Home Life and Burnout
It comes as no surprise that when asked to score their happiness at work from 1 (very unhappy) to 7 (very happy), burned-out physicians who responded to the Medscape survey gave a very low score (average of 3.5) compared with those who were not burned out (5.4). When asked about happiness at home, burned-out physicians gave a much higher rating (average of 5.5) but it was still lower than that of their non-burned-out peers (5.7). The happiest physicians at home were the non-burned-out nephrologists (5.9), dermatologists (5.9), orthopedists (5.8), emergency medicine physicians (5.8), and pediatricians (5.8). The 5 least happy at home were the burned-out HIV/ID physicians (4.7), intensivists (4.8), cardiologists (4.8), gastroenterologists (4.8), and psychiatrists (4.9). See Figure 4. There did not seem to be any correlation between a specialty's happiness status and its burnout severity ranking.
Figure 4. Physician rating of happiness at home (1 = very unhappy; 7 = very happy).
Although no strong evidence exists on whether home life is a major contributing cause of burnout, a recent study on surgeons found that those with conflicts between work and home were more likely to have burnout (36.9% vs 17.1%; P < .001). In the Archives of Internal Medicine survey on burnout, physicians were asked about work-life balance; those practicing preventive medicine, dermatology, and general pediatrics had the highest satisfaction ratings, whereas general surgery and its subspecialties and ob/gyns had the lowest. When looking at Medscape survey responses from these specialties, burned-out dermatologists and pediatricians rated themselves at the mid to lower end of the severity scale and also were among the happiest at home. Burned-out surgeons and ob/gyn respondents were on the higher end of the burnout severity score, but they were also in the top half of the "happiness at home" scores.
Marriage and Children
All physicians, burned out or not, who responded to the survey had a high rate of marriage or life with a domestic partner, but the rate for the burned-out group (82%) was slightly lower than that for their non-stressed peers (87%). This percentage proportion did not differ much among all specialties. There was also a slight association between having more children and a lower rate of burnout, with 35% of burned-out physicians having 1 child or no children compared with 27% of non-burned-out peers. A third of all physicians had 3 or more children (30% of burned-out physicians vs 35% of their less stressed colleagues). The idea that having children mitigates rather than increases the risk for burnout is supported by some studies.[25,26]
Pastimes, Vacations, and the Burnout Effect
According to a 2009 survey from the U.S. Travel Association, activities with the greatest interest among US adults are, in order of popularity, visiting friends and relatives, sightseeing, going to beaches, visiting museums, going to national or state parks, going on cruises, visiting theme parks, traveling to cities, and visiting mountain areas. Physicians' pastime and vacation interests didn't differ much from their patients'. Spending time with family was the favorite pastime of all physicians, and foreign travel and visiting beaches were their favorite vacations.
Favorite pastimes. Percentages were nearly identical for all pastimes listed in the survey, with spending time with family being the favorite (about 86% of all physicians, burned out or not) (Figure 5). Exercise was next, followed by travel; the no-burnout group favored travel a bit more than the stressed group (68% vs 64%). Physicians as a group tend to like reading (62%), cultural events (50%), and food and wine (44%) more than the outdoor sports golf (12%) and hunting or fishing (9%). There were some differences within specialties between the burnout and no-burnout groups, but general preferences were the same.
Figure 5. Physicians' favorite pastimes.
Favorite vacations. Physicians like the same vacations, with the most popular being foreign travel (53%) and beach vacations (51%). See Figure 6. Although burned-out and non-burned-out physicians matched up closely for all types of vacations, the burned-out group slightly preferred beach vacations (53% vs 49%) and had slightly less interest in foreign travel (50% vs 55%). There was also a slight preference by burned-out physicians for adventure vacations, winter sports, and camping and hiking, perhaps because of a greater need to burn off stress.
Figure 6. Physicians' favorite vacation spots.
Amount of vacation time. How much time physicians spent taking those vacations and enjoying their pastimes differed between those who were burned out and those who weren't. Nearly 40% of all burned-out physicians take 2 weeks or less of vacation a year compared with 25% of their less stressed peers. And only 17% of burned-out physicians take 4 or more weeks compared with 26% of their peers. Taking fewer vacation days in the burnout group was consistent across all specialties. There was very little difference between burned-out physicians and their nonstressed peers in their choices of favorite pastimes or vacations. The primary disparity was in the time they had to enjoy them.
Whether taking fewer vacation days produced the stress or the stress was caused by too much time at work cannot be determined from this survey. An interesting study covered by Medscape Medical News found that 1 hour of facilitated peer support every other week during working hours was more beneficial than taking that time off. Sessions were designed to identify and promote personal and professional satisfaction and foster a sense of community, exploring topics such as work-life balance, medical mistakes, and resiliency. The lead investigator observed that "a small amount of protected time during the workday did result in improved meaning from work and reduction in burnout. This was true in both arms of the study, but the effects were larger in the facilitated small group arm."