General Surgeon 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 general surgeons were given the same criteria, 42% responded that they were burned out. The 2 specialties with the highest percentage of burnout were those that deal with severely ill patients -- emergency medicine and critical care -- but generalists closely followed, with family physicians next and surgeons coming in fourth, tied with ob/gyns. Surprisingly, pediatricians were 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. Ob/gyn came in first with a severity score of 4.1, followed, surprisingly, by pathologists at 4. Six specialties, including general surgery, followed with severity scores of 3.9 (1 = does not interfere with my life; 7 = so severe that I am thinking of leaving medicine altogether).

General surgeons 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 5.4, "spending too many hours at work" at 4.7, and "the present and future impact of Affordable Care Act" at 4.6. The least important stressors were problems with employers, compassion fatigue, and difficult colleagues or staff. 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 slightly higher percentage of female general surgeons reported burnout (43% vs 39% of men), which is consistent with most specialties. 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 general surgeons. It peaks in midlife, with 35% of burned-out general surgeons being 46-55 years of age, and decreases to 26% of those between ages 56 and 65. The burnout rate drops to 11% of those after age 66, but this 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 general surgeons gave a very low score (3.5) compared with their more satisfied counterparts (5.4). They were much happier at home (5.1) than at work but still slightly 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 no difference at all between burned-out general surgeons and their less stressed peers in choosing favorite pastimes. Percentages were closely matched for all choices, with the most popular pastimes for all general surgeons being spending time with family (about 84%). Surgeons next selected exercise, with the burnout group slightly trailing their less stressed peers (67% vs 70%, respectively), followed by travel (68% vs 64%). General surgeons in both groups tend to like reading (60%), cultural events (44%), and food and wine (about 43%). These more passive pastimes are preferred over the outdoor sports golf (selected by 19% of the burned-out group vs 21% of the non-burned-out group) and hunting or fishing, chosen by about 15% of both groups.

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 general surgeons don't fare much better than their American patients. And those who are burned out do worse than their peers. About 44% of burned-out general surgeons take 2 weeks of vacation or less each year compared with 27% of their peers. And 53% of burned-out general surgeons take 2 or more weeks compared with 71% of their happier 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] General surgeons, burned out or not, generally like the same types of vacations, although more of the burned-out group chose beach vacations (54% vs 49%), while those in the no-burnout group favored foreign travel slightly more than their stressed peers (50% vs 46%). Overall, there was very little difference between the 2 general surgeon groups in regard to preferred 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 burned-out and non-burned-out general surgeons were similar in regard to the types of volunteer work they did, although a third of the burned-out surgeons chose pro bono clinical work compared with a quarter of their less stressed colleagues. About 17% of both groups worked with religious organizations. There was only a small difference in the percentage of those who didn't volunteer at all (29% of the burned-out group vs 26% of their more satisfied peers).

General surgeons 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, general surgeons' scores were well above average, with those who were burned out only slightly 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, 6% of non-burned-out general surgeons 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 well over half of all general surgeons who responded claim to exercise at least twice a week, the percentage is lower among burned-out general surgeons (55%) vs their less stressed peers (67%). In addition, 36% of the burned-out group exercise once a week at most compared with 28% of the non-burned-out 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] General surgeons who reported their BMI in the Medscape survey do better than their patients; among the non-burned-out group, 60% claimed to be of normal weight or underweight compared with 45% 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: Fifty-five percent reported being overweight or obese compared with 46% 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 much of a problem among nearly all general surgeons, with only 4% of the burned-out group and 3% of the non-burned-out group being smokers. About a quarter of all surgeons used to smoke 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 general surgeon responders have moderate drinking habits, and little difference was seen between those who are burned out and those who are not. A quarter of burned-out general surgeons and 21% of the non-burned-out group don't drink at all. Fifty-five percent of burned-out and 58% of less stressed general surgeons have fewer than 1 drink per day, and about 20% of both groups have 1 or more drinks per day.

Income seems to be a significant factor in how burned-out vs non-burned-out general surgeons view themselves. In response to this question, 57% of burned-out general surgeons consider their savings to be adequate and more for their age group and professional stage compared with 71% of their less stressed peers. There was a 13% difference between the 2 groups who believe that they have minimal savings to unmanageable debt: 39% of burned-out general surgeons compared with 26% 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 general surgeons have a spiritual belief, regardless of active participation. On the whole, general surgeons are less religious than the general population. When asked whether they have any religious or spiritual belief, three quarters of all general surgeons answered that they do and a quarter do not.

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 53% of the burned-out believers attending services compared with 61% of their peers, a difference of 8%.

Instead of asking Medscape general surgeons 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.

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 general surgeons have a high rate of marriage or life with a domestic partner (85%), which is about the same as their less stressed peers (87%)

In the Medscape survey, 30% of burned-out and 20% of non-burned-out general surgeons have 1 child at most. A high percentage of general surgeons have 3 or more children, with a lower association in burned-out general surgeons (37%) vs their non-burned-out peers (44%).

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 general surgeons who came to the United States as adults (36%) compared with about 42% of those who were either born here or came to the United States as children. This survey does not explain the discrepancy, but one could surmise that 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."