Abstract
Objective
To evaluate the frequency and demographic predictors of engaging in personal well-being activities among US internal medicine physicians.
Participants and Methods
A national cross-sectional survey was conducted from June 23, 2023, through May 8, 2024, targeting a random sample of practicing internal medicine physicians. Data on demographic characteristics and frequency of well-being activities (exercise, meditation, hobbies, volunteering, and social events) were collected. Of 1421 invited physicians, 629 (44.3%) responded. Descriptive statistics and multivariable logistic regression were used to assess levels of engagement and analyze associations between engagement frequency and physician demographic characteristics.
Results
Among the 629 respondents, engagement in well-being activities varied. The percentage of physicians reporting high engagement was 54.1% (339/627) for exercise (≥4× in past 7 days), 43.7% (272/623) for hobbies (≥4× in past 30 days), 32.6% (205/628) for meditation (≥1× in past 7 days), 31.5% (197/625) for volunteering (≥1× in past 30 days), and 26.9% (168/624) for social events (≥4× in past 30 days). Length of time in medical practice was significantly associated with higher odds of engaging in exercise and volunteering. Compared with White respondents, Black or African American respondents were more likely to volunteer and less likely to engage in hobbies. Asian respondents were more likely to meditate and less likely to attend social events and engage in hobbies. Differences by sex emerged only in meditation, with higher engagement among women.
Conclusion
Internal medicine physicians showed high engagement in various personal well-being activities with substantial demographic variations observed. Our findings underscore the importance of considering individual physician characteristics when designing initiatives to enhance physician well-being and reduce burnout.
There is growing interest in understanding how well-being activities—such as exercise, hobbies, meditation practices, volunteering, and social events—affect physician mental health. While the positive impacts of exercise have been extensively studied,1 other well-being techniques are also being explored. Participation in leisure activities and hobbies has been shown to correlate with increased professional engagement through lower stress levels and better coping mechanisms.2,3 Mindfulness-based activities such as meditation practice appear to reduce burnout and stress for extended periods.4 Beyond intrapersonal pursuits, fostering social support and meaningful connections, such as building strong friendships, participating in community groups, or engaging in regular gatherings, are correlated with lower burnout and higher resilience.5 Volunteering fosters a sense of companionship, leading to fewer depressive symptoms and less stress and loneliness.6,7
Although interpersonal connections and behaviors related to physical and mental well-being can improve coping and resilience, the degree to which internal medicine physicians engage in these well-being activities is unknown. In a national survey, we thus sought to better understand how internal medicine physicians engage in exercise, hobbies, meditation practices, volunteering, and social activities so that we may perhaps inform strategies to improve physician well-being.
Participants and Methods
We conducted a nationwide cross-sectional survey of internal medicine physicians practicing in the United States, primarily to assess burnout levels and prevalence.8 The survey also collected data on various factors hypothesized to be associated with burnout, including ways in which respondents engaged in well-being activities. Our survey was administered via mail to a random sample of internal medicine physicians between June 23, 2023, and May 8, 2024. Subjects were randomly selected from a cohort of physicians identified through Physician Professional Data, a national repository of physician information maintained by the American Medical Association. We oversampled Veterans Affairs–affiliated internal medicine physicians (30%) because we suspected that working in an integrated health care system with lower medical liability may influence wellness. We also oversampled hospitalists (30%). The remaining 40% were selected randomly with equal proportions (10% each) across each of the 4 US geographic regions (Northeast, Midwest, South, and West).
Our survey included questions assessing both professional and personal factors that were hypothesized to be associated with physician well-being. The survey assessed how frequently respondents engaged in physical exercise, meditation practices, personal hobbies, volunteering, and social events. Following the survey distribution methods described by Dillman,9 we sent each physician a prenotification email (when an email address was available) or letter, followed by a survey mailing that included a study information letter, the survey, a postage-paid return envelope, and an incentive of US $20 (cash) to encourage response. The paper survey also included a link that respondents could use to complete the survey online if they preferred. A reminder letter or email was sent to nonresponders 2 weeks after the survey mailing. Additional surveys were sent to nonresponders after 1, 2, and 3 months. Surveys returned as undeliverable and those indicating respondents were retired were removed from the final sample.
Completing the survey implied consent. Completed surveys did not include personally identifiable information and were anonymous. The study was reviewed and deemed exempt from regulation by the University of Michigan Institutional Review Board (HUM00228326).
