Ophthalmologist 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 ophthalmologists were given the same criteria, the response was not as discouraging: 35% responded that they were burned out and 65% 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. Ophthalmologists were among the least burned-out specialists, ranking near 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. However, ophthalmologists had the distinction of being the least burned out, with a mean severity score of 3.4 (1 = does not interfere with my life; 7 = so severe that I am thinking of leaving medicine altogether).

Ophthalmologists 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 "the present and future impact of Affordable Care Act." 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 ophthalmologists reported burnout (64% vs male ophthalmologists at 35%), 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 ophthalmologists. It peaks in midlife and holds steady throughout most of their professional career, with 34% of burned-out ophthalmologists being within the ages of 46 and 55 and 30% between 56 and 65. The burnout rate drops significantly to 11% 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 ophthalmologists gave a very low score (3.7) compared with their more satisfied counterparts (5.5). This rate matched that of the general population. They were much happier at home (5.1) than at work but less so than their non-burned-out peers (5.8). 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 ophthalmologists and their less stressed peers in choosing favorite pastimes. Percentages were nearly identical for all choices, with the most popular pastimes being spending time with family (89% of burned-out ophthalmologists and 87% of those who were less stressed). Exercise was next (76% for both the burned out and not burned out), followed by travel (70%, burned out; 68%, not burned out). Ophthalmologists tend to like reading (59%, burned out; 62%, not burned out), cultural events (49%, burned out; 50%, not burned out), and food and wine (47%, burned out; 44%, not burned out) more than outdoor sports such as golf (16% for both burned out and not burned out) and hunting or fishing (10%, burned out; 11%, 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 fare much better than their American patients. And those who are burned out tend to do worse than their peers. About 38% of burned-out ophthalmologists take less than 2 weeks of vacation each year compared with 23% of their happier peers. And 61% of burned-out ophthalmologists take more than 2 weeks compared with 76% 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] Ophthalmologists like the same vacation types, burned out or not. The burned-out physicians were slightly less likely to prefer beach vacations compared with their less stressed colleagues (50% vs 52%) and had slightly less interest in foreign travel (49% vs 55%). There were, however, very little differences between burned-out and non-burned-out ophthalmologists for all types of vacations. The main difference, of course, is that the burned out group tends to spend less time taking them.

As with pastimes and vacations, in the Medscape survey the proportions of ophthalmologists who were burned out and not burned out matched up fairly closely in regard to the types of volunteer work they did. About 40% of both groups did pro-bono clinical work; around 23% of their work was associated with religious organizations, and 12% volunteered in their children's schools. Of note, there was really no difference between burned-out ophthalmologists and their less stressed peers in the percentage of those who didn't volunteer at all (18% vs 19%, respectively).

Ophthalmologists 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 (5.40) than their non-burned-out colleagues (5.90).

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, 4% of non-burned-out ophthalmologists and 5% 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 ophthalmologists who responded exercise at least twice a week, the percentage is slightly lower among burned-out ophthalmologists (64% vs 69% of their less stressed peers). However, 31% of the burned-out group exercised once a week at most compared with 28% 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] Ophthalmologists 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 64% 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: 36% reported being overweight or obese compared with 32% 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 ophthalmologists, both those who are burned out and those who are not, with only 1%-2% 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 ophthalmologist responders have very moderate drinking habits, and little difference was seen between those who are burned out and those who are not: 25% of burned-out ophthalmologists don't drink at all compared with 26% of less stressed physicians. Over 50% of all ophthalmologists have fewer than 1 drink per day, whereas 19% of those who report burnout and 21% of those who do not have 1 or more drinks per day.

Income seems to be a significant factor in how burned-out vs non-burned-out ophthalmologists view themselves. In response to this question, 69% of burned-out ophthalmologists consider themselves to have adequate savings for their age group and professional stage compared with 75% of their less stressed peers -- a difference of 6%. There was a 9% difference between those who believe that they have minimal savings to unmanageable debt: 28% of burned-out ophthalmologists compared with 19% 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 ophthalmologists have a spiritual belief, regardless of active participation. There was no difference in responses in the burnout and non-burnout groups, but ophthalmologists are generally less religious than the general population. When asked whether they have any religious or spiritual belief, 77% of burned-out ophthalmologists and 78% of those not burned out said that they do. Slightly less than a quarter of all ophthalmologists had no belief system.

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 60% of the burned-out believers attending services compared with 65% of their peers, a difference of 5%.

Instead of asking Medscape ophthalmologists 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 83% compared with 81% of their non-burned-out peers, and 41% declared social conservatism vs 42% 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 ophthalmologists have a high rate of marriage or life with a domestic partner (85%); this is only slightly lower than the percentage for their less stressed peers (87%).

In the Medscape survey, 31% of burned-out ophthalmologists have 1 child at most, compared with 25% of their non-burned-out peers. More than 30% of ophthalmologists have 3 or more children, with a higher association in non-burned-out ophthalmologists (40%) than in their burned-out peers (31%).

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 slightly higher in ophthalmologists who came to the United States as adults -- 38% compared with 35% of those who were born here and 36% of those who came here as children. This differs from responses in other specialties, in which foreign-born physicians tend to be less burned out. This survey does not explain the discrepancy.

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 physicians 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."