Dermatologist Lifestyles -- Linking to Burnout: Medscape Survey

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 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 dermatologists were given the same criteria, 36% responded that they were burned out, which, tied with radiologists, was among the lowest percentages of physicians surveyed.

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 13th with a mean score of 3.8 suggests that the severity of dermatologists' burnout is not particularly intense (1 = does not interfere with my life; 7 = so severe that I am thinking of leaving medicine altogether.)

Dermatologists 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 5.5, "the present and future impact of Affordable Care Act" at 4.8, and "spending too many hours at work" at 4.5. The least important stressors were "compassion fatigue" and "difficult employer." 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]

A far higher percentage of female dermatologists reported burnout (61% vs 34% of men). Women may have more conflicts between work and home, particularly if they have children.

The rate of burnout is lowest in the youngest and oldest dermatologists. Of those who reported burnout, the highest percentages, which are only about 27%, held steady throughout most of their career (ages 36-66) and then dropped to 11% 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 dermatologists gave a very low score (3.7) compared with their more satisfied counterparts (5.6). They were much happier at home (5) than at work but still less so than their non-burned-out peers (5.9). 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.

There was no difference at all between burned-out dermatologists 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 (87% of all dermatologists). Both groups next selected exercise (about 74%), followed by travel (71%). Dermatologists in both groups tend to like reading (about 64%) and cultural events (57%) more than the outdoor sports, golf and hunting or fishing, which were the choices of 7% and 6%, respectively, of the burned out dermatologists and 12% and 7% of those who were not burned out. The only noticeable difference between the groups was in the enjoyment of food and wine, which was preferred by the less stressed group at 51% over their burned-out peers (43%).

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 majority of dermatologists take more than 2 weeks of vacation, with slightly fewer burned out dermatologists reporting this than their less stressed colleagues (69% vs 73%), respectively).

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] Dermatologists, burned out or not, generally like the same types of vacations, with foreign travel being the big winner at around 55% in both groups. Going to the beach followed at about 40%. Overall, there was very little difference between the 2 dermatologist groups in regard to preferred types of vacations, although the burned-out group spends slightly less time experiencing them.

As with pastimes and vacations, in the Medscape survey the rate of volunteering among dermatologists was high, particularly in those who felt less stress; only 13% of this group and a quarter of the burned-out group never volunteered. The preferred work in both groups was pro-bono local clinical work (about 39% each), followed by working for religious organizations (20% of the burned-out and 26% of the non-burned-out dermatologists). The non-burned-out group had higher participation rates for all of the other jobs listed except volunteering in their children's schools, although the difference here was very small.

Dermatologists 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, dermatologists' scores were well above average, although those who were burned out were less confident about their health (5.5) than their non-burned-out colleagues (6.1).

The most recent CDC statistics report that 26.2% of Americans exercise less than once a month -- essentially not at all. Dermatologists do far better. In the Medscape survey, 4% of non-burned-out dermatologists and 6% 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] Nearly three quarters (72%) of the non-burned-out group responded that they exercise at least twice a week; that percentage is far lower among burned-out dermatologists (57%). In addition, 37% of the burned-out dermatologists exercise only once a week at most compared with 24% 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] Dermatologists 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 66% 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: About a third reported being overweight or obese compared with 24% 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 dermatologists, with only 1% of the burned-out group and none of the non-burned-out group currently being smokers.

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 dermatologist responders have very moderate drinking habits, with little difference between those who are burned out and those who are not. A third of the no-burnout group and 29% of the burnout group do not drink at all. About 54% of all dermatologists claim to have fewer than 1 drink per day, with 18% of burned-out physicians and 13% of their less stressed colleagues having 1 or more drinks per day.

Income seems to be a significant factor in how burned-out vs non-burned-out dermatologists view themselves, which might provide a clue for at least one cause of their stress. In response to this question, 65% of burned-out dermatologists consider themselves to have adequate savings for their age group and professional stage compared with 79% of their less stressed peers. There was a 14% difference between those who believe that they have minimal savings to unmanageable debt: 29% of burned-out dermatologists compared with 15% 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 dermatologists have a spiritual belief, regardless of active participation. There is almost no difference in the spiritual leanings of the 2 groups of dermatologists, although the members of this specialty are less religious than the general population. When asked whether they have any religious or spiritual belief, about three quarters of both groups said that they do, with the rest having no belief system.

When physicians who claimed to have a religious or spiritual belief were asked whether they actively attend services, there was a notable difference in attendance between the burned-out and non-burned-out groups, with 54% and 67% of the groups, respectively, saying that they attend.

Instead of asking Medscape dermatologists 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 a third 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 dermatologists have a high rate of marriage or life with a domestic partner (77%), but it is still lower than that of their less stressed peers (83%). Ten percent of both groups are single and living alone.

In the Medscape survey, of interest, 32% of both burned-out and non-burned-out dermatologists have 1 child at most, and, coincidentally, the same percentage of both have 3 or more children.

p>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 dermatologists who came to the United States as adults (23% compared with 35% of those who were born here and 49% of those who came to the United States as children). This survey does not explain the discrepancy, but one could surmise that foreign-born physicians who came here as adults might have fewer expectations.

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."