Descriptive statistics (means and SDs for continuous variables and percentages for categorical variables) were generated for physician demographic factors and well-being activities. Multivariable adjusted logistic regression was used to assess the associations between physician demographic factors and well-being practices. Dichotomous outcome variables for the well-being practices were derived. Frequently exercising was defined as exercising at least 4 days within the past 7 days. Frequently meditating was defined as engaging at least once in the past 7 days. Frequently engaging in personal hobbies and attending social events were defined as 4 times or more within the past 30 days. Frequently volunteering was defined as volunteering at least once within the past 30 days. We measured burnout using the well-validated 22-item Maslach Burnout Inventory–Human Services Survey (under license from Mind Garden),10 which assesses 3 domains of burnout: emotional exhaustion, depersonalization, and reduced personal accomplishment. Given a lack of consensus for defining burnout, we used 2 common definitions consistent with previous research.11 First, a dichotomous outcome of extreme burnout was defined as scores meeting set thresholds in all 3 burnout domains (ie, emotional exhaustion ≥27; depersonalization ≥10; and personal accomplishment ≤33). Second, a dichotomous outcome of at least 1 manifestation of burnout was defined as scoring high in the emotional exhaustion (ie, ≥27) and/or depersonalization (ie, ≥10) domains. The full survey instrument is provided as a Supplemental Appendix (available online at http://www.mcpiqojournal.org).
We considered P values of <.05 to be statistically significant. All analyses were conducted in Stata SE 18.5 (StataCorp).
Results
Of the 1421 physicians invited to participate in the study, 629 (44.3%) completed the survey. Most of these surveys (74.9%, n=471) were completed on paper, with the remaining responses gathered electronically. Physician characteristics are summarized in Table 1. Among all respondents, 59.8% (n=376) were men, 57.6% (n=362) were White, and 84.9% (n=534) were married or living as if married. The median number of years practicing as an internal medicine physician was 23 years (IQR, 15-29 years).
Table 1.
Characteristics of Internal Medicine Physician Study Participants
| Characteristic | Value, n (%) |
|---|---|
| Race | |
| White | 362 (57.6) |
| Asian | 189 (30.0) |
| Black or African American | 31 (4.9) |
| Native Hawaiian or Pacific Islander | 2 (0.3) |
| American Indian or Alaskan Native | 1 (0.2) |
| Other | 26 (4.1) |
| Missing | 18 (2.9) |
| Ethnicity (Hispanic or Latinx) | |
| No | 582 (92.5) |
| Yes | 29 (4.6) |
| Missing | 18 (2.9) |
| Sex | |
| Male | 376 (59.8) |
| Female | 237 (37.7) |
| Missing/prefer not to answer | 16 (2.5) |
| Marital status | |
| Married or living as if married | 534 (84.9) |
| Single, never married | 33 (5.2) |
| Divorced | 33 (5.2) |
| Separated | 11 (1.7) |
| Widowed | 7 (1.1) |
| Missing | 11 (1.7) |
| Children under age 18 y | |
| No | 352 (56.0) |
| Yes | 266 (42.3) |
| Missing | 11 (1.7) |
| Type of facility for most clinical work | |
| Community medical center or clinic | 277 (44.0) |
| Veterans Affairs medical center or clinic | 186 (29.6) |
| Academic medical center or clinic | 86 (13.7) |
| Other | 69 (11.0) |
| Missing | 11 (1.7) |
| Clinical work setting | |
| Inpatient setting only | 254 (40.4) |
| Outpatient setting only | 236 (37.5) |
| Both inpatient and outpatient | 100 (15.9) |
| Other | 33 (5.2) |
| Missing | 6 (1.0) |
| Rolea | |
| Primary care physician | 307 (48.8) |
| Hospitalist | 299 (47.3) |
| Missing | 23 (3.7) |
| Time spent | |
| Time spent in practice (y), median (IQR) | 23 (15-29) |
| Time spent working per week (h), median (IQR) | 50 (40-70) |
These percentages do not equal 100% because 2 separate questions with dichotomous responses were posed as follows: (1) Do you consider yourself a hospitalist? (2) Do you provide primary care?
