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Anesthesiologist Lifestyles -- Linking to Burnout: A Medscape Survey

Carol Peckham Contributor Information

March 28, 2013

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The following slides present the major findings of the 2013 physician lifestyle survey, which focused on the links between work burnout and physicians' lives outside of practice.

Slide 1.

A national survey published in the Archives of Internal Medicine in 2012 reported that US physicians suffer more burnout than other American workers.[1] Some 45.8% of physicians were experiencing at least 1 symptom of burnout: loss of enthusiasm for work, feelings of cynicism, and a low sense of personal accomplishment. In Medscape's current survey, when anesthesiologists were given the same criteria, 42% responded that they were burned out and 58% said that they were not. They were tied for fourth place in burnout rate with internists, general surgeons, and ob/gyns. Pediatricians were among the least burned-out specialists, along with rheumatologists, psychiatrists, and pathologists.

Slide 2.

Burnout is serious. According to a 2013 study, job stress, coupled with inadequate treatment for mental illness, may account for the higher-than-average rate of suicide among US physicians.[2] In the Medscape survey, it was no surprise that physicians in specialties with the highest percentage of burned-out members generally reported greater severity in their own burnout. However, ranking 14th with a mean score of 3.8 (1 = does not interfere with my life; 7 = so severe that I am thinking of leaving medicine altogether) suggests that the severity of anesthesiologists' burnout is not particularly intense.

Slide 3.

Anesthesiologists were given a list of stressors and asked to rate how important they were as a cause of burnout on a scale of 1 to 7, where 1 = not at all important and 7 = extremely important. The top-rated stressors were "too many bureaucratic tasks" at 5.2, "the present and future impact of Affordable Care Act" at 5, and "spending too many hours at work" at 4.9. The least important stressors were compassion fatigue and computerization. It is clear that external stressors play the major role in physician burnout. In a Medscape Primary Care roundtable discussion, Roy Poses, MD, of Brown University said, "Most interventions meant to improve burnout have treated it like a psychiatric illness, not a rational response to a badly led, dysfunctional healthcare system."[3]

Slide 4.

A far higher percentage of female anesthesiologists reported burnout (56% vs 42% of men). Women may have more conflicts between work and home, particularly if they have children.

Slide 5.

The rate of burnout is lowest in the youngest and oldest anesthesiologists. The rate peaks in midlife, with 40% of burned-out anesthesiologists being 46-55 years of age. Then it drops to 28% between ages 56-65 and, significantly, to 6% after age 66, which is most likely due to retirement or cutting back on hours.

Slide 6.

It comes as no surprise that when asked to score their happiness at work from 1 (very unhappy) to 7 (very happy), burned-out anesthesiologists gave a very low score (3.5) compared with their more satisfied counterparts (5.4). They were much happier at home (5) than at work but still less so than their non-burned-out peers (5.8). In the Archives of Internal Medicine survey,[1] physicians were asked about work-life balance; those practicing preventive medicine, dermatology, and general pediatrics gave the highest satisfaction ratings, whereas those in general surgery and its subspecialties, as well as obstetrics/gynecology, reported the lowest rates.

Slide 7.

There was no difference at all between burned-out anesthesiologists and their less stressed peers in choosing favorite pastimes. Percentages were well matched for all choices, with the most popular pastime being spending time with family (about 87% of all anesthesiologists). Anesthesiologists next selected exercise (74% of burned-out anesthesiologists and 71% of less stressed peers), followed by travel (71% and 68%, respectively). Anesthesiologists in both groups tend to like reading (about 60%), cultural events (45%-48%), and food and wine (45%) more than outdoor sports like golf and hunting or fishing, which were the choices of 11% and 15%, respectively, of the burned-out physicians.

Slide 8.

With an average of 13 paid vacation days per year, Americans are far worse off than those in other developed countries (eg, Italy, 42; France, 37; Germany, 35; United Kingdom, 28; Canada, 26; Japan, 25). Unlike other physician groups, a great majority of anesthesiologists take more than 2 weeks of vacation, with somewhat fewer burned-out anesthesiologists reporting this than their less stressed colleagues (80% vs 88%).

Slide 9.

According to a 2009 survey from the US 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 regions.[4] Anesthesiologists, burned out or not, generally like the same types of vacations, with going to the beach being the favorite (59% of burned-out physicians vs 52% of less stressed colleagues). Over half of both groups also chose foreign travel (51% vs 54%, respectively). Overall, there was very little difference between the 2 anesthesiologist groups in regard to preferred types of vacations. The burned-out group had a slight preference for adventure (22%), camping (20%), and winter sports (21%) compared with the non-burned-out physicians (15%, 16%, and 19%, respectively), which could suggest a need to let off steam.

Slide 10.

