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Medscape Internist Lifestyle Report 2015

Carol Peckham

January 26, 2015

Slide 1.

Compared with other American workers, US physicians suffer more burnout, according to a national survey.[1] Burnout is defined as loss of enthusiasm for work, feelings of cynicism, and a low sense of personal accomplishment. In Medscape's Physician Lifestyle Report 2013, 43% of internists responded that they were burned out. This year that number went up: 50% reported burnout. An editorial published in the Journal of General Internal Medicine reported burnout rates ranging from 30% to 65% across specialties, with the highest rates of burnout incurred by physicians at the front line of care, such as emergency medicine and primary care physicians.[2] The 2015 Medscape survey results reflect this same pattern, with the highest burnout rates found in critical care (53%) and emergency medicine (52%), and with half of all family physicians, internists, and general surgeons reporting burnout.

Slide 2.

Burnout has been shown to negatively affect patient care,[3] and many of the factors that lead to burnout are also associated with a higher likelihood of physicians leaving their practice.[2] Rates of suicide are higher in physicians than in the general population,[4] with studies indicating that job stress is a factor.[5] Medscape asked burned-out internists to rate the severity of their burnout from 1 ("does not interfere with my life") to 7 ("so severe that I'm thinking of leaving medicine"). Internists gave their burnout a score of 4.18, which was tied with ob/gyns at sixth place in severity. Of interest, the three specialties reporting the highest severity ratings—nephrology (4.30), cardiology (4.29), and plastic surgery (4.28)—were not those with the largest percentage of burned-out physicians.

Slide 3.

Bureaucracy and loss of autonomy are known causes of stress.[6,7] This report provides more evidence of the importance of these factors, with bureaucratic tasks and spending too many hours at work rated as the most frequent causes of internist burnout, with scores of 4.96 and 4.29, respectively, based on a scale of 1 ("not at all important") to 7 ("extremely important"). In fact, being able to control work hours is increasingly found to play an important role in reducing stress and, therefore, burnout among physicians.[7-9] This year, insufficient income (4.04) and feeling like just a cog in a wheel (3.86) were also found to be important causes of internist burnout. One study found that PCPs with the highest number of electronic medical record functions also experienced the highest amount of stress.[10]

Slide 4.

National surveys have reported a burnout rate of 60% in female physicians, which is higher than that of their male peers.[2] The Medscape report supports these findings. More female internists (55%) reported burnout than males (47%). Female and male internists had higher burnout rates this year than they reported in the 2013 survey (50% of women and 39% of men). Of interest, the findings for family physicians were opposite, with lower burnout rates this year for both men and women. Some studies suggest that burnout in men may differ from that in women; in men it tends to be characterized by depersonalization, whereas women describe emotional exhaustion.[11]

Slide 5.

More than half of internists under the age of 55 report burnout, which differs from most other physicians, who report far less burnout in the youngest group. This is a startling change from the 2013 survey, where burnout was reported by only 15% of internists in that younger age group and peaked at 30% of internists between the ages of 36 and 55. Even family physicians report a lower burnout percentage (43%) in those under 35. As with other physicians, burnout declines with age, to only 19% in internists 66 and over.

Slide 6.

When asked about favorite pastimes, burned-out internists and their less stressed peers tended to like the same ones to the same degree. Percentages were nearly identical for all, with about three quarters of internists in both groups preferring to spend time with family. However, this was a lower percentage than those who chose this pastime in 2013 (88% of burned-out internists and 84% of their non–burned-out peers). About two thirds of all internists like travel and exercise. Both non–burned-out and burned-out internists far preferred reading and cultural events to outdoor sports such as golf and hunting or fishing.

Slide 8.

Although studies suggest that taking time off reduces stress, the United States is one of only 13 countries in the world that do not mandate vacation time. Approximately one fourth of US workers do not have paid time off; about half are in the bottom fourth of earners vs a much smaller 10% of those in the top quarter.[12] Even US internists don't fare very well in terms of vacation time, although over half (55%) of burned-out internists take more than 2 weeks each year, which is still a lower percentage than their non–burned-out peers (66%).

