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References

  1. Shanafelt TD, Hasan O, Dyrbye LN, et al. Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014. Mayo Clin Proc. 2015;90:1600-1613.
  2. Shanafelt TD, Boone S, Tan L, et al. Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Arch Intern Med. 2012;172:1377-1385. http://archinte.jamanetwork.com/article.aspx?articleid=1351351 Accessed December 5, 2015.
  3. Chapman EN, Kaatz A, Carnes M. Physicians and implicit bias: how doctors may unwittingly perpetuate health care disparities. J Gen Intern Med. 2013;28:1504-1510. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3797360 Accessed. December 14, 2014
  4. Penner LA, Dovidio JF, West TV, et al. Aversive racism and medical interactions with black patients: a field study. J Exp Soc Psychol. 2010;46:436-440.
  5. O'Reilly KB. Confronting bias against obese patients. American Medical News. September 2, 2013.
  6. Gudzune KA, Beach MC, Roter DL, Cooper LA. Physicians build less rapport with obese patients. Obesity (Silver Spring). 2013;21:2146-2152. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3694993/ Accessed December 5, 2015.
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  8. Hill KP. Medical marijuana for treatment of chronic pain and other medical and psychiatric problems: a clinical review. JAMA. 2015;313:2474-2483
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Contributor Information

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

Disclosure: Carol Peckham has disclosed no relevant financial relationships.

Caption Writer

Sarah Grisham
Freelance Writer
Albuquerque, New Mexico

Disclosure: Sarah Grisham has disclosed no relevant financial relationships.

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Medscape Oncology Lifestyle Report 2016: Bias and Burnout

Carol Peckham  |  January 13, 2016

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Slide 1

This year's Oncology Lifestyle Report covers two important aspects of a physician's personal life that could affect patient care: burnout and bias. Over 15,800 physicians responded from over 25 specialties, providing some surprising responses relating to these issues. The survey also repeated some of last year's questions on marijuana use and prescribing to determine whether there were any changes in responses, given its legitimacy in more states. (Note: Values in charts have been rounded and may not match sums described in the captions.)

Slide 2

This year's Medscape survey, echoing other recent national surveys,[1,2] strongly suggests that burnout among US physicians has reached a critical level. Burnout in these surveys is defined as loss of enthusiasm for work, feelings of cynicism, and a low sense of personal accomplishment. In this year's Medscape report, the highest percentages of burnout occurred in critical care, urology, and emergency medicine, all at 55%. Family medicine and internal medicine follow closely at 54%. Oncologists fall below the middle, at 46%. In last year's report, the highest percentages of burnout were in critical care (53%) and emergency medicine (52%). Of note, however, burnout rates for all specialties are higher this year than last, including among oncologists, who reported a burnout rate of 44% in the 2015 Lifestyle Report. A survey published in the Mayo Clinic Proceedings compared burnout between 2011 and 2014 and observed an increase in the percentage of physicians reporting at least one burnout symptom from 45.5% to 54.4%.[1]

Slide 3

Physicians were asked to rate the severity of their burnout on a scale of 1 to 7, where 1 equals "It does not interfere with my life," and 7 equals "It is so severe that I am thinking of leaving medicine altogether." Of the physicians reporting burnout, oncologists at 4.4 ranked second among all physicians on severity of burnout, the same level of severity seen in eight other specialties. Intensivists had the highest average severity rating, at 4.7. Physicians with the lowest burnout ratings were rheumatologists and psychiatrists (3.9). It should be noted, however, that just as the percentages of burnout have increased among all physicians compared with last year's Medscape Lifestyle Report, so have the severity ratings. Last year, oncologists had a severity rating of 4.1, which was still lower than this year's rating.

Slide 4

In this year's Medscape lifestyle survey, as in previous years, more female oncologists (58%) expressed burnout than their male peers (40%). Of note, these percentages have trended up in general for both male and female physicians since this question was first asked in Medscape's 2013 survey. Among oncologists, burnout has also increased slightly between 2013 and 2016 among both men (from 36% to 40%) and women (from 56% to 58%).

Slide 5

Oncologists were asked to rate causes of burnout on a scale of 1-7, where 1 equals "Does not contribute at all," and 7 equals "Significantly contributes." Top on the list with an average rating of 5.1 was having too many bureaucratic tasks, followed by too many work hours at 4.6 and increasing computerization (4.3). This year, the survey added the option "Maintenance of certification requirements," which was in fourth place at 4.2 as a cause of burnout. Among oncologists who commented anecdotally to the question on burnout causes, insurance issues were frequently cited.

Slide 6

In this year's Medscape survey, physicians were asked whether they believed that they had biases toward specific types or groups of patients. Overall, 40% of physicians admitted that they did. Within the top 10 of those who said that they did indeed perceive that they had some degree of bias were physicians who had the most direct contact with patients: emergency medicine physicians (62%), orthopedists (50%), and psychiatrists (48%), followed by family physicians and ob/gyns (47%). Two of the specialties least likely to report bias were those also least likely to be directly involved with patients: pathologists (10%) and radiologists (22%). However, only 27% of oncologists, who typically have direct contact with their patients, admitted bias. One limitation in this survey is the issue of implicit bias, which occurs without conscious awareness. It is frequently at odds with one's personal beliefs and can unwittingly perpetuate disparities.[3] In one study, black patients tended to react less positively to physicians with relatively low explicit but relatively high implicit bias than to physicians who were either (1) low in both explicit and implicit bias, or (2) high in both explicit and implicit bias.[4] One physician who responded to this survey commented, "[W]hile my subconscious attitudes and perceptions may be affected, I check these at the door and do my best to be empathic no matter what."