Frequencies of engaging in well-being practices among physicians are summarized in the Figure. We previously reported extreme burnout prevalence of 9.8% (61/622)12 and 1 manifestation of burnout prevalence of 61.4% (382/622).13 For extreme burnout, we found lower burnout prevalence among those frequently meditating (6.4% (13/202) vs 11.5% (48/419); P=.049), attending social events (5.5% (9/165) vs 11.4% (52/457); P=.03), and volunteering (5.1% (10/195) vs 11.9% (51/427); P=.01). For 1 manifestation of burnout, we found lower burnout prevalence among those frequently exercising (56.1% (188/335) vs 67.5% (193/286); P=.004), engaging in hobbies (56.1% (152/271) vs 65.6% (227/346); P=.02), and volunteering (55.4% (108/195) vs 64.2% (274/427); P=.04). Adjusted multivariable regression results assessing the relationships between physician demographic factors and various well-being practices are displayed in Table 2.
Figure.
Percentage of physicians frequently engaging in different well-being activities.
Table 2.
Multivariable-Adjusted Associations Between Demographic Characteristics and Well-Being Practices
| Characteristic | OR | 95% CI | P |
|---|---|---|---|
| Exercise at least 4 d in the past 7 d | |||
| Race | |||
| White (ref) | — | — | — |
| Black or African American | 0.53 | 0.24-1.15 | .11 |
| Asian | 0.71 | 0.48-1.04 | .08 |
| Other | 0.53 | 0.23-1.21 | .13 |
| Practice as an internal medicine physician (y) | 1.04 | 1.02-1.06 | .001 |
| Work duration (h/wk) | 1.00 | 0.99-1.06 | .66 |
| Female | 1.09 | 0.76-1.55 | .65 |
| Married | 1.16 | 0.69-1.93 | .57 |
| Children under 18 y | 0.70 | 0.47-1.06 | .09 |
| VA physician | 1.50 | 0.99-2.27 | .05 |
| Hospitalist | 1.18 | 0.78-1.80 | .44 |
| Personal hobbies at least 4 times in the past 30 d | |||
| Race | |||
| White (ref) | — | — | — |
| Black or African American | 0.14 | 0.05-0.40 | <.001 |
| Asian | 0.49 | 0.34-0.72 | <.001 |
| Other | 0.56 | 0.25-1.27 | .17 |
| Duration of practice as an internal medicine physician (y) | 1.01 | 0.98-1.03 | .60 |
| Work duration (h/wk) | 0.99 | 0.98-1.00 | .17 |
| Female | 1.04 | 0.72-1.48 | .85 |
| Married | 0.77 | 0.46-1.30 | .33 |
| Children under 18 y | 1.08 | 0.71-1.63 | .73 |
| VA physician | 1.18 | 0.79-1.77 | .42 |
| Hospitalist | 1.21 | 0.79-1.84 | .38 |
| Meditation practice at least 1 time in the past 7 d | |||
| Race | |||
| White (ref) | — | — | — |
| Black or African American | 1.13 | 0.49-2.61 | .78 |
| Asian | 1.59 | 1.07-2.37 | .02 |
| Other | 1.46 | 0.64-3.33 | .37 |
| Duration of practice as an internal medicine physician (y) | 1.01 | 0.99-1.04 | .28 |
| Work duration (h/wk) | 1.01 | 0.99-1.02 | .14 |
| Female | 1.51 | 1.04-2.20 | .03 |
| Married | 1.53 | 0.86-2.73 | .15 |
| Children under 18 y | 0.93 | 0.60-1.44 | .74 |
| VA physician | 1.25 | 0.82-1.89 | .31 |
| Hospitalist | 0.62 | 0.40-0.98 | .04 |
| Attend social event at least 4 times in the past 30 d | |||
| Race | |||
| White (ref) | — | — | — |
| Black or African American | 0.71 | 0.29-1.72 | .45 |
| Asian | 0.47 | 0.30-0.75 | .001 |
| Other | 1.57 | 0.69-3.54 | .28 |
| Duration of practice as an internal medicine physician (y) | 1.01 | 0.98-1.03 | .58 |
| Work duration (h/wk) | 0.99 | 0.98-1.00 | .12 |
| Female | 1.25 | 0.84-1.85 | .28 |
| Married | 1.08 | 0.60-1.92 | .81 |
| Children under 18 y | 1.17 | 0.73-1.87 | .52 |
| VA physician | 0.55 | 0.34-0.87 | .01 |
| Hospitalist | 0.74 | 0.47-1.18 | .21 |
| Volunteer at least 1 time in the past 30 d (y/n) | |||
| Race | |||
| White (ref) | — | — | — |
| Black or African American | 2.78 | 1.27-6.07 | .01 |
| Asian | 1.11 | 0.74-1.67 | .62 |
| Other | 1.56 | 0.68-3.54 | .29 |
| Duration of practice as an internal medicine physician (y) | 1.05 | 1.02-1.07 | .001 |
| Work duration (h/wk) | 0.99 | 0.98-1.00 | .08 |
| Female | 1.18 | 0.81-1.73 | .38 |
| Married | 1.86 | 1.02-3.41 | .04 |
| Children under 18 y | 1.64 | 1.05-2.58 | .03 |
| VA physician | 1.04 | 0.68-1.59 | .85 |
| Hospitalist | 1.20 | 0.77-1.87 | .42 |
VA, Veteran Affairs.
