Which medical specialty is the happiest?

[Guest guest]

Docs:

Interesting profile of medical physicians. Turns out that

rheumatologists are the happiest. Internists, gastroenterologists,

and neurologists the least happy. Go figure.

Lyndon McGill, D.C.

EvolvHealth Wellness Advisory Council Member

Salem, Oregon

www.SalemSpineClinic.com

www.EvolvingDaily.com

Profiles in Happiness: Which Physicians Enjoy Life Most?

Carol Peckham

Posted: 03/22/2012

Introduction

How happy are physicians with their lives outside of work? And

are some specialists happier than others? What are physicians'

political leanings, and are they religious? Are physicians fat and

do they exercise as often as they advise their patients to? These

are some of the questions asked in Medscape's Physician Lifestyle

Report: 2012, which is based on a member survey that garnered

responses from nearly 30,000 US physicians representing 25

specialties.

The medical literature includes hundreds of studies on work

satisfaction, but almost none involve physician life outside the

hospital or the office. Currently many physicians express

unhappiness with their life in practice. According to a 2010

Merritt Hawkins survey sponsored by the Physicians Foundation, 40%

of physicians said that they planned to drop out of patient care

in the next 1-3 years. This Medscape report attempts to discover

how physicians view their lives outside of practice and whether

they are any different from the rest of America and from each

other in the way they live, love, and play.

The Happiest Physician: Who Is It?

According to a 2006 Pew Report, 34% of Americans say that they

are "very happy," 50% "pretty happy," and 15% "not too happy."[1]

Medscape asked US physicians how happy they were with their lives

outside of medicine and to rate their level of happiness on a

scale of 1 to 5, with1 being the least happy and 5 being the most.

Approximately one third of physicians -- both men and women --

rated themselves a 5 (approximating the "very happy" in the Pew

report) and 40% rated themselves a 4 (suggesting "pretty happy").

The average happiness score for physicians who responded was 3.96,

which is on the cheerful side but not overwhelmingly happy.

It should be noted that there was no significant difference in

this score between men and women, who rated themselves 3.96 and

3.95, respectively. Also, the physician state of happiness does

not appear to rely on political leaning. The ratings ranged only

from 3.95 to 3.97 among the 4 combinations of fiscal or social

conservatives or liberals.

After all of the various answers to the Medscape survey were

assessed using this rating system, profiles emerged of the

happiest and least happy physicians.

The Happiest Physician

Looking more deeply into other responses, it is no surprise to

find that the happiest physician lives the American dream. With a

rating of 4.09, the most cheerful physician of all, whether male

or female, is a rheumatologist. She was born in the United States

and is of normal weight and excellent health. He exercises 4 or

more times a year, has 1 or 2 drinks a day, and doesn't smoke. She

is in great financial shape, with more than adequate savings and

no debt. He is married, actively practices his faith, and

volunteers for his religious organization. One of the more

interesting findings was that happiness was greatest in physicians

over 60 years of age. This coincides with a U-shaped trend

discussed in a study by Arthur Stone and colleagues[2]

showing increased psychological well-being after the age of 50

years. In that study, as in the Medscape survey, men and women had

very similar age profiles of well-being.

The Unhappiest Physician

The least happy physicians are internists, gastroenterologists,

and neurologists (all tied at 3.88). Our unhappy physician is in

poor health, exercises less than once a week, and is obese. He is

in his mid-50s and came to the United States as an adult. Her

finances are in terrible shape; she has no savings and

unmanageable debt. He is separated and doesn't volunteer. She has

a spiritual belief but doesn't attend any services. These

miserable doctors still manage not to drink alcohol.

A special note on generalists: Family physicians, internists,

general surgeons, pediatricians, and emergency medicine physicians

tended to take fewer vacation days, have less money, and report

poorer health than most other physician groups. Nevertheless,

pediatricians and family and emergency medicine doctors rated

themselves in the top 10 of the happiness scores. Internists and

general surgeons were scored as 2 of the 10 least happy

physicians, suggesting that factors other than money and health

might play a role in a physician's emotional state.

How Do Physicians Spend Their Free Time (If They Have Any)?

The Medscape article Are Doctors

Happy? focused on the emotional state of physicians as

related to their practice. It included an interview with Neelum

Aggarwal, MD, a Chicago neurologist who frequently lectures on

stress and burnout. When she conducts workshops on this topic, Dr.