As with pastimes and vacations, in the Medscape survey the proportions of burned-out and non-burned-out anesthesiologists were similar in regard to the types of volunteer work they did, although 31% of burned-out physicians and 28% of less stressed peers didn't volunteer at all. Pro-bono clinical work was preferred (19% of the burned-out group, 15% of the non-burned-out), with religious organizations next at 22% and 19%, respectively.

Slide 11.

Anesthesiologists were asked to rate their physical health on a scale of 1 to 7, where 1 = in poor health and 7 = extremely healthy. In general, anesthesiologists' scores were well above average, and those who were burned out were only slightly less confident about their health (5.4) than their non-burned-out colleagues (5.8).

Slide 12.

The most recent CDC statistics report that 26.2% of Americans exercise less than once a month -- essentially not at all. In the Medscape survey, 5% of non-burned-out anesthesiologists and 7% of the burned-out group confessed to not exercising at all. The CDC also reported that about 21% of US adults participated in enough aerobic and muscle-strengthening exercises to meet guidelines. Guidelines for muscle strengthening require exercising more than twice per week; for aerobic exercises it's at least 150 minutes per week.[5] Although well over half of all anesthesiologists who responded exercise at least twice a week, the percentage is lower among burned-out anesthesiologists (57%) vs their less stressed peers (66%). In addition, of the burned-out group, 35% exercise once a week at most compared with 28% of the less stressed group.

Slide 13.

According to a CDC report, 35.8% of US men and women were overweight in 2011 and 27.8% were obese. Only 34.5% were of normal weight and 1.8% were underweight.[6,7] Anesthesiologists who reported their BMI in the Medscape survey do better than their patients; among the non-burned-out group, 61% claimed to be of normal weight or underweight compared with 50% of their burned-out peers. However, weight is still a problem even among these professionals, and those who are burned out tend to weigh more: Nearly half reported being overweight or obese compared with 39% of their happier peers.

Slide 14.

Although the national quit rate has increased over the past few years, according to recent CDC data, 21% of Americans still smoke.[8] Smoking is not a problem among nearly all anesthesiologists, with only 3% of the burned-out group and 2% of the non-burned-out group being smokers.

Slide 15.

As reported in a 2010 Gallup poll, 67% of American adults drink alcohol, a rate that has been "remarkably stable" since this began being tracked in 1939.[9] In the most recent CDC report, 57.1% of US adults had at least 1 drink within the past month, 18.3% of adults are binge drinkers, and 6.6% confess to being heavy drinkers (adult men having more than 2 drinks per day and adult women having more than 1 drink per day).[10] Medscape anesthesiologist responders have very moderate drinking habits, and no difference at all was seen between those who are burned out and those who are not. Twenty-seven percent don't drink at all. Fifty-four percent of all anesthesiologists have fewer than 1 drink per day, and 19% have 1 or more drinks per day.

Slide 16.

Income seems to be a significant factor in how burned-out vs non-burned-out anesthesiologists view themselves, which might provide a clue for at least one cause of their stress. In response to this question, 60% of burned-out anesthesiologists consider themselves to have adequate savings for their age group and professional stage compared with 76% of their less stressed peers. There was a 16% difference between those who believe that they have minimal savings to unmanageable debt: 35% of burned-out anesthesiologists compared with 19% of their happier peers.

Slide 17.

According to a 2008 Pew Report, 88% of Americans believe in God or a universal spirit.[11] In our Medscape poll, instead of asking for specific religious affiliations, we wanted to know whether anesthesiologists have a spiritual belief, regardless of active participation. There is almost no difference in the spiritual leanings of the 2 groups of anesthesiologists, although the members of this specialty are less religious than the general population. When asked whether they have any religious or spiritual belief, about 70% said that they do. About 30% of all anesthesiologists have no belief system.

Slide 18.

When physicians who claimed to have a religious or spiritual belief were asked whether they actively attend services, there was also almost no difference in attendance between the burnout and non-burnout groups, with about 58% of believers attending services.

Slide 19.

Instead of asking Medscape anesthesiologists whether they are Democrat, Republican, or Independent, the survey question 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 objective was to get a sense of political biases rather than voting habits. There weren't great differences between the burned-out and non-burned-out groups, although burned-out physicians were slightly more fiscally conservative at 72% compared with 66% of their non-burned-out peers, and 37% declared social conservatism vs a third of their less stressed colleagues.

Slide 20.
According to Paul Griner, MD, author of The Power of Patient Stories: Learning Moments in Medicine, "If you are not spending relaxed time with your loved ones, having some fun outside of work, or enjoying interpersonal relationships, you are at a greater risk for burnout." Like all physicians, burned-out anesthesiologists have a high rate of marriage or life with a domestic partner (84%), which is only slightly lower than that for their less stressed peers (88%).
Slide 21.

