Medscape Global Physicians' Burnout and Lifestyle Comparisons
Tim Locke | February 14, 2019 | Contributor Information
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They all treat patients, but how do the work and home lives of doctors in France, Germany, Portugal, Spain, the UK, and the United States differ? We reveal the findings of an online survey of nearly 20,000 doctors who shared their experiences and views with us. Read on for answers to some big questions. Which country sees the most doctors experiencing burnout or depression? Who works the longest hours? Who gets the most time off work?
Full-timers – working over 40 hours a week – are most common in Germany, France, and Portugal. The country with the most part-time doctors was the UK with more than one in four UK doctors working 30 hours or fewer.
Burnout and/or depression was a significant issue for doctors. Across the countries surveyed between 36% to 51% being burned out and/or depressed. Burnout was most common in Spain and Portugal. Depression alone was far higher in Germany (24%) than the next highest, France (6%). However, German doctors were burned out less often than in other countries. Doctors in the UK were most likely to report experiencing neither burnout and/or depression.
The vast majority of doctors who suffer both burnout and depression from all countries surveyed told us they feel that burnout contributes to their depression. For those with burnout, most picked a middle range when asked to rate frequency on a scale between rarely and always. When it came to ranking the severity of burnout – from not interfering with life to being so severe they are thinking of quitting medicine – most picked a mid-range answer. However, across the countries 20-25% said burnout was severe enough to think about leaving medicine, except for Spain where this was only 9%. Over half of burned out doctors in our survey have been experiencing burnout for at least one year.
We asked doctors who experienced burnout to say what contributes to it the most. Some answers may give an insight into the different healthcare systems in each country. Overall, bureaucratic tasks, like charts and paperwork, was the biggest single issue across the countries, with this being mentioned most in Portugal and the US, and least in Spain and the UK. Long working days was the next big issue, and more so for Portugal, Germany and France, and cited least in Spain. Lacking respect from employers, administrators, staff, or colleagues was the third biggest issue, and more so in Portugal, while it was mentioned the least in the US. German and Portuguese doctors least often feel like a cog in the wheel. French and German doctors most often mention the emphasis on profits over patients. German doctors least often find lack of respect from patients a factor.
Government regulations are least often mentioned in Spain, but highest in the UK. Insufficient earnings or compensation is a substantial factor in Portugal and Spain, but mentioned least by French doctors. Increased computerisation and electronic health records is most often mentioned in the US, but least often in the UK. Lack of control or autonomy is more often mentioned in the UK and US, but least in France. Maintaining certification requirements has less of an impact in Portugal and Spain, but was mentioned most in the UK. Decreasing reimbursements is a greater factor in the US, and lowest in France.
When asked about things that could help reduce burnout, many of the answers tally with reducing the issues raised in the previous question. French doctors most often cite having more support staff. Portuguese doctors cite this least. Better working hours or schedules was most popular in France and the UK, the least in Germany. More respect from peers and managers was high on Spain's wish list, but least so in the US. Emphasis on patients over profits resonated most in Germany and France. As you might expect with the NHS, patients over profit was less of an issue in the UK than elsewhere. Earning more was chosen most in Germany, Portugal and Spain, but least in France. Decreased government regulations is least often cited in Portugal and Spain, but most popular in Germany. More reasonable patient loads is least often suggested in France, and joint highest in Spain and the UK.
More flexible working was most popular as a solution in Portugal, least in Spain. Better respect from patients was most requested in Portugal, least in the UK and Germany. Educational and professional opportunities are more commonly cited in Portugal and Spain, least in Germany and the US. Having more control or autonomy was most popular in the US and UK, least in France. France ranked lowest for wanting more paid time off, Portugal was highest.
We asked what best described their depression for those experiencing it. The most common answer was colloquial depression - feeling down, blue, or sad - for 57% - 73% of respondents. Germany, Portugal, and the US, were highest for this answer, the UK was lowest. Clinical depression – described as severe depression lasting some time, not caused by a normal grief event - was more common in France, Spain, and the UK. It was lowest in Germany.
For doctors in our survey their job was by far the biggest answer given across all the countries for the biggest contributor to depression. Doctors in Spain cited it the most, Germany the least. Concerns about finances are linked to work, and this was an issue most for doctors in the UK and US, and least for doctors in France. Family matters were mentioned by doctors in the US most, and least in France. Romantic relationships were an issue most in Portugal and least in France. Regarding health, their own health, rather than that of patients, was an issue most for Spanish doctors, and least in Portugal.
Few of the doctors who experienced burnout or depression said they are seeking professional help or planning to seek it. UK doctors were most likely to say they were currently seeking professional help, Spain ranked lowest. Germany and the UK ranked lowest for planning to seek help, Portugal was highest. Having past professional help was most often mentioned in France, least in Portugal.
With most doctors deciding not to seek professional help for burnout or depression, we asked why not. The most popular answer was symptoms not being severe enough. This answer was most common in Spain, the least in Germany. US and French doctors were most likely to say they were too busy, the Spanish least so. The belief they can deal with it without a professional is also frequently mentioned, more so in Portugal, the least in France. The issue of being concerned about disclosure was biggest in the UK, smallest in Spain. A distrust of mental health professionals was most common in Germany, least in Portugal.
