Infectious Diseases 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 infectious disease (ID)/HIV specialists were given the same criteria, the response was almost as discouraging: 40% responded that they were burned out. 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. ID/HIV specialists ranked 11th on the list. 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. Infectious disease specialists ranked 17th, ranking them in the middle of the pack, with a mean severity score of 3.7 (1 = does not interfere with my life; 7 = so severe that I am thinking of leaving medicine altogether).

ID/HIV specialists were given a list of stressors and asked to rate how important each was 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," "spending too many hours at work," and "income not high enough," while the least important stressors included variables such as the Affordable Care Act, computerization, difficult colleagues, or compassion fatigue. 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 ID/HIV specialists reported burnout (54% vs 36% 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 ID/HIV specialists. It peaks in midlife, with 39% of burned-out ID/HIV specialists being within the ages of 46 and 55. The burnout rate drops significantly, to only 3%, 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 ID/HIV specialists gave a very low score (3.4) compared with their more satisfied counterparts (5.3). This rate matched that of the general population. They were much happier at home (4.7) 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 were only a few differences between burned-out ID/HIV specialists and their less stressed peers in choosing favorite pastimes. Percentages were nearly identical for all choices, with the exception of exercise and musical activities. While almost three quarters of non-burned-out ID/HIV specialists like exercise, only 57% of their stressed peers do. On the other hand, 24% of burned-out physicians preferred musical activities compared with 15% of their less stressed peers. Other popular pastimes were spending time with family, travel, reading, and attending cultural events.

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. About 48% of burned-out ID/HIV specialists take only 2 weeks of vacation, if not less, each year compared with 27% of their happier peers. And only 54% of burned-out ID/HIV specialists take more than 2 weeks compared with 71% of their non-burned-out peers. Use that vacation!

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] ID/HIV specialists, burned out or not, like the same vacation types, with foreign travel topping the list for both. The burned-out physicians slightly preferred beach vacations compared with their less stressed colleagues (50% vs 38%). Other major differences were seen with spa vacations (preferred by 23% of burned-out physicians compared with 11% of their less stressed peers), vacation homes (19% vs 24%, respectively), camping/hiking (16%, 23%); and cruises (10%, 16%). The other big difference in vacations, 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 ID/HIV specialists who were burned out and not burned out matched up fairly closely in regard to the types of volunteer work they did. However, it was noted that only 18% of the burned-out physicians did pro-bono clinical work vs 28% of those less stressed. And while 24% of non-burned-out physicians worked with religious organizations, only 12% of their burned-out peers did. There was also a difference between burned-out ID/HIV specialists and their less stressed peers in the percentage of those who didn't volunteer at all (34% vs 26%, respectively).

Infectious disease specialists 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, these specialists were well above average, but, to be expected, those who were burned out were less confident about their health (5.2) 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, 3% of non-burned-out ID/HIV specialists and 4% 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 ID/HIV specialists who responded exercise at least twice a week, the percentage is lower among burned-out specialists (55% vs 66% of their less stressed peers).

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] ID/HIV specialists 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 56% of their burned-out 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 ID/HIV specialists, both those who are burned out and those who are not; only 1% of them are current 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 ID/HIV specialists have very moderate drinking habits, and little difference was seen between those who are burned out and those who are not. Twenty percent have at least 1 drink per day.

Income seems to be a significant factor in how burned-out vs non-burned-out ID/HIV specialists view themselves. In response to this question, 56% of burned-out ID/HIV specialists consider themselves to have adequate savings for their age group and professional stage compared with 72% of their less stressed peers -- a difference of 16%. There was also a substantial difference between those who believe that they have minimal or no savings and unmanageable debt: 41% of burned-out ID/HIV specialists feel this way, compared with 20% 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 ID/HIV specialists have a spiritual belief, regardless of active participation. There was a small difference in responses in the burnout and non-burnout groups. When asked whether they have any religious or spiritual belief, 65% of burned-out ID/HIV specialists and 73% 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 difference emerged between the burned-out and non-burned-out groups, with 45% of the burned-out believers attending services compared with 63% of their less-stressed peers, a difference of 18%, which is far greater than that reported by other physician groups.

Instead of asking Medscape ID/HIV specialists 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. ID/HIV specialists are among the most liberal physician groups, with 73% of the burned-out group and 70% of the less stressed physicians professing social liberalism, while 53% of burned-out and 56% of non-burned-out specialists described themselves as fiscal conservatives.

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." Burned-out ID/HIV specialists have a moderate rate of marriage or life with a domestic partner (72%); the percentage for their less stressed peers is substantially higher (87%).

Could kids guard against burnout? In the Medscape survey, 54% of burned-out ID/HIV specialists have 1 child at most, compared with 29% of their non-burned-out peers. When comparing groups with 2 or more children, 47% of the burned-out specialists had 2 or more children vs 70% of their less stressed peers.

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 ID/HIV specialists who came to the United States as adults (26%) compared with 43% of those who were born here and 59% 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."