure 1.2).25 This is above the total for

the private industry as noted by the orange bar in Figure 1.2. If

hospitals and general medical and surgical hospitals are combined, together they have a

higher number of injuries and illnesses resulting in days away from work than all

industries including ambulance services. Since these injuries/illnesses caused the

providers to take time off work, they were likely more serious incidents than needle

MSDs are a widespread issue across industries throughout the United States and

in many other countries.34 A study by Urwin, et al., (1998) reported that half of the US

population likely has pain due to MSDs.35 According to OSHA, hospitals are the 6th

highest industry with non-fatal work injuries such as MSDs.36 It is well known that non-

neutral body positioning, high forces, and repetition of tasks-that are all experienced by

surgical team members in the OR greatly influence the development of MSDs especially

when experienced concurrently.37, 38 The main focus of surgical research and

advancements has been on the patient; however, non-neutral body positioning that

surgeons assume can actually affect performance 39 and surgical outcomes.19

Additionally, if the work conditions in the operating room are not improved along with

however, ergonomic design in the environment should be able to accommodate these

differences.22,

28 The OR environment and technologies including table height limitations, improper monitor positioning,

and non-ideal instrument handles can increase MSDs due to poor body mechanics such as non-neutral body

positioning and improper load bearing).21

There are many job tasks in the OR that can be harmful: repeated motions (especially

involving high manual forces such as dissection), non-neutral body positioning (during

dynamic tasks such as suturing and dissecting or static tasks such as retraction), and

extended periods of standing 43 are all potentially harmful and often seen in

combination for surgical team providers.33 Although there is evidence of exposure to all

specific workplaces such as the OR, surgical providers cannot easily self–regulate their

workload using the current evidence-base.37 Currently, the health care system demands

surgical team members to learn the limits of their body in real-time during procedures

to determine whether or not a task is too stressful, which raises safety concerns. Self-

regulation of workload can be difficult or impossible in a situation where lives are at

stake and the system doesn’t always allow autonomy nor does it incorporate balance in

scheduling and case-load to accommodate individual-specific workload limits.

Although MSDs are a common type of work-related illness in laparoscopic surgery,47

the prevalence of MSDs is difficult to accurately calculate especially since the category of

MSD covers a broad range of illnesses that affect the muscles, tendons, ligaments, joints,

nerves, and connected vascular system in an individual.33 MSDs usually are not linked to one

reporting would result in loss of income. Regardless of the reasoning behind not

reporting, this culture creates an environment in which a surgeon or surgical team

member could be practicing at a reduced capacity and potentially increasing the risk for

patient harm.

Further complicating the study of MSDs is the influence by many other

components of the surgical work system. A thorough investigation into these components

through a systems approach can provide a bigger picture of the situation and act as a

foundation for designing studies on MSDs and the associated risk factors for surgical

team members.