Medscape Radiologist Lifestyle Report 2015

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, just under 40% responded that they were burned out. This year that number went up: 46% reported burnout. Radiologists, at 49%, ranked seventh from the top among the other specialists. 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.

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 radiologists 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"). Radiologists reported a severity score of 4.09, about in the middle of all specialties. 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.

Bureaucracy and loss of autonomy and control are known causes of stress.^[6-10] This report provides more evidence of the importance of these factors among radiologists, with bureaucratic tasks rated as the most frequent cause of burnout with a score of 4.28, based on a scale of 1 ("not at all important") to 7 ("extremely important"). The impact of the Affordable Care Act (4.04) was second in importance as a cause of radiologist burnout. Of interest, among physicians in general, the ACA has fallen in importance as a cause of burnout, from third in 2013 to fifth this year.

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 radiologists (54%) reported burnout than males (47%), which was lower for women and higher for men than what was reported in 2013 (62% and 35%, respectively). 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]

Radiologists in the youngest group (under 36) report a burnout rate of 40%. It peaks in mid-life, with 58% of radiologists between ages 46 and 55 reporting burnout. It then declines to 50% between ages 56 and 65. The burnout rate is lowest in the oldest radiologists (30%).

When asked about favorite pastimes, burned-out radiologists and their less stressed peers tended to like the same ones to the same degree, although there were some slight differences. More than three quarters of radiologists wanted to spend time with family (77% of those burned out and 79% of those not burned out). About two thirds of all radiologists like exercise and travel. Both burned-out and non–burned-out radiologists far preferred the more sedentary pastimes (reading, cultural events, and food and wine) to the outdoor sports (golf and hunting/fishing).

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] Radiologists fare better than other Americans and many other physicians in terms of vacation time, but burnout may affect the amount of time they take. Seventy-seven percent of burned-out radiologists take more than 2 weeks per year, compared with 87% of their non–burned-out peers.

Volunteer activity associated with religious organizations and school pulled in the largest number of responses, and there was little difference between burned-out and non–burned-out radiologists. The most frequent response to the question about volunteer activity was "I never volunteer." There was essentially no difference between the groups: 37% of the burned-out group and 38% of the non–burned-out group do not volunteer.

Physicians who have a healthy lifestyle are more likely to preach what they practice compared with the general public.^[13] In our report, radiologists 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 58% of burned-out radiologists reporting very good to excellent health compared with 70% of their non–burned-out colleagues.

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, although burnout seems to be related to exercise, with 70% of non–burned-out radiologists and 61% of burned-out radiologists reporting exercising at least twice a week. Nine percent of radiologists who were not burned out and 17% of those who were avoided exercise altogether, which was a higher rate for both groups than what was reported in 2013 (4% of non–burned-out and 6% of burned-out radiologists, respectively).

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. Radiologists 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, 37% confessed to being overweight to obese (32% and 5%, respectively) compared with 31% of those who were not burned out (28% overweight, 3% obese). These numbers have not budged much since the 2013 report.

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 radiologist responders have very light to moderate drinking habits, and little difference was seen between those who are burned out and those who are not. About a quarter said they didn't drink at all (27% of burned-out radiologists and 24% of their non–burned-out peers), and about half (49%) of all radiologists claimed to have less than one drink per day.

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. Radiologists report a slightly lower rate of marijuana history, with 29% of burned-out and 25% of non–burned-out radiologists reporting ever having tried it. Two percent of burned-out and 3% of non–burned-out radiologists 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. Burnout does not seem to be associated with marijuana usage.

Radiologist 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 beverages per day, 54% claim to have ever used marijuana. And the less radiologists drink, the less likely they are to have used marijuana; only 14% of those who don't drink at all claim to have ever used marijuana.

According to the 2014 Gallup poll, the youngest and oldest age groups had the lowest percentages of reported marijuana history (36% and 17%, respectively).^[19] Just about half (49%) of Americans 30-49 years of age and slightly less than half (44%) of those aged 50-64 have used it. Among radiologists in our survey, the highest usage rate (33%) is among the baby boomers, ages 56-65. It drops in the next two younger age groups, with 28% of those 46-55 and 19% of those 36-45 reporting use. That number rises again among the youngest radiologists (under 36) to 30%.

Twenty-seven percent of all radiologists report having used marijuana at some point in their history, sixth from the top among other specialists. In this survey, emergency medicine physicians report the highest history of marijuana use (31%), followed by plastic surgeons, orthopedists, and psychiatrists (all at 29%). The specialists 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.

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 radiologists who have ever used marijuana, 64% support total legalization and 20% support it only for medicinal purposes. Even among radiologists who have never used marijuana, 60% support some form of legalization (31% total and 29%, medicinal).

Burnout appears to have some association with radiologists' view of their assets—or lack of them. In the current report, 29% of burned-out radiologists consider themselves to have minimal savings to unmanageable debt, compared with 23% of their less stressed peers. Sixty-five percent of burned-out radiologists believe that they have adequate savings or more, compared with 70% of their less stressed peers, which are lower rates in both groups than those reported in 2013 (70% and 78%, respectively).

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 radiologists have a spiritual belief, regardless of active participation. There were no differences in responses from the burned-out and non–burned-out groups. When asked whether they have any religious or spiritual belief, 71% of both groups reported that they do and 29% reported no belief system, which tied in with the Gallup poll results. Some studies have reported that spirituality may be protective against burnout,^[23-25] but the Medscape survey found no association.

When radiologists who claimed to have a religious or spiritual belief were asked whether they actively attend services, no differences emerged between the non–burned-out (58%) and burned-out (57%) groups. There were also no differences in the responses to this question between this year's report and the one published in 2013.

Instead of asking Medscape radiologists 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. Sixty percent of radiologists who are burned out and 62% of non–burned-out radiologists claim to be socially liberal, and 78% of burned-out radiologists and 75% of those who are not claim to be fiscally conservative. 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]

Among radiologists living with a partner, 47% report being burned out compared with a 60% burnout rate in those who are without partners. Although not reflected in this graph, 86% of radiologists were currently either married or living with a partner.

Regarding burnout and citizenship status, burnout rates are lowest in radiologists who came to the United States as adults, with 32% saying they are burned out vs 52% of those who were born in the US and 49% of those who have been here since childhood. This survey does not explain why radiologists born and raised outside of the US are less likely to report burnout, 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]