Aggarwal always asks participants what activities they enjoy most.

"The doctors who are doing well -- the ones who aren't in a

burnout or stress cycle -- have an answer right off," she says.

"You hear, 'I like to fish,' 'I love to camp,' 'I go bowling.' But

the sad thing is that many doctors don't have an answer." The

Medscape survey attempted to dig more deeply into this question

and find out more about their interests.

How Much Vacation Time Do Physicians Take?

With an average of 13 paid vacation days per year, Americans in

general do far worse than those in other developed countries (eg,

Italy, 42 days; France, 37; Germany, 35; United Kingdom, 28;

Canada, 26; and Japan, 25).[3] The amount of time

taken off by physicians varied widely. On the most fortunate side,

nearly half of anesthesiologists (48.3%) and radiologists (48.8%)

who answered our survey took more than 4 weeks of vacation each

year. About a third to a half of physicians get in 2-4 weeks of

vacation time a year. Like their fellow Americans, however, over a

third (38.3%) of family physicians and almost as many emergency

medicine physicians (35.3%), internists (33.9%), and general

surgeons (32.5%) take off for 2 weeks a year at most. Such a

response among generalists provides even more support that many

are having a difficult time. (An exception: 44% of plastic

surgeons shared these short vacations and only 11% had 4 or more

weeks, giving them the least vacation time of all physicians.

Also, with a self-rated happiness score of 3.89, these specialists

also found themselves near the bottom of that list as well.)

What Do Physicians Do When They Have Free Time?

According to a 2009 survey from US Travel Association,[4]

activities with the greatest interest among US adults are, in

order of popularity, visiting friends and relatives, sightseeing,

going to beaches, visiting museums, going to national or state

parks, going on cruises, visiting theme parks, traveling to

cities, and visiting mountain regions. Physicians who answered the

survey preferred vacations traveling abroad and at the beach.

Women appeared to enjoy these vacations more than men did. Not

surprising, more women than men preferred luxury hotels and more

men liked winter sports trips than women. Not listed as an answer

choice in the Medscape survey but mentioned most frequently in the

write-in responses was visiting family members. Other write-in

preferred activities were long train rides, nonmedical learning

trips, and doing nothing at all. One respondent, in fact, only

wanted to "sip tea quietly."

When they had free time at home, male and female physicians rated

their top choices as exercise and physical activity, reading,

cultural events, and food and wine. Over a third of men but only

25%of women liked surfing the Web, although over 13% of women

favored social media compared with about 8% of men. About 17% of

men enjoyed managing finances compared with less than 6% of women.

How Do Physicians Gauge the State of Their Personal Finances?

As of December 2011, a Gallup poll reported that 52.5% of

Americans considered themselves to be thriving, 43.7% were

struggling, and 3.7% were suffering.[5] Our Medscape

survey indicates that many physicians also perceive themselves as

having financial difficulties. Over 38.8% of the physicians in

active practice who responded said that they had no or minimal

savings for their age and stage. Only 12.8% of these physicians

believe their savings to be more than adequate. Such responses

could reflect the more difficult economic climate for the younger

generation of physicians. Of note, well over 80% of physicians in

our survey who are semi- or completely retired believe that they

have adequate or more than adequate savings for their stage in

life, but they comprise only 15% of all who responded.

When looking by groups at the percentage of physicians having no

savings and unmanageable debt, it was not surprising to find more

generalists in the top 5 (family physicians 8.6%, general surgeons

7.4%, pediatricians 7.1%, and intensivists 6.8%). The specialty

with the most physicians who reported unmanageable debt, however,

was plastic surgery at 9.3% (see Table 1).

