Neurologist 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 neurologists were given the same criteria, the response was slightly more encouraging: 41% responded that they were burned out, tying them with urologists for eighth place on the list of most burned-out specialists. The 2 specialties with the highest percentage of burnout were those that dealt with severely ill patients -- emergency medicine and critical care -- while generalists rounded out the top of the list: family physicians, internists, and general surgeons. 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. Neurologists ranked 10th in terms of burnout severity, with a mean severity score of 3.8 (1 = does not interfere with my life; 7 = so severe that I am thinking of leaving medicine altogether).

Neurologists 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," "spending too many hours at work," and "income not high enough." The least important stressors were "difficult colleagues, staff, or employers." 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 neurologists reported burnout (56%) vs their male colleagues (40%), 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 neurologists. It peaks in midlife and holds steady throughout most of their professional career, with 31% of burned-out neurologists being within the ages of 46 and 55 and 26% between 56 and 65. The burnout rate drops significantly to 6% 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 neurologists gave a very low score (3.7) compared with their more satisfied counterparts (5.3). These scores were similar to those reported by the general population. They were much happier at home (5) than at work but less so than their non-burned-out peers (5.6). 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. These ratings generally correlated with the severity ratings in the Medscape survey.

There was very little difference between burned-out neurologists and their less stressed peers in choosing favorite pastimes. Percentages were nearly identical for all choices, with the most popular pastime being spending time with family (85% of burned-out neurologists and 86% of those who were less stressed). Physical activity was next (67% and 70%), followed by travel (both 67%). Other popular hobbies included attending cultural events and institutions (eg, museums, theater), reading, food and wine, and music. Neurologists not reporting burnout were slightly (~3%) more likely to exercise and take advantage of cultural resources and happenings.

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 44% of burned-out neurologists take only 2 weeks of vacation, if not less, each year compared with only 24% of their happier peers. And only 54% of burned-out neurologists take 2 or more weeks compared with 74% 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] Neurologists, burned out or not, like the same vacation types, including beach vacations, foreign travel, and road trips. However, burned-out neurologists were less likely to take foreign vacations (53% vs 61%).

As with pastimes and vacations, in the Medscape survey the proportions of neurologists who were burned out and not burned out matched up closely in regard to the types of volunteer work they did. However, the unstressed respondents were more likely to provide pro-bono clinical work (26% vs 21%), participate in organized religious events (23% vs 20%), and assist in international clinical work (7% vs 4%). Thirty-three percent of burned-out neurologists reported never volunteering compared with just 26% of those not reporting burnout.

Neurologists were asked to rate their physical health on a scale of 1 to 7, where 1 = in poor health and 7 = extremely healthy. Neurologist ratings matched those of the overall physician sample: 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, 5% of non-burned-out neurologists 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] Although more than half of all neurologists who responded exercise at least twice a week, the percentage is lower among burned-out neurologists (56% vs 64% of their less stressed peers). In addition, 38% of the burned-out group exercised once a week at most compared with 31% 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] Neurologists who reported their BMI in the Medscape survey do better than their patients; among the non-burned-out group, 61% claimed to be of normal weight or underweight compared with 57% 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: 42% 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 neurologists, both those who are burned out and those who are not, with only 1% 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 neurologist responders have very moderate drinking habits, and little difference was seen between those who are burned out and those who are not. Twenty-eight percent of burned-out neurologists don't drink at all compared with 34% of less stressed colleagues. Some 59% of burned-out neurologists and 54% of those not reporting burnout have fewer than 1 drink per day, while 4% of the burned-out sample have 2 or more drinks per day vs only 1% of the non-stressed group.

Income seems to be a significant factor in how burned-out vs non-burned-out neurologists view themselves. In response to this question, 54% of burned-out neurologists consider themselves to have adequate savings for their age group and professional stage compared with 58% of their less stressed peers. Forty percent of burned-out neurologists compared with 36% of their peers claim to have minimal savings to unmanageable debt.

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 neurologists have a spiritual belief, regardless of active participation. There was no difference in responses in the burnout and non-burnout groups, but neurologists are generally less religious than the general population, with 72% of both burned-out and non-burned-out respondents reporting religious or spiritual belief; 28% reported having no belief system.

Nearly 60% of burned-out and non-burned-out neurologists who reported having a spiritual belief actively attend religious services. These findings are similar to those in the overall physician sample.

Instead of asking Medscape neurologists 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 slightly more fiscally conservative at 70% compared with 65% of their non-burned-out peers. Fifty-eight percent of non-burned-out neurologists report being socially liberal vs 55% of their more stressed peers.

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 neurologists have a high rate of marriage or life with a domestic partner, although burned-out neurologists are 4% less likely to be in their first marriage (68% vs 72%).

In the Medscape survey, 23% of burned-out neurologists have no children compared with 21% of the non-stressed sample; these numbers are higher than those reported in the overall physician population, in which 21% of burned-out respondents and just 15% of non-burned out respondents reported having no children. Near-equal proportions of the burned-out and non-burned-out neurologists report having either 1 child (~14%) or 2 children (~38%). These numbers are similar for the overall physician sample.

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 neurologists who came to the United States as adults -- 32% compared with 46% of those who were born here and 34% of those who came here 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."