Pathologist 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 pathologists were given the same criteria, the response was not as discouraging: 32% responded that they were burned out -- the lowest rate reported by any specialty -- and 68% 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. Pathologists ranked 24th, on the list, other least burned-out specialists were rheumatologists, psychiatrists, and pediatricians.

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. Although they had the lowest rate of burnout overall, pathologists who reported being burned out had the dubious distinction of ranking second among specialists in severity of burnout, with a mean severity score of 4 (1 = does not interfere with my life; 7 = so severe that I am thinking of leaving medicine altogether). Only ob/gyns reported a higher severity of burnout (4.1).

Pathologists 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 "feeling like just a cog in the wheel." The least important stressors -- understandably -- were "too many difficult patients," "increasing computerization of practice," and "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 pathologists reported burnout (61% vs 38% 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 pathologists. It peaks in midlife and holds steady throughout most of their professional career, with 35% of burned-out pathologists between the ages of 46 and 55 and 32% between the ages of 56 and 65. The burnout rate drops significantly to 7% 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 pathologists gave a much lower score (3.4) compared with their more satisfied counterparts (5.5). They were much happier at home (5.0) 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. These ratings generally correlated with the severity ratings in the Medscape survey, with dermatologists and pediatricians rating themselves at the low end of the severity scale and surgeons and pathologists on the high end.

There was hardly any difference between burned-out pathologists 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 (85% of burned-out pathologists and 80% of those who were less stressed). Exercise and physical activity was next (66%), followed by travel (60%). Pathologists tend to like reading (67%), cultural events (49%), and food and wine (40%) more than outdoor sports such as golf (6%) and hunting or fishing (8%).

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 32% of burned-out pathologists take only 2 weeks of vacation, if not less, each year compared with 23% of their happier peers. And 66% of burned-out pathologists take 2 or more weeks compared with 72% of their less stressed colleagues.

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] Pathologists like the same vacation types. Foreign travel was the first choice, but burned-out pathologists had slightly less interest in it than their happier peers. Both groups listed beach vacations as their second choice (45%). Burned-out physicians had slightly more interest in hiking (21% vs 18%) and adventure vacations (15% vs 12%). There was, however, very little difference between burned-out and non-burned-out pathologists 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 pathologists who were burned out and not burned out matched up closely in regard to the types of volunteer work they did. About 22% of both groups did volunteer work for religious organizations. A larger number of burned-out pathologists did pro-bono clinical work (15%) than their happier colleagues (10%), and fewer volunteered at their children's schools (11% vs 15%). Of note, there was only a slight difference between burned-out pathologists and their less stressed peers in the percentage of those who didn't volunteer at all (35% vs 33%, respectively).

Pathologists 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, pathologists were well above average, at 5.3 for those who were burned out and 5.7 for those who were not.

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 pathologists and 7% 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 pathologists who responded exercise at least twice a week, the percentage is lower among burned-out pathologists (56% vs 63% of their less stressed peers). In addition, 44% of the burned-out group exercised less than once a week at most compared with 36% 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] Pathologists who reported their BMI in the Medscape survey do better than their patients; an equal number of non-burned-out and burned-out physicians, 60%, claimed to be of normal weight or underweight. However, weight is still a problem even among these professionals, and those who are burned out tend to weigh more: 39% 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 pathologists, both those who are burned out and those who are not, with only 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 pathologist responders have very moderate drinking habits, and little difference was seen between those who are burned out and those who are not. Thirty-three percent of burned-out pathologists don't drink at all compared with 30% of their less stressed peers. About 50% of all pathologists have fewer than 1 drink per day. But 19% of those who report burnout and 18% of those who are less stressed have 1 or more drinks per day.

Income and savings seem to be significant factors in how burned-out vs non-burned-out pathologists view themselves. In response to this question, 61% of burned-out pathologists consider themselves to have adequate savings for their age group and professional stage compared with 70% of their less stressed peers -- a difference of 9%. There was an 11% difference between those who believe that they have minimal or no savings and unmanageable debt: 35% of burned-out pathologists compared with 24% 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 pathologists have a spiritual belief, regardless of active participation. Responses from the burned-out and less stressed groups were similar, but pathologists generally are less religious than the general population. When asked whether they have any religious or spiritual belief, 68% of burned-out pathologists and 65% of those not burned out said that they do. About one third of all pathologists 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 55% of the burned-out believers attending services compared with 59% of their happier peers.

Instead of asking Medscape pathologists 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 (70% compared with 68% of their non-burned-out peers) and just about as socially conservative (30% compared with 29%).

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 pathologists have a high rate of marriage or life with a domestic partner (79%), but this is slightly lower than the percentage for their less stressed peers (85%).

In the Medscape survey, 46% of burned-out pathologists have 1 child at most, compared with 34% of their less stressed peers. Sixteen percent of burned-out pathologists have 3 or more children, compared with 27% of their happier colleagues.

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 pathologists who came to the United States as adults -- 24% compared with 35% of those who were born here and 32% 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."