Gastroenterologist Lifestyles -- Linking to Burnout: A 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 gastroenterologists were given the same criteria, the response was not as discouraging: 37% responded that they were burned out and 63% said that they were not. The 2 specialties with the highest percentage of burnout were those that dealt with severely ill patients: emergency medicine and critical care. Others at the top of the list are generalists: family physicians, internists, and general surgeons. Gastroenterologists were among the least burned-out specialists, ranking toward the bottom of the list. Surprisingly, pediatricians were also among the least burned-out specialists, along with rheumatologists, 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. Gastroenterologists had the distinction of citing some of the least severe burnout, with a mean score of 3.6 (1 = does not interfere with my life; 7 = so severe that I am thinking of leaving medicine altogether).

Gastroenterologists 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" and "spending too many hours at work." 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 higher percentage of female gastroenterologists reported burnout (37% vs 32% of men), which is consistent with the general physician population. 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 gastroenterologists. It peaks early, with 33% of burned-out gastroenterologists between the ages of 36 and 45, and holds steady throughout most of their professional career, with 30% of burned-out gastroenterologists being 46-55. Between 56 and 65 it drops slightly, with only 23% reporting burnout. The burnout rate drops significantly to 5% after age 66, but this could be 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 gastroenterologists gave a very low score (3.6) compared with their more satisfied counterparts (5.4). They were much happier at home (4.9) than at work but less so than their non-burned-out peers (5.7). 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 hardly any difference between burned-out gastroenterologists and their less stressed peers in choosing favorite pastimes. Percentages were very similar for all choices, with the most popular pastime being spending time with family (87% of burned-out gastroenterologists and 88% of those who were less stressed). Travel was next (65%), followed by exercise (61%), for burned-out gastroenterologists; for those less stressed, the order was reversed, with exercise coming in next (71%) followed by travel (68%). Gastroenterologists tend to like reading (53%, burned out; 57%, not burned out), cultural events (48%, burned out; 47%, not burned out), and food and wine (36%, burned out; 47%, not burned out) more than outdoor sports such as golf (15%, burned out; 17%, not burned out) and hunting or fishing (11%, burned out; 8%, not burned out).

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 always fare much better than their American patients. About 39% of burned-out gastroenterologists take less than 2 weeks of vacation each year compared with 17% of their peers. And those who are burned out tend to do worse than their peers in terms of longer vacations: 60% of burned-out gastroenterologists take more than 2 weeks compared with 81% of their peers.

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] Gastroenterologists, burned out or not, like the same vacation types. Burned-out physicians like foreign travel but not as much as their less stressed colleagues do (55% vs 62%) and they have slightly less interest in beach vacations (47% vs 52%). There are very few differences between burned-out and non-burned-out gastroenterologists for all types of vacations. The main difference, of course, is that the burned-out group spends less time taking them.

As with pastimes and vacations, in the Medscape survey the proportions of gastroenterologists who were burned out and not burned out matched up closely in regard to the types of volunteer work they did. Just over 25% of both groups did pro-bono clinical work, almost 20% of their work was associated with religious organizations, and almost 10% volunteered in their children's schools. There was also not much of a difference between burned-out gastroenterologists and their less stressed peers in the percentage of those who didn't volunteer at all (37% vs 31%, respectively).

Gastroenterologists were asked to rate their physical health on a scale of 1 to 7, where 1 = in poor health and 7 = extremely healthy. To be expected, those who were burned out were slightly less confident about their health (5.1) 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, 5% of non-burned-out gastroenterologists and 9% 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 more than half of all gastroenterologists who responded exercise at least twice a week, the percentage is lower among burned-out gastroenterologists (42% vs 69% of their less stressed peers).Of note, 49% of the burned-out group exercised 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] Gastroenterologists who reported their BMI in the Medscape survey do mostly better than their patients. Among the non-burned-out group, 61% claimed to be of normal weight or underweight compared with 54% 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: 46% 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 gastroenterologists, both those who are burned out and those who are not, with only 2%-3% of them 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 gastroenterologist responders have very moderate drinking habits, and little difference was seen between those who are burned out and those who are not. Among all gastroenterologists, 33% don't drink at all. About 50% of all gastroenterologists have fewer than 1 drink per day, and 15% of those who report burnout and 18% of those who are more content have 1 or more drinks per day.

Income seems to be a significant factor in how burned-out vs non-burned-out gastroenterologists view themselves. In response to this question, 52% of burned-out gastroenterologists consider themselves to have adequate savings for their age group and professional stage compared with 69% of their less stressed peers -- a difference of 17%. There was a 20% difference between those who believe that they have minimal savings to unmanageable debt: 41% of burned-out gastroenterologists compared with 21% of their 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 gastroenterologists have a spiritual belief, regardless of active participation. There was no great difference in responses among the burned-out and non-burned-out groups, but gastroenterologists are less religious than the general population. When asked whether they have any religious or spiritual belief, 77% of burned-out gastroenterologists and 75% of those not burned out said that they do.

When physicians who claimed to have a religious or spiritual belief were asked whether they actively attend services, a slight difference emerged between the burned-out and non-burned-out groups, with 49% of the burned-out believers attending services compared with 56% of their peers, a difference of 7%.

Instead of asking Medscape gastroenterologists if 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 more fiscally conservative at 74% compared with 62% of their non-burned-out peers, and 48% declared social liberalism vs 56% 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 gastroenterologists have a high rate of marriage or life with a domestic partner (81%), but this is lower than the percentage for their less stressed peers (90%).

In the Medscape survey, 27% of burned-out gastroenterologists have 1 child at most, compared with 25% of their non-burned-out peers, and 36% of all gastroenterologists 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, burnout rates are lowest in gastroenterologists who came to the United States as adults: 32% compared with 37% of those who were born here and 43% of those who came here as children. This survey does not explain the discrepancy, but one could surmise that adult foreign-born physicians 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."