Table 1. Physicians and Financial Status

Specialty

Have more

than

adequate

savings,

manageable

or no debt

Have

adequate

savings,

manageable

or no debt

Have

minimal

savings,

manageable

or no debt

Have no

savings and

unmanageable

debt

Anesthesiology

15.1%

51.0%

23.3%

3.8%

Cardiology

16.8%

48.0%

24.3%

4.7%

Critical Care

12.5%

42.7%

32.8%

6.8%

Dermatology

17.5%

49.4%

20.5%

4.3%

Diabetes & Endocrinology

12.6%

45.9%

28.5%

6.3%

Emergency Medicine

13.6%

49.2%

25.9%

6.3%

Family Medicine

10.3%

43.5%

32.3%

8.6%

Gastroenterology

18.1%

46.9%

26.0%

3.8%

General Surgery

13.6%

44.9%

27.7%

7.4%

HIV/ID

14.6%

49.4%

23.8%

3.3%

Internal Medicine

12.5%

42.3%

32.9%

6.3%

Nephrology

12.9%

50.5%

24.3%

4.7%

Neurology

12.0%

45.2%

29.8%

5.9%

Ob/Gyn & Women's Health

15.2%

46.0%

27.3%

6.4%

Oncology

15.7%

51.5%

21.5%

3.9%

Ophthalmology

17.5%

48.7%

22.1%

5.5%

Orthopaedics

20.8%

46.0%

19.9%

6.1%

Other (please specify)

12.6%

47.1%

27.7%

6.5%

Pathology

19.1%

48.1%

21.1%

5.3%

Pediatrics

11.9%

47.2%

28.3%

7.1%

Plastic Surgery

11.4%

40.9%

32.0%

9.3%

Psychiatry & Mental Health

13.3%

45.4%

29.6%

4.5%

Pulmonary Medicine

15.5%

50.3%

24.4%

2.4%

Radiology

21.0%

50.3%

16.6%

4.4%

Rheumatology

15.0%

49.1%

24.8%

3.3%

Urology

19.1%

50.1%

20.0%

5.5%

How Spiritual Are Physicians and How Do They View Death?

How Religious Are Physicians?

According to a 2008 Pew Report,[6] 88% of Americans

believe in God or a universal spirit. The Medscape survey, instead

of asking for specific religious affiliations, wanted to know

whether physicians have a spiritual belief, regardless of active

participation. When asked if they have any religious or spiritual

belief, 83% of physicians reported that they do, with slightly

over 40% of them actively practicing their faith. The remaining

17% had no belief system.

Although an association between being religious and lower rates

of depression is widely held, a recent study suggests that people

who develop depression might simply be more likely to stop going

to services.[7] The Medscape survey seems to reflect

this. When looking at the happiness scores by religious belief,

the happiest were those who actively practiced (4.03) and the

least happy were those with a spiritual belief but no active

practice (3.89) -- not the nonbelievers (3.92). Also from the

survey, family physicians, pediatricians, rheumatologists,

ophthalmologists, and rheumatologists were the most actively

religious groups and they were also within the top 10 on the

happiness score. Those who had the highest percentage of spiritual

belief and no active practices (plastic surgeons 44.5%,

intensivists 40.6%, cardiologists 40.2%, gastroenterologists 39.8%

and general surgeons 39.7%) shared happiness scores toward the

bottom of the list: 3.89, 3.90, 3.92, 3.88, and 3.89,

respectively. There was no obvious happiness trend among those

with the highest nonbelief percentages (pathologists 23.6%,

intensivists 23.4%, infectious disease physicians 23.1%,

radiologists 21.9%, and psychiatrists 21.8%), whose happiness

scores were 3.93, 3.90, 3.97, 3.99, and 3.99, respectively (see

Table 2).

Of note, the Pew report found significantly more men than women

claiming no religious affiliation (20% and 13%, respectively). The

Medscape survey found almost no differences at all between male

and female physicians in having or not having a belief and

actively or not actively practicing their faith.