In the Medscape survey, about a quarter of non-burned-out and 34% of burned-out anesthesiologists have 1 child at most. Over a third of anesthesiologists have 3 or more children, with a slightly lower association in burned-out anesthesiologists (30%) vs their non-burned-out peers (35%). There are more childless burned-out anesthesiologists (21% vs 15% of less stressed colleagues).

Slide 22.

According to a 2007 report from the Migration Policy Institute, 26.3% of physicians have come to the United States as adults.[12] In the Medscape survey, burnout rates are lower in anesthesiologists who came to the United States as adults (33% compared with 45% of those who were born here). This survey does not explain the discrepancy, but one could surmise that foreign-born physicians might have fewer expectations.

Slide 23.

This word cloud was created from the write-in responses to a question asking about important stressors. The word "patients" is most prominent, suggesting that this relationship is key in physician burnout. In dealing with this issue, Dr. Griner advises physicians to "participate actively in health reforms that will return a greater level of control to physicians and their patients. These include payment for value and greater patient participation in decision-making about care. Reorganizing primary care practices to allow more time for complex patients and recognition by insurers that excessive hassle is bad for patients and physician are also vital. These changes should lead to more satisfied patients and physicians and less burnout."

In the Archives article,[1] the authors sum up the very challenging problem of physician burnout: "Collectively, the findings...indicate that (1) the prevalence of burnout among US physicians is at an alarming level, (2) physicians in specialties at the front line of care access (emergency medicine, general internal medicine, and family medicine) are at greatest risk, (3) physicians work longer hours and have greater struggles with work-life integration than other US workers, and (4) after adjusting for hours worked per week, higher levels of education and professional degrees seem to reduce the risk for burnout in fields outside of medicine, whereas a degree in medicine (MD or DO) increases the risk. These results suggest that the experience of burnout among physicians does not simply mirror larger societal trends."

Slide 24.

Contributor Information

Author

Carol Peckham
Director of Editorial Development, Medscape

References

  1. Shanafelt TD, Boone S, Tan L, et al. Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Arch Intern Med. 2012;172:1377-1385. http://archinte.jamanetwork.com/article.aspx?articleid=1351351 Accessed February 7, 2013.
  2. Gold KJ, Sen A, Schwenk TL. Details on suicide among US physicians: data from the National Violent Death Reporting System. Gen Hosp Psychiatry. 2013;35:45-49. http://download.journals.elsevierhealth.com/pdfs/journals/0163-8343/PIIS016383431200268X.pdf Accessed February 8, 2013.
  3. Centor RM, Morrow RW, Poses RM, et al. Doc burnout -- worse than other workers'. Medscape Roundtable in Primary Care. November 13, 2012. //www.medscape.com/viewarticle/774013 Accessed February 20, 2013.
  4. US Travel Association. Travel facts and statistics. http://www.ustravel.org/news/press-kit/travel-facts-and-statistics Accessed February 8, 2012.
  5. CDC. Behavioral Risk Factor Surveillance System. Physical Activity - 2011. http://apps.nccd.cdc.gov/brfss/page.asp?yr=2011&state=All&cat=PA#PA Accessed February 20, 2013.
  6. CDC. Health, United States, 2010; with special feature on death and dying. US Department of Health and Human Services. National Center for Health Statistics. http://www.cdc.gov/nchs/data/hus/hus10.pdf#fig14 Accessed February 20, 2013.
  7. CDC. Behavioral Risk Factor Surveillance System. Overweight and Obesity (BMI) - 2011. Weight classification by Body Mass Index (BMI). http://apps.nccd.cdc.gov/brfss/list.asp?cat=OB&yr=2011&qkey=8261&state=All Accessed February 20, 2013.
  8. CDC. Behavioral Risk Factor Surveillance System. Prevalence and Trends Data. Tobacco Use - 2011. Adults who are current smokers. http://apps.nccd.cdc.gov/brfss/list.asp?cat=TU&yr=2011&qkey=8161&state=All Accessed February 20, 2013.
  9. Newport F. U.S. drinking rate edges up slightly to 25-year high. Gallup Wellbeing. July 30, 2010. http://www.gallup.com/poll/141656/drinking-rate-edges-slightly-year-high.aspx Accessed February 20, 2013.
  10. CDC. Behavioral Risk Factor Surveillance System. Prevalence and Trends Data. Alcohol Consumption - 2011. http://apps.nccd.cdc.gov/brfss/page.asp?yr=2011&state=All&cat=AC#AC Accessed February 20, 2013.
  11. Pew Forum on Religion & Public Life/U.S. Religious Landscape Survey. February 2008. http://religions.pewforum.org/pdf/report-religious-landscape-study-full.pdf Accessed February 13, 2013.
  12. Clearfield E, Batalova J. Foreign-born health-care workers in the United States. Migration Policy Institute. http://www.migrationinformation.org/USFocus/display.cfm?id=583#6 Accessed February 20, 2013.