Slide 9.

Volunteer activity associated with religious organizations pulled in the largest number of responses, but non–burned-out internists did more of this work (20%) than burned-out peers (16%). The largest difference between the groups was seen in whether they volunteered at all: 33% of the non–burned-out group and 43% of the burned-out group never volunteer. These numbers have increased since the 2013 report, with 29% of non–burned-out and 36% of burned-out internists admitting to no volunteer work that year.

Slide 10.

Physicians who have a healthy lifestyle are more likely to preach what they practice compared with the general public.[13] In our report, internists were asked to rate their physical health on a scale from "poor" to "excellent." The great majority rated their own health as "good" to "very good/excellent." However, to be expected, those who were burned out were less confident about their health, with 51% of burned-out internists reporting very good to excellent health compared with 66% of their non–burned-out colleagues.

Slide 11.

The most recent CDC statistics report that less than half (48%) of all adults meet the age-appropriate 2008 Physical Activity Guidelines.[14,15] A 2013 study in JAMA Internal Medicine found that healthcare workers are better at some behaviors than their patients, notably in exercising within the previous 30 days.[16] Our report supported this conclusion, with 64% of non–burned-out internists and 53% of burned-out internists reporting exercising at least twice a week. On a discouraging note, 13% of internists who were not burned out and 19% of those who were avoided exercise altogether, which was a higher rate for both groups than that reported in 2013 (5% of non–burned-out and 6% of burned-out internists, respectively) and slightly higher than that reported by all physicians.

Slide 12.

According to the most recent CDC report, the prevalence of obesity in 2011-2012 was about 35%, a rate that has remained relatively unchanged since 2003.[17] The 2013 JAMA Internal Medicine study of lifestyle behaviors in healthcare workers[16] showed little differences in rates of overweight or obesity between the healthcare professionals studied and their patients. Physicians who reported their body mass index (BMI) in the Medscape survey do better than the general public, but a significant number are overweight or obese. Among the burned-out group, 47% confessed to being overweight to obese (36% and 11%, respectively) compared with 42% of those who were not burned out (35% overweight, 8% obese). These numbers have not budged much since the 2013 report.

Slide 13.

The latest statistics from the CDC on US alcohol consumption reported a prevalence of previous-year drinking of 70.5% and a prevalence of past-month excessive drinking of 29.7%.[18] Medscape responders have very light to moderate drinking habits, and no difference was seen between those who are burned out and those who are not. Forty percent of burned-out and 37% of non–burned-out internists said they didn't drink at all, and slightly under half (44% and 47%, respectively) claimed to have less than one drink per day.

Slide 14.

A 2014 Gallup poll[19] reported that 38% of Americans have tried marijuana, an increase of only 5% since 1985. Only 7% say that they are currently using it. Internists report a slightly lower rate of marijuana history, with about 20% of both burned-out and non–burned-out internists reporting ever having tried it. However, 3% of burned-out and 2% of non–burned-out internists say they've used marijuana in the past year, which is a lower percentage than that found in the Gallup poll in the general population and is in line with use reported by physicians overall in our survey. As with drinking, burned-out and non–burned-out internists do not report very different rates of marijuana use.

Slide 15.

Internist responses to questions about use of alcohol and marijuana suggest that higher levels of alcohol consumption are associated with a greater tendency to use marijuana. Of those who have more than two alcoholic drinks per day, 46% claim to have ever used marijuana, and the less internists drink, the less likely they are to have used marijuana; only 10% of those who don't drink at all claim to have ever used marijuana.

Slide 16.

According to the 2014 Gallup poll, the youngest and oldest age groups had the lowest percentages of reported marijuana use (36% and 17%, respectively).[19] Just about half (49%) of Americans ages 30-49 years and slightly less than half (44%) of those 50-64 have used it. Among internists in our survey, the highest usage (29%) is among the baby boomers, ages 56-65. It drops considerably in the next two younger age groups, with only 16% of those 46-55 and only 14% of those 36-45 reporting use. That number rises again among the youngest internists (under 35) to 23%.