Table 2. Physicians and Religion

Specialty

Happiness

Score*

No

Beliefs

Religious With

Active Practice

Have Religious

or Spiritual

Belief but No

Practice

Anesthesiology

4.00

17.37%

39.42%

36.42%

Cardiology

3.92

14.17%

39.50%

40.16%

Critical Care

3.90

23.44%

30.73%

40.63%

Dermatology

4.06

17.32%

38.39%

36.02%

Diabetes & Endocrinology

3.90

18.89%

35.19%

39.26%

Emergency Medicine

4.01

20.06%

35.99%

38.98%

Family Medicine

3.97

12.86%

49.50%

32.26%

Gastroenterology

3.88

13.75%

41.25%

39.79%

General Surgery

3.89

13.92%

40.05%

39.00%

HIV/ID

3.97

23.01%

32.64%

35.56%

Internal Medicine

3.88

14.99%

39.83%

39.17%

Nephrology

3.90

17.35%

40.69%

34.38%

Neurology

3.88

20.15%

33.78%

38.96%

Ob/Gyn & Women's Health

3.96

13.28%

42.71%

38.95%

Oncology

3.89

15.88%

40.99%

35.62%

Ophthalmology

4.03

12.21%

43.82%

37.72%

Orthopaedics

3.96

14.69%

39.73%

38.53%

Pathology

3.93

23.63%

32.61%

37.44%

Pediatrics

4.00

12.98%

49.70%

31.92%

Plastic Surgery

3.89

12.10%

37.01%

44.48%

Psychiatry & Mental Health

3.99

21.84%

32.73%

38.26%

Pulmonary Medicine

3.95

12.50%

41.77%

38.41%

Radiology

3.99

21.88%

33.37%

37.06%

Rheumatology

4.09

9.35%

44.86%

37.85%

Urology

4.04

13.37%

42.96%

38.42%

What Would Physicians Do if They Were Told They Had a Terminal

Illness?

In a 2011 poll conducted by the National Journal and the Regence

Foundation,[8] 71% of the general population felt that

quality was more important than length of life, 23% felt that it

was important to extend life with every intervention available,

and only 6% didn't know or didn't answer the question. Physicians,

according to the Medscape poll, were more ambivalent, with

slightly over 23% uncertain about how they would respond if they

were told they had a terminal illness. Almost 65% of physicians

said that they would choose quality over length of life, and only

about 12% were certain about wanting to have aggressive treatment.

A Medscape physician-only

discussion on this topic overwhelmingly supported the

decision for palliative care vs aggressive treatment for extending

life. In the discussion, a primary care physician whose

mother-in-law had died recently said, "She chose no medical or

oncologic interventions after her hemi-colectomy 19 months ago. No

pain meds, only supportive measures. A true profile in courage to

choose to die on her own terms."

The responses varied slightly by age. The percentage of those who

would choose more aggressive treatments rose slightly during

mid-life, from about 10% in the 31- to 40-year age group to 14.3%

in those between 41 and 50 years of age. This dipped back down to

around 10% after age 50. When the responses were filtered by

religious or spiritual belief, over 70% of those with no belief

system reported that they would choose quality of life over

extending life. Slightly fewer who reported having a spiritual

belief would choose the same path (63% of those actively

practicing their religion and 65% of those not actively

practicing).

Where Do Most Physicians Lean on the Political Spectrum?

A Rasmussen Report[9] in May 2011 reported that 29% of

American voters characterize themselves as both fiscal and social

conservatives, and only 10% said that they are liberal in both

areas. In the Medscape poll, physicians seem to be slightly more

extreme on either side. When asked about their political leanings,

approximately 37% of male physicians and 25.5% of women defined

themselves as being conservative both socially and fiscally. Only

18.4% of male physicians but 27.5% of female physicians described

their views as being liberal in both areas. When broken down, the

great majority of physicians are fiscally conservative (77% of men

and 68.9% of women), regardless of their social leanings. Women

tended to be more liberal both socially (66.8%) and fiscally

(31.1%) than their male peers (58.6% and 23%, respectively).

When looking at political biases by specialty, the most

conservative physicians (reporting themselves as conservative

fiscally and socially) tended to be in the operating room: plastic

surgeons (82.2%), orthopaedists (82%), anesthesiologists (80%),

urologists (79.4%), ophthalmologists (77.6%), and general surgeons

(76.5%). The most liberal physicians (both socially and fiscally)

were infectious disease physicians (74.4%), psychiatrists (72.1%),

intensivists (67.7%), neurologists (64.1%), and oncologists

(63.5%) (see Table 3).

