Psychiatrist 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 psychiatrists were given the same criteria, the response was less discouraging, with 33% reporting burnout. This puts psychiatry, along with pathology, pediatrics, and rheumatology, among the least burned-out specialties. The 2 specialties with the highest percentage of burnout were those that dealt with severely ill patients -- emergency medicine and critical care -- while family physicians, internists, and general surgeons were also at the top of the list.

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. Psychiatrists were among those reporting the least severe burnout, reporting an average severity score of 3.6 (1 = burnout that does not interfere with my life and 7 = so severe that I am thinking of leaving medicine altogether).

The surveyed psychiatrists 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 "Inability to provide patients with the quality care that they need." The least important stressors were "Difficult colleagues and staff" and "Difficult employer." It is clear that external stressors play a 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 psychiatrists reported burnout (> 60% vs 30% of male psychiatrists), 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 psychiatrists. Reported burnout peaks in midlife and holds steady throughout most of their professional career, with 33% of psychiatrists between the ages of 46 and 55 reporting burnout and 31% of those ages 56-65 reporting burnout. The burnout rate drops significantly to 10% 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 psychiatrists gave a lower score (3.5) compared with their more satisfied counterparts (5.4), results that mirrored overall physician findings. Outside of work, burned-out psychiatrists appear slightly less happy, scoring 4.9 vs 5.7 of their happier peers. Non-burned-out physicians in both the psychiatrist and total samples scored their work happiness a 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.

Burned-out psychiatrists reported pastimes similar to those of their less stressed peers. The most popular activities were spending time with family (86% of burned-out psychiatrists and 85% of those who were less stressed) and exercise (69% of burned-out psychiatrists and 68% of non-burned-out psychiatrists). Next on the list were travel, reading, cultural events, and food and wine. Despite the similarities, non-burned-out respondents were significantly more likely to report reading as a favorite pastime.

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 41% of burned-out psychiatrists take only 2 weeks of vacation, if not less, each year compared with 25% of their happier peers. And only 58% of burned-out psychiatrists take 2 or more weeks compared with 72% 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] Psychiatrists report liking the same vacation types, burned out or not, but there was one noteworthy difference: Burned-out psychiatrists were 8% less likely to take foreign vacations.

As with pastimes and vacations, in the Medscape survey the proportions of psychiatrists who were burned out and not burned out matched up closely in regard to the types of volunteer work they did. However, slightly more non-burned-out psychiatrists reported providing pro-bono clinical work (23% vs 20%) and participating in organized religious activities (21% vs 17%). A third of burned-out respondents reported never volunteering, compared with 26% of their less stressed peers.

Psychiatrists were asked to rate their physical health on a scale of 1 to 7, where 1 = in poor health and 7 = extremely healthy. Psychiatrist figures exactly matched the average for the entire pool of polled clinicians, with non-burned-out respondents considerably more confident about their health than those who were burned out (5.7 vs 5.1).

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, 6% of non-burned-out psychiatrists and 8% 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 psychiatrists responded that they exercise at least twice a week, the percentage is considerably lower among the burned-out population (54% vs 67%).

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] Psychiatrists 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 47% 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: 52% 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 psychiatrists, with only 4% and 2% of burned-out and non-burned-out respondents, respectively, reporting actively smoking. Over 70% of both groups have never smoked. Of some interest, the psychiatrist smoking rate seems to be higher than in the general population, where 81% of all physicians never smoked.

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 psychiatrist responders have very moderate drinking habits, and little difference was seen between those who are burned out and those who are not. About 30% of both groups report not drinking at all while around half of all respondents claim having fewer than 1 drink per day, numbers similar to the average of all physician respondents.

Income seems to be a significant factor in how burned-out vs non-non-burned-out psychiatrists view themselves. In response to this question, 50% of burned-out psychiatrists consider themselves to have adequate savings or more for their age group and professional stage compared with 66% of their less stressed peers. There was a 15% difference between those who believe that they have minimal savings to unmanageable debt: 44% of burned-out respondents compared with 29% 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 psychiatrists have a spiritual belief, regardless of active participation. There was only a slight difference in responses between the burned-out and non-burned-out groups, with around 70% of both groups reportedly being spiritual. However, psychiatrists are less spiritual than the general physician population, in which 74% of burned-out and 76% of non-burned-out doctors reported being spiritual.

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 50% of the burned-out believers attending services compared with 54% of their peers.

Instead of asking Medscape psychiatrists 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. Response rates were similar overall between groups, but 5% more of the burned-out psychiatrists reported being fiscally conservative.

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." Although marriage rates are high among all psychiatrists, those who are burned out are 8% less likely to be married or living with a domestic partner. And compared with the overall physician sample, both burned-out and non-burned-out psychiatrists have higher divorce rates: 10% and 7% vs 7% and 5%, respectively.

In the Medscape survey, 26% of burned-out psychiatrists have no children, compared with just 17% of their non-burned-out peers. About 28% of non-burned-out psychiatrists have 3 or more children compared with 25% of those feeling stressed, a number considerably lower than that for the overall physician population (35% of non-burned-out respondents and 30% of those reporting burnout).

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 psychiatrists who came to the United States as adults: 25% compared with 36% of those who were born here and 33% 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."