This year's Obstetrics and Gynecology 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.)

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%. Ob/gyns fall above the middle, at 51%. 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 ob/gyns, who reported a slightly lower burnout rate of 49% 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]

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, ob/gyns, at 4.3, tied with four other specialties and were above the middle of all physicians for severity of burnout. 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, ob/gyns had a severity rating of 4.2, which was slightly lower than this year's rating, though higher in rank among all physicians.

In this year's Medscape lifestyle survey, as in previous years, more female ob/gyns (57%) expressed burnout than their male peers (43%). 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. This is true among ob/gyns, in whom burnout has increased between 2013 and 2016 in both men (from 38% to 43%) and women (from 52% to 57%).

Ob/gyns 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 4.7 was too many bureaucratic tasks, followed by increasing computerization (4.3) and too many work hours (4.2). This year, the survey added the option "Maintenance of certification requirements," which was in 10th place for ob/gyns at 3.2 as a cause of burnout. Among ob/gyns who commented anecdotally to the question on burnout causes, ICD-10 coding, meaningful use requirements, and lack of respect were frequently cited.

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%). Forty-seven percent of ob/gyns, 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."

When ob/gyns who admitted biases were asked to characterize them, 60% of them picked patient weight, which is often cited in other studies as a concerning physician bias,^[5] as the factor most likely to trigger bias. Patients' emotional problems came in second at 57%. The next two most common biases were intelligence (45%) and language differences (36%). When asked to add other patient characteristics that evoke bias, ob/gyns most frequently cited poor lifestyle choices, such as substance abuse and smoking, and patients with a sense of entitlement.

Although 47% of ob/gyns admitted bias (see slide 6), only 9% said that it affected their treatment, the same percentage as that reported by both pediatricians and internists. 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]

When looking at bias by age group, the older an ob/gyn becomes, the lower the likelihood of admitting to bias. More than one half (58%) of the youngest ob/gyns (35 or under) responded that they had biases, which declined to 31% in the oldest group (66 and over).

If one aspect of burnout is depersonalization, then one would expect there to be a relationship with bias. In this survey, ob/gyns who reported burnout were more likely to also report bias. Fifty-one percent of ob/gyns who expressed burnout reported biases, whereas fewer non–burned-out ob/gyns (41%) said they had biases.

In this survey, there appears to be some relationship between ob/gyns' spiritual belief and bias. Forty-five percent of ob/gyns who said that they were either spiritual or religious admitted to bias, and 51% of those without such beliefs expressed biases.

There seems to be a slight relationship between ob/gyn bias and political leaning. Ob/gyns who defined themselves as socially liberal, whether fiscally conservative or liberal, had a slightly higher bias (51% and 50%, respectively) than those who were socially conservative, whether also fiscally conservative (43%) or fiscally liberal (39%).

This survey suggests that the longer one resides in the United States, the more biased one becomes. Only 23% of ob/gyns who came to the United States as adults said that they were biased compared with 46% of those who have lived here since childhood or 50% of those who were born in this country.

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 61%, ob/gyns are above the middle and higher in rank among all physicians than they were in the 2014 survey. Ob/gyns are also, unlike most other physician specialties, as happy at home as they were in 2014 (60%). 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]

At 31%, ob/gyns ranked above the middle of physicians in happiness at work (either very or extremely happy at work), but far less content than they were in 2014 (40%). 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 ob/gyns, the percentages then were much higher (53% and 46%, respectively).

Similar percentages of male and female ob/gyns report happiness away from work (62% and 61%, respectively). However, more male than female ob/gyns are happy at work (35% and 27%, respectively). It is interesting to note that, as reported in slide 4, more female ob/gyns (57%) expressed burnout than their male peers (43%), which is reflected here among happiness levels at work.

At 63%, ob/gyns are tied with four other specialties, all of whom ranked above the middle among physicians who exercise twice a week. 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.

When looking at physicians who reported that they were overweight to obese, ob/gyns, at 46%, ranked higher 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.

This is the second year that Medscape has included questions on marijuana use. The highest percentages of ob/gyns who admit to having used marijuana are in the youngest (age 35 and under) and second oldest (age 56-65) groups (32% and 37%, respectively). Among other ob/gyn age groups, around one quarter reported ever having used the drug.

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] It's no surprise, then, that 97% of ob/gyns have not prescribed it.

Like most physicians surveyed, male ob/gyns fare somewhat better than their female peers regarding savings and debt. Sixty-three percent of male vs 58% of female ob/gyns have adequate savings or more and no debt. Thirty-nine percent of female and 32% of male ob/gyns, however, report minimal savings, unmanageable debt, or both.

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, 58% of male ob/gyns but only 50% of their female peers believe that their income and assets are sufficient to meet their needs. Fewer men (25%) than women (35%) say that their assets aren't enough right now, but they expect them to improve; and 17% of male and 16% of female ob/gyns have no hope that they will ever be sufficient.