Slide 17.

In this survey, internists, at 20%, are tied with dermatologists and family physicians and are ranked toward the low end of the list of physicians who report ever having used marijuana. Emergency medicine physicians report the highest history of marijuana use (31%) followed by plastic surgeons, orthopedists, and psychiatrists at 29%. The least likely to have ever used marijuana are nephrologists (15%), endocrinologists (16%), and rheumatologists (17%). Marijuana use among specialties does not appear to be related to reported burnout.

Slide 18.

A 2014 Gallup poll reported that over half (51%) of Americans support legalization, with the largest number of supporters in the East and the West.[20] In a Medscape survey conducted last year on marijuana, about 70% of physicians believed that it had real medical benefits, although only 1% had ever personally used marijuana for medicinal purposes.[21] Among internists who responded to this survey, 60% of those who have ever used marijuana support total legalization, and 21% support it only for medicinal purposes. Even among internists who have never used marijuana, 47% support some form of legalization (18% total and 29% medicinal).

Slide 19.

Burnout appears to have some association with internists' view of their assets—or lack of them. In the current report, 44% of burned-out internists consider themselves to have minimal savings to unmanageable debt, compared with about one third of their less stressed peers. And 49% of burned-out internists believe that they have adequate savings or more, compared with 60% of their less stressed peers. These percentages are lower than in the overall physician population, where over half (56%) of burned-out respondents and fully two thirds (66%) of non–burned-out physicians reported more comfortable financial status. (About 8% of physicians in both groups opted not to answer this question.) These findings are essentially unchanged from the 2013 report.

Slide 20.

According to a 2014 Gallup Poll, 30% of Americans say that religion is largely out of date, a trend that has increased steadily since the 1950s, when only 7% held this view.[22] In our Medscape poll, instead of asking for specific religious affiliations, we wanted to know whether internists have a spiritual belief, regardless of active participation. There were no differences in responses from the burned-out and non–burned-out groups, but internists on the whole are less religious/spiritual than the general population. When asked whether they have any religious or spiritual belief, about three quarters of all internists reported that they do, and a quarter had no belief system. Some studies have reported that spirituality may be protective against burnout,[23-25] but the Medscape survey found no association.

Slide 21.

When internists who claimed to have a religious or spiritual belief were asked whether they actively attend services, a slight difference emerged between the non–burned-out and burned-out groups, with 61% of the non–burned-out believers attending services compared with 56% of their burned-out peers. There were no differences in the responses to this question between this year's report and the one published in 2013.

Slide 22.

Instead of asking Medscape internists whether they are Democrat, Republican, or Independent, the survey 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 aim was to get a sense of political biases rather than voting habits. Over half of internists claim to be socially liberal, and 58% are fiscally conservative regardless of burnout status. Unlike most other physicians, fewer internists claim to be fiscal conservatives this year than in the 2013 report (70% of burned-out and 65% of non–burned-out internists). Of interest, a 2007 study of medical students found them much more likely to be liberal than conservative and also more liberal than other young American adults.[26]

Slide 23.

Slightly less than half (49%) of internists who are living with partners are burned out, while 54% of those without partners experience burnout. When looking at specific living status, the highest rates of burnout were among those who are separated or never married and living alone (60%). Those who were widowed had the lowest burnout rate (25%).

Slide 24.

Regarding burnout and citizenship status, burnout rates are lowest in internists who came to the United States as adults, with 46% saying they are burned out vs 52% of those who were born in the US and 51% who have been here since childhood. This survey does not explain the discrepancy, although one physician offers a sobering thought. Commenting in a recent Medscape article on physician suicide, the writer said, "I am a doctor in Mosul, Iraq, actively practicing since 1977. What stress [is there] in the USA?"[27]

Slide 25.

Contributor Information

Carol Peckham
Director, Editorial Services
Art Science Code LLC
New York, New York

Disclosure: Carol Peckham has disclosed no relevant financial relationships.


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