Table 3. Physicians' Political Leaning

Specialty

Fiscally

Conservative

Socially

Liberal

Anesthesiology

80.29%

51.17%

Cardiology

75.33%

54.20%

Critical Care

64.58%

67.71%

Dermatology

73.82%

59.45%

Diabetes & Endocrinology

63.33%

62.22%

Emergency Medicine

76.10%

57.57%

Family Medicine

69.22%

52.53%

Gastroenterology

71.88%

56.46%

General Surgery

76.54%

52.19%

HIV/ID

51.05%

74.48%

Internal Medicine

63.19%

58.39%

Nephrology

64.04%

62.15%

Neurology

61.78%

64.15%

Ob/Gyn & Women's Health

71.80%

58.73%

Oncology

66.31%

63.52%

Ophthalmology

77.62%

56.03%

Orthopaedics

82.01%

47.83%

Other (please specify)

70.48%

57.98%

Pathology

69.22%

58.24%

Pediatrics

60.97%

62.28%

Plastic Surgery

82.21%

53.74%

Psychiatry & Mental Health

55.37%

72.16%

Pulmonary Medicine

66.16%

57.93%

Radiology

76.12%

57.84%

Rheumatology

68.69%

57.48%

Urology

79.47%

54.18%

Are Physicians Happily Married?

Among physicians who responded to this survey, over 85% of men

and 71% of women are married, a rate far above that of the general

US population. In fact, the current US Census found a drop in the

percentage of married Americans over the past 40 years, from 72%

in 1970 to just 48% in 2011.[10] This parallels a

recent Pew Research report[11] finding that only 51% of

US adults are currently in a marital relationship. The report also

found that the current marriage rate for people under 30 was only

20%. In the Medscape survey, nearly half of physician respondents

in that same age group reported being married.

When looking at marital status and happiness, the highest

self-rated happiness scores went to both men and women who were in

their first marriage. In any case, living with a partner boosted

happiness in general over living alone. One minor exception: The

happiness scores for female physicians who were widowed were

slightly higher than those for women who were single and living

with a partner. In fact, among both men and women without

partners, being a widow or widower was not as unhappy a state as

being divorced, and everyone was better off emotionally, it

seemed, than those in the difficult state of separation.

Over 30% of married physicians who responded met either in

medical school or as colleagues. Of interest in this regard, a

1999 study reported that although men and women in dual-doctor

families differed from other physicians in many aspects of their

professional and family lives, they achieved their career and

family goals as frequently.[12]

How Healthy Are Physicians?

The Medscape survey asked physicians to rate their health on a

scale of 1 to 5, with 1 being in very poor health and 5 being in

excellent health. The healthiest specialists by self-report were

dermatologists (4.23), plastic surgeons (4.22), endocrinologists

(4.20), orthopaedists (4.19), and cardiologists (4.17). The 5

least healthy were intensivists (3.98); pediatricians (4.01); and

ob/gyns, pathologists, and psychiatrists, all tied at 4.02.

General surgeons (4.04), internists, and family physicians (tied

at 4.05) and emergency physicians (4.06) were also among the 10

least healthy physicians. It is tempting to hypothesize that the

stresses of general medicine may play a role in the health of

physicians.

How Many Physicians Are Overweight?

According to CDC statistics, in 2008 40% of US men were

overweight and 32% were obese.[13] Physicians in our

survey didn't do much better: Approximately 37% of male doctors

reported being overweight, with 5.3% being obese. This was very

similar to a 2004 study[14] that found 38% of male

physicians to be overweight and 8% obese, suggesting that the

situation has not improved much over the past 7 years. As for

women, according to the CDC, 28.6% were overweight in 2008 and 35%

were obese. In the Medscape survey the percentage of female

physicians who reported being overweight tended to be slightly

higher than the nation's women (31.3%), but obesity rates were

much lower (6.2%).

In terms of specialty, again, the generalists tended to be the

heaviest. The 5 physician groups reporting the highest BMIs (25

and over) were family physicians (43.9%), intensivists (42.7%),

ob/gyns (42.3%), general surgeons (41.3%), and internists (37.4%)

(see Table 4).

Table 4. Physician Weight

Specialty

Normal

(BMI

18.5 -

24.9)

Obese

(BMI ≥

30)

Overweight

(BMI 25 -

29.9)

Underweight

(BMI ≤ 18.5)