Exercise
Approximately half of respondents (54.1%, n=339/627) reported engaging in exercise or other physical activities at least 4 days in the past 7 days. Exercise frequency varied, with the most common being 5 days per week (17.4%, n=109/627). Multivariable regression revealed that the odds of exercising was greater among respondents with a greater number of years practicing as an internal medicine physician (OR, 1.04; 95% CI, 1.02-1.06; P=.001).
Personal Hobbies
When examining personal hobbies, 83.1% (n=518/623) of respondents reported engaging in these activities at least once, and 43.7% (n=272/623) engaged 4 or more times in the past 30 days. Multivariable regression showed that, when compared with White respondents, Black or African American (OR, 0.14; 95% CI, 0.05-0.40; P<.001) and Asian (OR, 0.49; 95% CI, 0.34-0.72; P<.001) respondents had lower odds of frequently engaging in personal hobbies.
Meditation Practice
Among all respondents, 61.8% (n=388/628) practiced some form of meditation (eg, breathing exercises, visualization, and yoga) in the past year, and 32.6% (n=205/628) engaged at least once in the past 7 days. Among those who engaged in meditation and who specified how long they had practiced meditation (n=333), total durations of practice varied, with the most respondents reporting practice for either 1-5 years (37.8%, n=126/333) or more than 10 years (31.8%, n=106/333). Multivariable logistic regression highlighted that Asian respondents had increased odds of meditating frequently (OR, 1.59; 95% CI, 1.07-2.37; P=.02) compared with White respondents. Female respondents also had increased odds (OR, 1.51; 95% CI, 1.04-2.20; P=.03). Respondents working as hospitalists had decreased odds of frequent meditation (OR, 0.62; 95% CI, 0.40-0.98; P=.04).
Social Event Attendance
When asked about attending social events within the past 30 days, 88.9% (n=555/624) of respondents attended at least 1 event and 26.9% (n=168/624) attended 4 or more events in the past 30 days. Asian respondents (OR, 0.47; 95% CI, 0.30-0.75; P=.001) and those working at Veterans Affairs facilities (OR, 0.55; 95% CI, 0.34-0.87; P=.01) had decreased odds of frequently attending in-person social events.
Volunteering
In terms of volunteering activities, 31.5% (n=197/625) of respondents volunteered at least once in the past 30 days, with 5.3% (n=33/625) volunteering 4 or more times in the past 30 days. Each additional year of practice as an internal medicine physician significantly increased the odds of volunteering (OR, 1.05; 95% CI, 1.02-1.07; P=.001). Black or African American respondents had higher odds of frequently volunteering compared with White respondents (OR, 2.78; 95% CI, 1.27-6.07; P=.01). Married respondents (OR, 1.86; 95% CI, 1.02-3.41; P=.04) and those with children under the age of 18 years (OR, 1.64; 95% CI, 1.05-2.58; P=.03) also had increased odds of frequent volunteering.
