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Intensivist Lifestyles -- Linking to Burnout: A Medscape Survey
Carol Peckham Contributor Information
March 28, 2013
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.
A national survey published in the Archives of Family 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 intensivists were given the same criteria, the response was more discouraging: half reported that they were burned out. In fact, the 2 specialties with the highest percentage of burnout were emergency medicine and critical care -- those that dealt with severely ill patients. Family medicine was third, and tied for fourth place at 42% were internists, ob/gyns, anesthesiologists, and general surgeons. Although generalists led the burnout pace, pediatricians surprisingly were among the least burned-out specialists, along with rheumatologists, ophthalmologists, psychiatrists, and pathologists.
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 also reported greater severity in their own burnout. Intensivists, in fact, ranked in third place, with a score of 3.9, matching physicians in family medicine, general surgery, internal medicine, radiology, and urology (1 = does not interfere with my life; 7 = so severe that I am thinking of leaving medicine altogether).
Intensivists were given a list of stressors and were 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." Topping the list with ratings of 5 or greater were factors that suggested an excessive workload and loss of control over the profession: "too many bureaucratic tasks and "spending too many hours at work." Of interest, however, unlike in most other specialties, compassion fatigue ranked as the third most important cause of burnout for intensivists. It was also listed among the top 3 of oncologists, which is not surprising considering that these specialists constantly deal with dying patients and their grieving loved ones. Critical care physicians also differed from other specialists by ranking the impact of the Affordable Care Act last in importance. 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]
Unlike most other specialties, where women are usually far more burned out than men, there was a nearly even split among intensivists. Perhaps intensivists have a more regular routine, such that conflicts between work and family life play a smaller role in creating stress vs in primary care and other specialties.
The rate of burnout is lowest in the youngest and oldest intensivists. It peaks between ages 36 and 45, with 37% of burned-out intensivists in this age group. Burnout rates drop to 29% in all intensivists between ages 46 and 55 and then decline further to 19% among those between 56 and 65 years, perhaps because of better coping mechanisms or higher income. The rate then decreases significantly to 3% after age 66, which is most likely due to retirement or cutting back on hours.
It comes as no surprise that when asked to score their happiness at work from 1 (very unhappy) to 7 (very happy), burned-out intensivists gave a much lower score (3.7) compared with their more satisfied counterparts (5.5). Intensivists were much happier at home (4.8) than at work but less so than their non-burned-out peers (5.7). In the Archives of Family 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. These ratings generally correlated with the severity ratings in the Medscape survey, with dermatologists and pediatricians rating themselves at the low end of the severity scale and surgeons and intensivists on the high end.
There was hardly any difference between burned-out intensivists and their less stressed peers in choosing favorite pastimes. Percentages were closely matched up for most choices, with the most popular pastime being spending time with family (87% of burned-out intensivists and 86% of those who were less stressed). Exercise was next, chosen by 69% of the burned-out intensivists and 66% of their less stressed peers. This was followed in both groups by travel and reading, although the burnout group was far less interested in reading (48%) than the non-burnout group (60%). This preference for reading was also lower among stressed intensivists than in most other specialties. None were particularly fond of golf (11%, burnout; 16%, no burnout) and hunting or fishing (3% and 8%, respectively).
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). US physicians don't fare much better than their American patients. And those who are burned out do worse than their peers. Less than half (41%) of burned-out intensivists take 2 weeks of vacation at most each year compared with 14% of their peers. And 58% of burned-out intensivists take 2 or more weeks compared with 86% of their happier peers.
As with pastimes and vacations, in the Medscape survey the proportions of intensivists who were burned out and not burned out matched fairly closely in regard to the types of volunteer work they did. The largest discrepancy between burned-out intensivists and their less stressed peers was seen in those who didn't volunteer at all (39% vs 30%, respectively). The non-burnout group chose international missions and foundations as their top 2 choices. Tied for first place among the burned-out intensivists were international work, children's schools, and religious organizations.
Intensivists 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, intensivists rated themselves well above the average physician, at 5.5, but, to be expected, those who were burned out were less confident about their health (5.3) than their non-burned-out colleagues (5.8).
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, 9% of all intensivists confessed to not exercising at all, which is a higher percentage than most other specialties reported. 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] The percentage of intensivists who exercise at least twice a week is lower among burned-out intensivists (50% vs 65% of their less stressed peers). In addition, 42% of the burned-out group exercised only once a week at most compared with 27% of the less stressed group.
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] Intensivists who reported their BMI in the Medscape survey do better than their patients; among the non-burned-out group, 62% claimed to be of normal weight or underweight compared with 47% 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: 53% reported being overweight or obese compared with 36% of their happier peers.
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 the great majority of intensivists, with only 2% of non-burned-out and 3% of burned-out intensivists being current smokers. About 17% of both groups once smoked but have quit.
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 intensivist responders have very moderate drinking habits. A quarter of burned-out intensivists and 29% of the less stressed group don't drink at all. About 55% of all intensivists have fewer than 1 drink per day, and 17% of non-burned-out and 20% of burned-out intensivists have 1 drink or more per day.
Income seems to be a significant factor in how burned-out vs non-burned-out intensivists view themselves. In response to this question, 56% of burned-out intensivists consider themselves to have at least adequate savings for their age group and professional stage compared with 72% of their less stressed peers. More significant is the 15% difference between those who believe that they have minimal savings to unmanageable debt: 38% of burned-out intensivists compared with 23% of their happier peers.
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 intensivists have a spiritual belief, regardless of active participation. There was a slight difference in responses in the burnout and non-burnout groups, but intensivists are generally less religious than the general population. When asked whether they have any religious or spiritual belief, 73% of burned-out and 67% of non-burned-out intensivists professed that they do.
When physicians who claimed to have a religious or spiritual belief were asked whether they actively attend services, a difference emerged between the burned-out and non-burned-out groups, with only 49% of the burned-out believers attending services compared with 63% of their less stressed peers.
Instead of asking Medscape intensivists 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 70% compared with 65% of their non-burned-out peers, and 35% declared social conservatism vs 33% of their less stressed colleagues.
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 intensivists have a high rate of marriage or life with a domestic partner (77%), but this is lower than the percentage for their less stressed peers (84%).
In the Medscape survey, 43% of burned-out intensivists have 1 child at most, compared with 34% of their non-burned-out peers. About 27% of both groups have 3 or more children.
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, of those born in the United States, 49% said that they were burned out, compared with 43% of those who came here as adults. (Almost three quarters of those who came to the United States as children responded that they were burned out. However, the number of these intensivists is very small.)
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 Family 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."