Slide 7

When oncologists who admitted biases were asked to characterize them, 60% of them picked emotional problems in their patients as the patient factor most likely to trigger bias. Weight, which is often cited in other studies as a concerning physician bias,[5] came in second at 45%. The two other common biases were intelligence (41%) and language differences (29%). When asked to add other patient characteristics that evoke bias, oncologists cited lack of compliance and refusing vaccinations.

Slide 8

Although 27% of oncologists admitted bias (see slide 6), only 4% said that it affected their treatment, which tied with intensivists and cardiologists. Our survey asked physicians two questions on such effects. The first was whether the effects were positive (ie, if their biases resulted in overcompensation and special treatment, such as extra time or a friendlier manner). The second was whether a biased attitude negatively affected treatment (eg, less time, less friendly). Responders could answer yes to both questions. Among all of the physicians who said that bias affected treatment, one quarter believed that their biases resulted in overcompensation and special treatment, whereas 29% admitted that they had only a negative effect on treatment. Twenty-four percent believed that their biases could have both effects, and another 22% suggested that neither choice was applicable. Also among all physicians who said that bias affected treatment, 72% and 61% reported that emotional problems and weight, respectively, had a negative effect on treatment. Weight bias has specifically been observed in a number of studies to elicit negative attitudes, including lack of emotional rapport with obese patients.[6,7]

Slide 9

When looking at bias by age group, the older an oncologist becomes, the lower the likelihood of admitting to bias. Forty percent of the youngest oncologists (35 or under) responded that they had biases, which declined to 15% in the oldest group (66 and over).

Slide 10

If one aspect of burnout is depersonalization, then one would expect there to be a relationship with bias. In this survey, oncologists who reported burnout were slightly more likely to also report bias. Thirty percent of oncologists who expressed burnout reported biases, whereas one quarter of non-burned-out oncologists said they had biases.

Slide 11

In this survey, there was little relationship between spiritual belief and bias. Twenty-eight percent of oncologists who said that they were either spiritual or religious admitted to bias, and one quarter of those without a belief expressed biases.

Slide 12

Oncologists who defined themselves as fiscally conservative/socially liberal had a slightly higher bias (37%) than those in the other political groups. One can draw no conclusions regarding oncologists' political leanings relative to bias.

Slide 13

Among nearly all specialists, the survey suggests that the longer one resides in the United States, the more biased one becomes. However, among oncologists, there was virtually no difference. Twenty-seven percent of oncologists who came to the United States as adults, 26% of those who have lived here since childhood, and 28% of those born in this country admitted to biases.

Slide 14

This year's lifestyle survey, as in previous ones, asked whether physicians were happy at home and ranked specialties by those who reported that they were very or extremely happy outside of work. Nephrologists and dermatologists were the happiest (68% and 66%) at home this year. At 51%, oncologists are second from the bottom and, as is the case with other physician specialties, are less happy this year compared with 2014 (59%). Of note, a major recent survey of US physicians reported a decrease in satisfaction of work/life balance between 2011 and 2014 from 48.5% to 40.9%.[1]

Slide 15

At 29%, oncologists ranked slightly below the middle in happiness at work (either very or extremely happy at work), and far less content than they were in 2014 (41%). Of all physicians who said that they were happy at work, dermatologists and ophthalmologists were the most content (39% and 38%, respectively). Dermatologists and ophthalmologists were also the happiest at work in the 2014 Medscape survey, but, as with oncologists, the percentages then were much higher (53% and 46%, respectively).

Slide 16

Male and female oncologists report about the same happiness levels at home (51% and 52%, respectively), but a higher percentage of men (33%) than women (20%) are happy at work. It is interesting to note that, as reported in slide 4, far more female oncologists (58%) expressed burnout than their male peers (40%), which is reflected here when ranking happiness levels.

Slide 17

At 63%, oncologists are toward the top of specialists who exercise twice a week or more, tied with four other specialists. The least active are psychiatrists (43%) and endocrinologists (50%). The most active physicians (those who exercise at least twice a week) are dermatologists (72%), orthopedists (69%), and ophthalmologists (68%). It is perhaps not a coincidence that dermatologists and ophthalmologists are also the happiest physicians at work.

Slide 18

When looking at physicians who reported that they were overweight to obese, oncologists, at 41%, ranked slightly lower than average. The physician specialties most likely to report excess weight are pulmonologists (51%), family physicians (49%), and emergency medicine physicians (47%). Of interest, dermatologists and ophthalmologists reported the lowest levels of overweight (23% and 28%, respectively), and they also had the highest happiness and exercise percentages.

Slide 19

This is the second year that Medscape has included questions on marijuana use. More older oncologists admit to having used marijuana (23% of those over 66) than their younger peers, with only 11% of those 35 and under ever having used.

Slide 20

Given the increase in the number of states where marijuana has been legalized for medical use, we asked physicians in our survey whether they are now prescribing it. At this time, the evidence on marijuana's medical benefits is sparse.[8] However, one of the proven benefits is to increase appetite in cancer patients, so it is of little surprise that 28% of oncologists have prescribed it-the highest percentage among all specialists.

Slide 21

Like most physicians, male oncologists fare slightly better than their female peers in their savings and debt, according to the Medscape survey. Sixty-five percent of male vs 58% of female oncologists have adequate savings or more and no debt. Thirty-eight percent of female and 32% of male oncologists report minimal savings, unmanageable debt, or both.

Slide 22

In a 2015 Medscape survey on debt and net worth, 61% of physicians responded that they live within their means and have little debt, and 24% even live below their means. Nevertheless, in this survey, only 49% of male oncologists and 45% of their female peers believe that their income and assets are sufficient to meet their needs. More men (42%) than women (32%) say that their assets aren't enough right now, but they expect them to improve; only 9% of male and 23% of female oncologists have no hope that they will ever be sufficient.

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