Radiologist 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 Family 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 radiologists were given the same criteria, 36% reported burnout, which was low on the list -- sixth from the least burned-out specialty (pathology). The 2 specialties with the highest percentage of burnout were emergency medicine and critical care -- those that deal with severely ill patients. Family medicine was third, and tied for fourth place at 42% were internists, ob/gyns, anesthesiologists, and general surgeons.

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, physicians in specialties with the highest percentage of burnout generally also reported greater severity in their own burnout. However, although most radiologists did not report burnout, those who did were tied with several specialties for third place in severity, with a score of 3.9 (1 = does not interfere with my life; 7 = so severe that I am thinking of leaving medicine altogether).

Radiologists were given a list of stressors and were 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. Topping the list were factors that suggested an excessive workload and loss of control over the profession: "too many bureaucratic tasks" and "spending too many hours at work." The impact of the Affordable Care Act was third in importance. 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]

Like most other specialties, women radiologists are far more burned out than men (62% vs 35%). Higher burnout rates in women are usually due to more conflicts between work and family life.

The rate of burnout is lowest in the youngest and oldest radiologists. It peaks between ages 46 and 55, with 35% of burned-out radiologists in this age group. Burnout rates drop to 28% in those between ages 56 and 65 and decrease significantly to 10% after age 66, which is a higher rate than in other specialties.

It comes as no surprise that when asked to score their happiness at work from 1 (very unhappy) to 7 (very happy), burned-out radiologists gave a much lower score (3.4) compared with their more satisfied counterparts (5.4). Radiologists were happier at home (4.9) than at work but less so than their non-burned-out peers (5.8). In the Archives of Family 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 radiologists on the high end.

There was not much variation between burned-out radiologists and their less stressed peers in choosing favorite pastimes. The most popular pastime was spending time with family (90% of burned-out radiologists and 84% of those who were less stressed). Exercise was next, chosen by 73% of the burned-out radiologists and 68% of their less stressed peers. This was followed in both groups by travel and reading, favored fairly equally by both groups.

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). Twenty-two percent of burned-out radiologists take 2 weeks of vacation at most each year compared with 10% of their peers. And 78% of burned-out radiologists take 2 or more weeks compared with 87% of their happier peers. Although burned-out radiologists take fewer days than their less stressed peers, in general this specialty has more vacation time than other physician groups.

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] Radiologists, burned out or not, like the same vacations but not all to the same degree. The most popular among the burned-out group is beach vacations (55% compared with 50% of their less stressed peers). Foreign travel is the first choice among non-burned-out radiologists (58% vs 48% of the burnout group). There were some differences between the 2 groups for other vacation types as well. For example, non-burned-out radiologists like road trips and cruises more than their burned-out colleagues do, whereas burned-out radiologists prefer adventure and camping vacations, perhaps to let off steam.

As with pastimes and vacations, in the Medscape survey the proportions of radiologists who were burned out and not burned out matched fairly closely in regard to the types of volunteer work they did. Some discrepancy was seen between burned-out radiologists and their less stressed peers in regard to who didn't volunteer at all (38% vs 33%, respectively). Both groups listed religious organizations and pro-bono clinical work as their 2 preferred volunteer jobs.

Radiologists 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, radiologists rated their health status fairly high, but, to be expected, those who were burned out were less confident about their health (5.3) than their non-burned-out colleagues (5.7).

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 burned-out radiologists and 6% of the less stressed 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] The percentage of radiologists who exercise at least twice a week is lower among burned-out radiologists (59% vs 67% of their less stressed peers). In addition, 37% of burned-out radiologists exercise only once a week at most compared with 27% 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] Radiologists who reported their BMI in the Medscape survey do better than their patients; among the non-burned-out group, 58% claimed to be of normal weight or underweight compared with 61% of their burned-out peers. However, weight is still a problem even among these professionals, and those who are burned out tend to weigh slightly 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 radiologists, with only 1% of non-burned-out and 2% of burned-out radiologists being current smokers. Twenty percent of the non-burnout group and 16% of the burnout group once smoked but have quit.

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 radiologist responders, burned out or not, have very moderate drinking habits. About 22% of all radiologists don't drink at all, about 54% have fewer than 1 drink per day, and approximately a quarter have at least 1 drink per day.

Income seems to be a factor in how burned-out vs non-burned-out radiologists view themselves. In response to this question, 70% of burned-out radiologists consider themselves to have at least adequate savings for their age group and professional stage compared with 78% of their less stressed peers. Perhaps more significant is the 13% difference between those who believe that they have minimal savings to unmanageable debt: 26% of burned-out radiologists compared with only 13% of their happier peers. Of interest, 9% chose the option "prefer not to say," which is the highest rate for this response among all physician groups surveyed.

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 radiologists have a spiritual belief, regardless of active participation. There was only a slight difference in responses in the burnout and non-burnout groups, but both groups of radiologists are less religious than the general population. When asked whether they have any religious or spiritual belief, 66% of burned-out and 68% of non-burned-out radiologists professed that they do.

When physicians who claimed to have a religious or spiritual belief were asked whether they actively attend services, no real difference emerged between the burned-out and non-burned-out groups, with 57% of the burned-out believers and 55% of their less stressed peers attending services.

Instead of asking Medscape radiologists 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 83% compared with 75% of their non-burned-out peers, and 36% declared social conservatism vs 35% 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 physician groups, both burned-out and non-burned-out radiologists have a high rate of marriage or life with a domestic partner (about 86%).

In the Medscape survey, 31% of burned-out radiologists have 1 child at most, compared with 25% of their non-burned-out peers. About a third of both groups have 3 or more children.

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, 37% of those born in the United States said that they were burned out, compared with a third of those who came here as children and 27% of those who came here as adults small.)

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 Family 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."