Pediatrician 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 pediatricians were given the same criteria, the response was a little more encouraging. Although over a third of pediatricians -- 35% to be exact -- were burned out, that is one of the lowest percentages in all of the medical specialties surveyed, with only psychiatrists (33%) and pathologists (32%) reporting a lower burnout rate. 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. Pediatricians ranked 20th on the list, tied with rheumatologists and ophthalmologists.

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. Pediatricians reported less severe burnout than most of their colleagues, with a mean score of 3.6 (1 = burnout that does not interfere with my life; 7 = so severe that I am thinking of leaving medicine altogether). That score was the same as that reported by endocrinologists, gastroenterologists, oncologists, orthopedists, psychiatrists, and rheumatologists; only ophthalmologists reported a lower aggregate score.

Pediatricians 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 "too many hours at work." The least important stressor was "compassion fatigue," a reassuring indicator that pediatricians are unlikely to be burned out by the children for whom they provide care. 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 much higher percentage -- almost double -- of female pediatricians reported burnout (61% vs 32% 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 pediatricians. It peaks in midlife and holds steady throughout most of their professional career, with a third (33%) of burned-out pediatricians between the ages of 46 and 55 years reporting burnout. The percentage drops significantly to only 5% among those still practicing at 66 years of age and older, but this could be due to retirement, cutting back on hours, or leaving the profession.

It comes as no surprise that when asked to score their happiness at work from 1 (very unhappy) to 7 (very happy), burned-out pediatricians gave a low score (3.6) compared with their more satisfied counterparts (5.4). This rate for the burned-out population, however, was better than that of the general population. But they were also less likely to report that they were happy at home (5.1) vs 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. 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 on the high end.

There was no difference at all between burned-out pediatricians 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 (about 90%). Exercise/physical activity, travel, and reading were next with slight variances in percentages reported by those with and without burnout. Pediatricians tend to like cultural events and food and wine more than outdoor sports such as golf and hunting or fishing.

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. Over a third (34%) of burned-out pediatricians take only 2 weeks of vacation, if not less, each year compared with 25% of their happier peers. And only 65% of burned-out pediatricians take 2 or more weeks compared with 74% of their non-burned-out 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] Pediatricians like the same vacation types, burned out or not. The burned-out physicians slightly preferred beach vacations compared with their less stressed colleagues (56% vs 53%) and had slightly less interest in foreign travel (53% vs 56%). There were, however, very little differences between burned-out and non-burned-out pediatricians 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 pediatricians who were burned out and not burned out matched up fairly closely in regard to types of volunteer work in which they participated: 15% vs 17% performed pro-bono clinical work, 26% vs 28% volunteered with religious organizations, and 25% vs 22% volunteered in their children's schools. A somewhat higher percentage of burned-out pediatricians performed no volunteer work compared with their less stressed peers (26% vs 22%).

Pediatricians 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, pediatricians who were burned out were less confident about their health (5.20) than their non-burned-out colleagues (5.80).

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 pediatricians 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 pediatricians who responded exercise at least twice a week, the percentage is lower among burned-out pediatricians (55% vs 65% of their less stressed peers). In addition, 40% of the burned-out group exercised once a week at most compared with 32% 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] Pediatricians 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 54% 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: 46% reported being overweight or obese compared with 37% 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 pediatricians, 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 pediatrician responders have very moderate drinking habits, and little difference was seen between those who are burned out and those who are not. Twenty-nine percent of burned-out pediatricians don't drink at all compared with a third of less stressed pediatricians. Over half of all pediatricians (54% non-burned-out and 57% burned-out) have fewer than 1 drink per day, and about 13% 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 physicians view themselves. In response to this question, 57% of burned-out pediatricians consider themselves to have adequate savings for their age group and professional stage compared with 68% of their less stressed peers -- a difference of 11%. Among pediatricians, there was a 13% difference between those who believe that they have minimal savings to unmanageable debt: 39% of burned-out pediatricians compared with 26% 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 pediatricians have a spiritual belief, regardless of active participation. The great majority of pediatricians expressed having a belief, but there was a fairly large difference in responses between the burnout and non-burnout groups, with 77% of burned-out pediatricians responding positively compared with 83% of their less stressed peers.

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 59% of the burned-out believers attending services compared with 67% of their peers, a difference of 8%.

Instead of asking Medscape pediatricians 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 70% compared with 65% of their non-burned-out peers, and 35% declared social conservatism vs 33% 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 pediatricians have a high rate of marriage or life with a domestic partner (80%), but this is lower than the percentage for their less stressed peers (86%).

In the Medscape survey, 34% of burned-out pediatricians have 1 child at most, compared with 26% of their non-burned-out peers. Almost a third of all pediatricians have 3 or more children, with a slightly higher association in non-burned-out pediatricians (36%) than in their burned-out peers (29%).

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 pediatricians who came to the United States as adults -- 27% compared with 38% of those who were born here and 30% 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."