Medscape Physician Lifestyle Report 2015
January 26, 2015
Compared with other American workers, US physicians suffer more burnout, according to a national survey. Burnout is defined as loss of enthusiasm for work, feelings of cynicism, and a low sense of personal accomplishment. In Medscape's Physician Lifestyle Report 2013, 39.8% responded that they were burned out. This year that number went up: 46% reported burnout. An editorial published in the Journal of General Internal Medicine reported burnout rates ranging from 30% to 65% across specialties, with the highest rates of burnout incurred by physicians at the front line of care, such as emergency medicine and primary care physicians. The 2015 Medscape survey results reflect this same pattern, with the highest burnout rates found in critical care (53%) and emergency medicine (52%), and with half of all family physicians, internists, and general surgeons reporting burnout.
Burnout has been shown to negatively affect patient care, and many of the factors that lead to burnout are also associated with a higher likelihood of physicians leaving their practice. Rates of suicide are higher in physicians than in the general population, with studies indicating that job stress is a factor. Medscape asked burned-out physicians to rate the severity of their burnout from 1 ("does not interfere with my life") to 7 ("so severe that I'm thinking of leaving medicine"). Of interest, specialties reporting the highest severity ratings (nephrology 4.30, cardiology 4.29, and plastic surgery 4.28) were not those with the largest percentage of burned-out physicians.
Bureaucracy and loss of autonomy are known causes of stress.[6,7] This report provides more evidence of the importance of these factors, with bureaucratic tasks and spending too many hours at work rated as the most frequent causes of burnout, with scores of 4.74 and 3.99, respectively, based on a scale of 1 ("not at all important") to 7 ("extremely important"). In fact, being able to control work hours is increasingly found to play an important role in reducing stress and, therefore, burnout among physicians.[7-9] This year, insufficient income (3.71) and computerization (3.68) were also found to be important causes of burnout. One study found that PCPs with the highest number of electronic medical record functions also experienced the highest amount of stress. Of interest, the Affordable Care Act dropped to fifth place as a burnout cause this year, from third place in the 2013 Medscape report.
National surveys have reported a burnout rate of 60% in female physicians, which is higher than that of their male peers. The Medscape report supports these findings. More female physicians (51%) reported burnout than males (43%), and both genders had higher rates than in the 2013 report (45% in women and 37% in men). Some studies suggest that burnout in men may differ from that in women; in men it tends to be characterized by depersonalization, whereas women describe emotional exhaustion.
Burnout rates are lowest in the youngest and oldest physicians, although even physicians under 35 report burnout rates of 44%. Burnout peaks in mid-life, with over half of physicians reporting burnout (51% of those between 36 and 45 years of age and 53% between ages 46 and 55) and then declines to 22% in physicians 66 and over.
When asked about favorite pastimes, burned-out physicians and their less stressed peers tended to like the same ones to the same degree. Percentages were nearly identical for all, with about 78% of physicians in both groups preferring to spend time with family. However, this was a lower percentage than those who chose this pastime in 2013 (86%). About two thirds of all physicians like travel and exercise. Both non–burned out and burned-out physicians far preferred reading (56%, 53%) and cultural events (47%, 46%) to outdoor sports such as golf (12%, 10%) and hunting or fishing (9%, 10%).
Although studies suggest that taking time off reduces stress, the United States is one of only 13 countries in the world that do not mandate vacation time. Approximately one fourth of US workers do not have paid time off; about half are in the bottom fourth of earners vs a much smaller 10% of those in the top quarter. Even US physicians don't fare very well in terms of vacation time. More than a third (36%) of burned-out physicians take 2 weeks or less each year, with 5% having no vacation, compared with 27% and 3%, respectively, of their non–burned-out peers.
Volunteer activity associated with religious organizations pulled in the largest number of responses, but non–burned-out physicians did more of this work (23%) than burned-out peers (18%). The largest difference between the groups was seen in whether they volunteered at all: 28% of the non–burned-out group and 37% of the burned-out group never volunteer. (This is an increase in non-volunteering among burned-out physicians from 2013, when 31% of the burned-out group responded that they didn't volunteer.)
Physicians who have a healthy lifestyle are more likely to preach what they practice compared with the general public. In our report, physicians were asked to rate their physical health on a scale from "poor" to "excellent." The great majority rated their own health as "good" to "very good/excellent." However, to be expected, those who were burned out were less confident about their health, with 54% of burned-out physicians reporting very good to excellent health compared with 70% of their non–burned-out colleagues.
The most recent CDC statistics report that less than half (48%) of all adults meet the age-appropriate 2008 Physical Activity Guidelines.[14,15] A 2013 study in JAMA Internal Medicine found that healthcare workers are better at some behaviors than their patients, notably in exercising within the previous 30 days. Our report supported this conclusion, with 68% of non–burned out physicians and 56% of burned-out physicians reporting exercising at least twice a week. Twelve percent of physicians who were not burned out and 17% of those who were avoided exercise altogether, which was a higher rate for both groups than that reported in 2013 (5% of non–burned-out and 7% of burned-out physicians, respectively).
