Long Work Hours Wreak Havoc in MDs' Personal Lives

All Work, No Play a Recipe for Family Conflict, Depression, and Burnout

Fran Lowry

September 23, 2013

All work and no play is a recipe for family conflict, depression, and burnout in physicians, especially among those who are in dual-career relationships, new research shows.

A survey of some 90,000 US physicians across all specialties and their working partners shows that many respondents report frequent work-home conflicts (WHC) due to the long hours they spend at work, causing them to suffer burnout, depression, and poor quality of life.

"Work-home conflicts are common in physicians and in the partners of physicians," lead author Liselotte N. Dyrbye, MD, from the Mayo Clinic, Rochester, Minnesota, told Medscape Medical News.

"We found that younger physicians, female physicians, and physicians who work in academic medical centers are the ones who are more likely to have work-home conflicts, and that these conflicts are driven by a lot of work hours," Dr. Dyrbye said.

"This makes sense, because the more hours you work, the more opportunity there is for work-home conflicts," she said.

The study was published online September 17 in the Journal of General Internal Medicine.

Choosing Work Over Home

Previous work conducted by this same team of investigators has examined work-home conflicts in US surgeons and academic internal medicine physicians.

The current study extends this research by looking at the issue of work-home conflict in a broader, more diverse group of physicians as well as in their partners.

In the current study, Dr. Dyrbye and her research team surveyed 89,831 physicians from all specialties listed in the Physician Masterfile. Of these, 7288 (27.7%) physicians completed the survey.

Of the physicians who completed the survey, 1644 provided their partner's contact information.

These partners were in turn surveyed, and 891 (54%) responded.

The median age of the physicians and their partners was 55 years and 51 years, respectively. Most (89.2% of physicians and 86.6% of partners) had children. The majority of physicians were male (75.2%), and most partners were female (73.0%).

Slightly more than half of the partners (n = 503, 56.5%) were employed, reporting a median of 40.0 hours of work per week. Also, most of the employed partners were working in nonmedical professions (58.2%); 40.9% worked in healthcare.

The survey results showed that 44.3% of physicians and 55.7% of employed partners experienced a work-home conflict in the last 3 weeks. Most were able to resolve their conflicts in a way that allowed their home and work responsibilities to be met.

However, physicians tended to choose work responsibilities over home responsibilities, with 28.4% reporting that they resolved their work-home conflict in favour of work, and 10.9% of physicians reporting they resolved the conflict in favor of home.

Compared with physicians, more employed partners tended to put home before work, with fewer (19.7%) choosing to resolve their work-home conflict in favour of work, and 20.1% choosing home.

Dose-Dependent Relationship

The more hours worked, the greater the work-home conflicts. Multivariate analysis showed that for each additional 10 hours per week worked, the odds ratio for a work-home conflict was 1.31 for physicians and 1.23 for their working partners (P < .0001).

Work-home conflicts were also associated with more burnout, depression, and poor quality of life.

Physicians with work-home conflicts were 47.1% more likely to have symptoms of burnout, compared with 26.6% for physicians without work-home conflicts. The trend was similar for the employed partners, with 42.4% having symptoms of burnout if they had work-home conflicts, compared with 23.8% with no work-home conflicts.

Both physicians and their employed partners with a recent work-home conflict were also more likely to have symptoms of depression, substantially lower overall mental and physical quality of life, and worse fatigue. Both groups were also more likely to be less satisfied with their partner and to be considering getting a separation or a divorce.

"These work-home conflicts are very important and have serious ramifications," Dr. Dyrbye said.

"We hope that our research draws attention to the fact that with more and more dual career relationships, work-home conflicts are something that managers and leaders of organizations need to be aware of and find solutions for, that it's not just an individual problem, and it can't just be up to the working spouse to try to figure it out," she added. "I hope that people can look closely at their policies and the opportunities for dual-career professionals to thrive within the organization."

A Warning

Commenting on the findings for Medscape Medical News, Michael Myers, MD, professor of clinical psychiatry, State University of New York (SUNY) Downstate Medical Center, Brooklyn, New York, said that the study is an important warning to young professionals that too much work may be putting their quality of life and their physical and mental health at risk.

"This paper gives us more ammunition to be able to tell our medical students that if you consistently work more than 56 hours…a week, and keep doing it over time, and your spouse is working 40 hours or more a week, you are really putting your conflict level and your relationship at risk, and you are putting yourself at risk for burnout. Perhaps this is an argument for people to cut back on their work hours," Dr. Myers, who is a coauthor, with Glen Gabbard, MD, of The Physician as Patient: A Clinical Handbook for Mental Health Professionals, said.

"I am very involved in medical education now, and it is good to have this kind of a study and to be able to explain to medical students and to residents that they have got to pay attention to these things, because these stresses are what their fathers and mothers who are a generation older are experiencing," he added.

The study was funded by the American Medical Association and the Mayo Clinic Department of Medicine Program on Physician Well-being. Dr. Dyrbye and Dr. Myers report no relevant financial relationships.

J Gen Intern Med. Published online September 17, 2013. Abstract

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