So where do doctors experiencing burnout and/or depression go to, or plan to see, to get professional help? The answers varied a lot across the countries in our survey, which may reflect different systems and titles for mental health professionals used. Therapists are most popular in Germany, but not mentioned in the UK. Social workers (MSWs) or counsellors are most often mentioned in the UK but hardly at all in Portugal or Spain. PhD psychologists are most common in Spain, followed by France, but not at all in Germany or the UK. Psychiatrists are most often chosen in Portugal, the least in the UK. Physician Health Programmes were most common in Germany and the UK, the least in Portugal. Doctors in Portugal were the ones most likely to turn to peers or colleagues for help, German doctors were least likely to do this. Only French doctors (10%) mentioned using an occupational physician.
The majority of all doctors surveyed indicate their current employer or workplace does not offer a programme to reduce stress and/or burnout. However, a significant number didn't know. Doctors in the US and UK were most likely to have a workplace programme available. However, UK doctors were also least likely to know if a programme was offered. Across the countries, where a programme is available for stress/burnout, only 20% to 30% of all doctors say they have used it, with the UK lowest and France highest. The same number of doctors who do not have a workplace stress/burnout reduction programme would be likely to participate if a scheme was offered.
Generally, 50 to 65% of doctors in our survey across the countries are 'very or extremely happy' with their life outside of work. The exception was France where only a third was very happy. The French were the most likely to give a mid-range answer between the extremes of happiness and unhappiness.
Across the countries 18% - 39% of physicians are very or extremely happy with their worklife, with Spain the happiest. However, just like their homelife, French doctors are least often happy with their life at work. They were the country most likely to give a mid-range answer between the extremes of workplace happiness and unhappiness.
Doctors are expected make healthy recommendations to their patients about exercise, weight management, stopping smoking, and moderating alcohol use. So do they listen to their own advice? Many countries' guidelines suggest taking some exercise every day, but our surveyed doctors doing this ranged from 11% to 2%. The UK and US were most likely to exercise daily, Portugal the least. Some never exercise at all – 24% in Portugal and 21% in France. We asked about smoking and vaping in France, Germany, Spain, and the UK. Smoking was most prevalent in France, the least in the UK. Vaping prevalence was low ranging from 6% in France to 1% in Spain. When it comes to weight 37% - 47% of physicians are trying to lose weight, highest in the US and UK
We asked about the number of alcoholic drinks consumed each week in all the countries, except the UK where we asked about alcohol units. A standard glass of wine is 2.1 units. One in 5 UK doctors reached or exceeded the recommended 14 units a week. Around the same number were teetotal, the same for the US and Portugal. Of those outside the UK drinking 10 or more drinks, Spain was highest. However, Spanish doctors were also least likely to be teetotal.
Around half of European doctors hold religious or spiritual beliefs, while in the US it's far more 69%. The UK and France were most likely to have no religious or spiritual beliefs, the US was lowest. In line with prevalence figures, US doctors more often found religious or spiritual beliefs help them cope with work challenges.
Different countries have different rules about the number of paid weeks of work employees are entitled to, but our survey shows that even in countries with higher allowances, not all doctors take the full amount. For example, UK employees should get 5.6 weeks a year, yet 43% of UK doctors take only 1-4 weeks. Some may be self-employed or run their own practice rather than being staff. Overall, most doctors take at least 3 weeks holiday annually. French and German doctors most often take 5 or more weeks, while Portuguese and US doctors least often do so. US doctors are most likely to just have one week of vacation a year while French doctors most often take more than 6 weeks.
The demographics of our survey produced some interesting differences in demographics across the countries surveyed. Germany had the most male doctors (67%), Portugal had the most female doctors (61%). In the age ranges, Portugal had the highest number of doctors aged under 28 (4%), the US had the highest aged 70 or older (6%). The US also had the most married physicians (77%), Portugal the most singletons (15%). France ranked highest for living with a partner (19%), the US lowest (5%). The partners of 25%-34% of European doctors were doctors themselves, but in the US was lowest at 21%. In Germany, 30% had healthcare working non-doctor partners, the highest number. The lowest was Portugal at 12%. French doctors are most often caregivers for their parents or other family members who are not children. French and German doctors were most likely to own their own solo practice, this was lowest in the UK. US and French doctors were most likely to be partners in their practice, while this was lowest in Portugal and Spain. Spanish doctors were most likely to be employees, with French doctors the least likely to be. Doctors in the UK, where the NHS is the biggest employer, were most likely to work in the public sector compared with France, Portugal, and Spain.
A total of 19,935 practising doctors in France (968), Germany (615), Portugal (800), Spain (1053), the UK (956), and the United States (15,543) took up an invitation to complete a 10 minute online survey in the language of each country. European data were collected from April 25 to June 19, 2018. US data were collected from July 19 to October 2, 2017.
The margin of error for the survey a 95% confidence level using a point estimate of 50% ranged from 0.79% for the US to 3.95% for Germany.
Follow the links for each country to read the full original survey reports:
US Lifestyle
US Burnout
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Contributor Information
Tim Locke
UK Editor, Medscape
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