Discussion
The results of our national survey provide a robust snapshot of the patterns of engagement in well-being activities among internal medicine physicians following the COVID-19 pandemic. Our data revealed that exercise is the most common frequently practiced well-being activity among respondents—which could be attributed to the emphasis medical training places on physical health and its benefits—followed by engaging in hobbies and meditation. Compared with the general public, our findings suggest that internal medicine physician respondents may engage more frequently in certain well-being activities (exercise, meditation, and volunteering). General public estimates have been reported for participating in exercise 3 or more times weekly (24.2%),14 meditating at least once in the past 12 months (14.2%),15 and volunteering at least once in the past 12 months (24.8%).16 Although there is no recently published research on the frequency of engaging in hobbies and social events among the general public, the US Bureau of Labor reported in 2022 that Americans spent a mean of 3.08 hours daily on leisure activities (eg, sports, exercise, recreation, and watching television) and 0.56 hours daily on socializing (eg, face-to-face social communication and hosting or attending social functions).17
The likelihood of engaging in well-being activities varied depending on physician characteristics. For instance, longer-practicing physicians had greater odds of exercising at least 4 days per week and volunteering at least once within the past 30 days. It is unclear what factors drive these associations, but it is perhaps attributable to longer-practicing physicians having higher income available for activities, more time to spend engaging in personal outlets and stress management exploration, or cultural acceptance of certain activities in older adults. In addition, younger physicians are more likely to have childcare and elder care responsibilities, which could limit their free time to devote to personal activities.17 Amount of work hours is unlikely to affect this association as longer-practicing physicians, on average, work a greater number of hours.18 In line with this, we did not find any associations between an increase in the number of hours worked per week and any of the well-being activities assessed. We also identified racial differences for hobbies, meditation, attending social events, and volunteering. Frequent meditation was most prominent among Asian respondents, which may be attributable to cultural exposure and acceptance. Asian respondents also had a lower likelihood of attending social events. Research in the general population suggests that individuals of non-White race and of Hispanic ethnicity were noted to have more social isolation and greater declines in companionship than White individuals.19 Black or African American and Asian respondents were less likely to frequently engage in hobbies than White respondents. The difference in hobby engagement may be linked to research showing non-White populations have more constraints on leisure activities than their White counterparts.20 Additionally, non-White individuals tend to shoulder more caregiving and informal home care responsibilities21 and have more mental health concerns,22 which are 2 major barriers to hobby engagement.23 Black or African American respondents were more likely to have volunteered within the past month. Although we are unaware of other data suggesting that Black or African American physicians are statistically more likely to formally volunteer, research has shown that Black physicians are more likely to work within communities designated as medically underserved and areas with shortages of health professionals.24 Compared with male respondents, female respondents were more likely to frequently engage in meditation practices, which is aligned with findings based on the general population.25 We also found greater odds of volunteerism among married respondents and those with children under the age of 18 years, consistent with previous research.26
Our study was limited in several ways. First, although we achieved representation from across the country, it is possible that the surveyed physicians differ in some respects from those who chose not to engage in the study. Response bias (eg, those with time to respond to the survey and those caring about or engaging more in well-being activities) may have impacted our results. Second, given the cross-sectional design of our study, findings may be susceptible to reverse causality, and our ability to draw causal inferences is limited. Third, we used a Likert scale for many responses, which leads participants to choose among predetermined options rather than capturing more nuanced input. Although we observe our definitions of engagement in well-being activities reasonably reflect “frequent engagement,” dichotomizing the data in other ways may impact our findings. Fourth, our discussion focused on comparing our cohort with the general population, which does not capture the more specific comparison with other individuals with similar education and income levels. Finally, defining activity engagement based on frequency rather than time spent may overlook how deeply individuals are engaged in these activities. Limitations notwithstanding, our national study provides insight into the well-being practices of a broad cohort of internal medicine physicians across the United States following the worldwide COVID-19 pandemic.
Conclusion
We found that internal medicine physicians are more actively involved in well-being activities such as exercise, meditation, and volunteering compared with the general population. Demographic factors such as length of practice, sex, and race appear to influence these behaviors, which likely reflects a complex interplay of cultural, economic, and social determinants. Future efforts to enhance physician well-being and reduce burnout should consider these types of individual physician characteristics.
Potential Competing Interests
The authors report no competing interests.
Ethics Statement
The study was reviewed and deemed exempt from regulation by the University of Michigan Institutional Review Board (HUM00228326). Completing a survey implied consent to participate in the study. The surveys did not include any personally identifiable information and were anonymous.
Acknowledgments
The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the US government.
Footnotes
Grant support: This work was supported by a grant from the Agency for Healthcare Research and Quality (grant number R18HS028963), who had no role in the study’s design, data collection, data analysis, reporting, or decision to submit for publication.
Supplemental material can be found online at http://www.mcpiqojournal.org. Supplemental material attached to journal articles has not been edited, and the authors take responsibility for the accuracy of all data.
Supplemental Online Material
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