BMI 25

and

Over

Anesthesiology

56.20%

4.16%

32.85%

1.02%

37.01%

Cardiology

58.40%

3.81%

31.76%

0.66%

35.56%

Critical Care

52.60%

9.38%

33.33%

0.52%

42.71%

Dermatology

68.90%

2.17%

18.11%

4.33%

20.28%

Diabetes &

Endocrinology

61.48%

5.93%

28.15%

0.74%

34.07%

Emergency Medicine

57.80%

4.58%

30.62%

2.71%

35.20%

Family Medicine

50.78%

8.86%

35.06%

1.05%

43.93%

Gastroenterology

63.96%

4.17%

26.88%

0.83%

31.04%

General Surgery

51.65%

6.78%

34.61%

1.25%

41.39%

HIV/ID

60.25%

3.77%

28.45%

0.84%

32.22%

Internal Medicine

56.00%

4.75%

32.66%

1.38%

37.41%

Nephrology

56.47%

5.05%

30.91%

0.95%

35.96%

Neurology

58.52%

4.59%

29.93%

1.48%

34.52%

Ob/Gyn & Women's

Health

51.61%

7.19%

35.11%

1.44%

42.30%

Oncology

54.72%

2.36%

33.48%

3.22%

35.84%

Ophthalmology

63.07%

2.35%

24.73%

4.38%

27.07%

Orthopaedics

56.37%

3.90%

32.08%

1.05%

35.98%

Other (please specify)

56.05%

4.73%

31.95%

2.22%

36.68%

Pathology

55.24%

6.82%

29.95%

2.33%

36.77%

Pediatrics

58.93%

5.58%

28.65%

2.38%

34.23%

Plastic Surgery

61.21%

4.63%

24.91%

3.20%

29.54%

Psychiatry & Mental

Health

57.23%

5.26%

30.39%

1.97%

35.65%

Pulmonary Medicine

58.84%

3.66%

29.88%

1.22%

33.54%

Radiology

62.64%

2.60%

25.87%

2.60%

28.47%

Rheumatology

58.41%

4.67%

28.97%

1.87%

33.64%

Urology

57.52%

3.34%

33.65%

1.19%

36.99%

How Often Do Physicians Exercise?

According to the CDC, between 1999 and 2009 the percentage of men

18 years of age and over who met the 2008 federal aerobic activity

and muscle-strengthening guidelines increased from 19% to 22%.[13]

According to the Medscape survey, then, physicians do better than

the average American, and the older they get the more they

exercise. About 48% of physicians under 30 exercise at least twice

a week. After age 61, more than 72% are exercising at least twice

a week. Whether this is a matter of free time or consciousness of

aging cannot be determined from this survey. According to the

response to the next question, about 7% of female and 8% of male

physicians do not exercise at all. For both men and women, aerobic

activities are by far the most common and popular exercises (over

71% for both).

Do Physicians Smoke and Drink?

Although the national quit rate has increased slightly over the

past few years, according to a 2011 poll, 18% of Americans

still smoke.[15] Among nonsmokers, physicians lead the

national pack: Only 2% of men and 1.28% of women report that they

smoke. About 9% of men and 5% of women were once smokers but quit.

As reported in a 2010 Gallup poll,[16] 67% of American

adults drink alcohol, a rate that has been "remarkably stable"

since this began being tracked in 1939. According to the Medscape

survey, male physicians are slightly ahead of the national

population, with 73.4% reporting that they drink. Female

physicians are closer to the national average, with 65% saying

that they drink alcohol. Our survey suggests that physicians tend

not to overindulge: Over half report having not even 1 drink a

day, and about a quarter of men and a third of women do not drink

at all. About 15% of men and 10% of women report having 1-2

alcoholic beverages a day, with only 3.3% of men and 1.25% of

women admitting to more than 2.

How Many US MDs Came From Other Countries?

According to a recent article in the New York Times, the

United States attracts more foreign physicians every year than the

United Kingdom, Canada, and Australia -- the next most popular

destinations for migrating doctors -- combined.[17] In

the Medscape survey, 20% of the physicians who responded came to

the United States as adults, which is slightly lower than the

26.3% rate reported by the Migration Policy Institute (MPI)[18]

in 2007. Although the Medscape survey did not address country of

origin, according to the MPI report, Asia is the origin of the

greatest proportion of foreign-born physicians -- around 22% --

followed by Europe/Canada/Oceania at about 16%. Africa contributes

about 12% and Latin America 6%. The New York Times article

pointed out the strain this can cause on underdeveloped nations,

citing as an example that the number of Ghanaian physicians

practicing in the United States in 2006 was about 20% of the

number of physicians working in Ghana itself.

View the complete Medscape

Physician Lifestyle Report.

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