Burnout, bias and body weight: how psychiatrists stack up against other specialists

Of all specialist physicians, those working in psychiatry are the least likely to report being burned out, according to the 2016 Medscape Lifestyle Report.¹ At 40%, psychiatrists are 3% more chilled even than dermatologists. Highest in the burnout stakes are critical care physicians, with 55%. Cardiologists come in at 50% and oncologists 46%.

Burnout was somewhat more common among female than male psychiatrists (43% vs 36%) but the proportion of burned out women in the profession has in fact been falling since 2013, when the figure stood at 62%. Among men, there has been a slight increase over the same period.

Data on the severity of burnout show a pattern similar to that for frequency. On a scale of 1 to 7, where 1 means that burnout does not interfere with my life, and 7 means so burned out I’m thinking of quitting medicine, psychiatrists averaged 3.9, level with rheumatologists at the bottom of the table. Critical care doctors were again top of the league, with 4.7.  

Bureaucracy breeds burnout

The top cause of burnout reported by psychiatrists – by a substantial margin – was too many bureaucratic tasks (rated 4.3 on a scale of 1-7, where 1 equals does not contribute at all, and 7 equals significantly contributes). A cluster of factors tied for second place: inability to provide patients with the quality of care that they need, insufficient income, too many hours at work, maintenance of certification, and increased computerisation all had scores of 3.4.

Difficult colleagues, staff and employers were ranked as relatively unimportant reasons for burnout (scores of 2.6-2.7).

Burnout is an aspect of physicians’ personal lives that could have a profound effect on the quality of patient care. So too is bias.

Intelligence and language sources of bias

Specialists were asked whether they thought they were biased in relation to certain groups of patients. Forty-eight percent of psychiatrists admitted that they were. This put them towards the head of a table topped by emergency medicine (62%). Unsurprisingly, bias in relation to patients was thought to be a factor by only 10% of pathologists.

However, while 48% of psychiatrists admitted experiencing bias, only 11% said that bias affected the way they treated a patient - and this may have been either a positive or negative effect.

Psychiatrists rated intelligence, followed by language differences, as the patient characteristics most likely to trigger bias. Race and gender were the least likely factors.

The likelihood of self-reported bias decreased with age, being cited by 67% of respondents under the age of 35 but only 38% of those aged 56 to 65. Psychiatrists who reported burnout were more likely than their non-burned out colleagues to report bias. The likelihood of bias was not related to presence or absence of spiritual belief or to liberal/conservative political allegiance.

One potential source of bias not asked about in the Medscape survey was comorbid substance abuse. This important topic was the focus of a presentation at the 2015 meeting of the American Academy of Addiction Psychiatry.²

Bernadine Han (Weill Cornell Medical College, New York) reported that psychiatry residents had more negative attitudes towards patients with substance use disorder in addition to mental health problems than towards patients with schizophrenia or depression alone. The extent of this negativity increases over the course of training.

The exercise and weight paradox

According to the Medscape survey, psychiatrists are among the happiest physician specialties outside work: 63% said they were extremely or very happy. This was also true of happiness at work (37% rating themselves as extremely or very happy). In both settings, male psychiatrists were more likely to be happy than their female counterparts.

Of all specialists, psychiatrists were the least likely to exercise twice a week (43%). Those most likely to exercise regularly were dermatologists (72%). Paradoxically, though, psychiatrists were among the specialists least likely to be overweight. Excessive weight was admitted to by 35% of psychiatrists compared to 51% of pulmonary physicians.

Over 15,800 physicians (representing 25 specialties) responded to the survey.