According to the most recent CDC report, the prevalence of obesity in 2011-2012 was about 35%, a rate that has remained relatively unchanged since 2003. The 2013 JAMA Internal Medicine study of lifestyle behaviors in healthcare workers showed little differences in rates of overweight or obesity between the healthcare professionals studied and their patients. Physicians who reported their body mass index (BMI) in the Medscape survey do better than the general public, but a significant number are overweight or obese. Among the burned-out group, 46% confessed to being overweight to obese (36% and 10%, respectively) compared with 39% of those who were not burned out (33% overweight, 6% obese). These numbers have not budged since the 2013 report.
The latest statistics from the CDC on US alcohol consumption reported a prevalence of previous-year drinking of 70.5% and a prevalence of past-month excessive drinking of 29.7%. Medscape responders have very light to moderate drinking habits, and no difference was seen between those who are burned out and those who are not. Just under a third of all physician responders said they didn't drink at all, and about half claimed having less than one drink per day.
A 2014 Gallup poll reported that 38% of Americans have tried marijuana, an increase of only 5% since 1985. Only 7% say that they are currently using it. Physicians report a slightly lower rate of marijuana history, with just under a quarter reporting ever having tried it. Three percent say they've used marijuana in the past year, which is a lower percentage than that found in the Gallup poll in the general population. As with drinking, burned-out and non–burned out physicians do not report different rates of marijuana use.
Physician responses to questions about use of alcohol and marijuana suggest that higher levels of alcohol consumption are associated with a greater tendency to use marijuana. Of those who have more than two alcoholic drinks per day, 45% claim to have ever used marijuana, and the less physicians drink, the less likely they are to have used marijuana; only 12% of those who don't drink at all claim to have ever used marijuana.
According to the 2014 Gallup poll, the youngest and oldest age groups had the lowest percentages of reported marijuana use (36% and 17%, respectively). Just about half (49%) of Americans ages 30-49 years and slightly less than half (44%) of those 50-64 have used it. Among physicians in our survey, the highest usage (32%) is among the baby boomers, ages 56-65. It drops considerably in the next two younger age groups, with 21% of those 46-55 and only 17% of those 36-45 reporting use. That number rises again among the youngest physicians (under 35) to 25%.
In this survey, emergency medicine physicians report the highest history of marijuana use (31%) followed by plastic surgeons, orthopedists, and psychiatrists at 29%. The least likely to have ever used marijuana are nephrologists (15%), endocrinologists (16%), and rheumatologists (17%). Marijuana use among specialties does not appear to be related to reported burnout.
A 2014 Gallup poll reported that over half (51%) of Americans support legalization, with the largest number of supporters in the East and the West. In a Medscape survey conducted earlier last year on marijuana, about 70% of physicians believed that it had real medical benefits, although only 1% had ever personally used marijuana for medicinal purposes. Among physicians who responded to this survey, 59% of those who have ever used marijuana support total legalization, and 20% support it only for medicinal purposes. Even among physicians who have never used marijuana, 51% support some form of legalization (23% total and 28% medicinal).
Burnout appears to have some association with physicians' view of their assets—or lack of them. In the current report, 39% of burned-out physicians consider themselves to have minimal savings to unmanageable debt, compared with 28% of their less stressed peers. Only 56% of burned-out physicians believe that they have adequate savings or more, compared with 66% of their less stressed peers. These findings are essentially unchanged from the 2013 report.
According to a 2014 Gallup Poll, 30% of Americans say that religion is largely out of date, a trend that has increased steadily since the 1950s, when only 7% held this view. In our Medscape poll, instead of asking for specific religious affiliations, we wanted to know whether physicians have a spiritual belief, regardless of active participation. There were no differences in responses from the burned-out and non–burned-out groups, but physicians on the whole are less religious/spiritual than the general population. When asked whether they have any religious or spiritual belief, about three quarters of all physicians reported that they do (77% of non–burned-out physicians and 75% of those burned out). About a quarter had no belief system, which tied in with the Gallup poll results. Some studies have reported that spirituality may be protective against burnout,[23-25] but the Medscape survey found no association.
When physicians who claimed to have a religious or spiritual belief were asked whether they actively attend services, a slight difference emerged between the non–burned-out and burned-out groups, with 62% of the non–burned-out believers attending services compared with 57% of their burned-out peers. There were no differences in the responses to this question between this year's report and the one published in 2013.
Instead of asking Medscape physicians whether they are Democrat, Republican, or Independent, the survey focused on whether members considered themselves liberal or conservative in fiscal and social areas. Without clear definitions of these terms, the responses are very subjective; the aim was to get a sense of political biases rather than voting habits. Fifty-seven percent of physicians claim to be socially liberal, and about two thirds are fiscally conservative, regardless of burnout status. Political views have not changed in the 2 years since the previous report. Of interest, a 2007 study of medical students found them much more likely to be liberal than conservative and also more liberal than other young American adults.
Slightly less than half (45%) of physicians who are living with partners are burned out, while just over half (53%) of those without partners experience burnout. When looking at specific living status, the highest rates of burnout (57%) were among those who were never married and living alone. Those who were widowed had the lowest burnout rates (37%), followed by physicians who were in a first marriage (45%) or remarried (44%).
Regarding burnout and citizenship status, burnout rates are lowest in physicians who came to the United States as adults, with 38% saying they are burned out vs 48% of those who were born in the US and 47% who have been here since childhood. This survey does not explain the discrepancy, although one physician offers a sobering thought. Commenting in a recent Medscape article on physician suicide, the writer said, "I am a doctor in Mosul, Iraq, actively practicing since 1977. What stress [is there] in the USA?"