A survey of physicians’ perceptions of their health care needs

Abstract

Background

Physicians may face unique challenges in accessing health care and managing their own health.

Aims

To evaluate physicians’ perceptions of their health care needs and desired services.

Methods

A written survey, distributed and collected anonymously among attendees at a large primary care continuing medical education conference.

Results

The survey was given to 346 physicians and 141 (41%) responded. The majority of physicians (53%) reported having difficulty accessing health care and reverting to self-diagnosis and treatment (63%). Over 83% reported having or knowing a colleague who had a career-threatening illness and 42% had experienced concern about a colleague’s ability to practise safely.

Conclusions

Physicians as an occupational group have challenges in accessing health care, very commonly suffer career-limiting illnesses and revert to self-diagnosis and treatment. Programmes tailored to providing health care to physicians are needed.

Introduction

Physicians as an occupational group share several common health risks. These include burnout, chemical dependency and suicide [1,2]. Some are exposed to radiation, communicable diseases, repetitive trauma and the demands of sustained postures [3–6]. When physicians experience injury or illness, the resulting impact on productivity can be profound for both the individual and the health care system [6]. It has long been recognized that when physicians are patients, they experience unique challenges in accessing care. Schneck [7] outlined a number of possible factors influencing how physicians respond to illness. Among those were fear that illness equates to weakness, inability to reverse roles, fear of loss of confidentiality and privacy and a tendency to subordinate personal needs to practice demands.

Compounding these unique challenges is the fact that many physicians do not have a primary care provider. Gross et al. [8] found that 77% of physicians involved in the Johns Hopkins Precursor study did not have a regular source of medical care and another study on Australian physicians found that only 42% had a primary care provider [9]. Physicians may neglect their own care and a study of Canadian physicians demonstrated that only 55% of physicians had a physical check-up in the prior 2 years and 44% were either overweight or obese [10]. Physicians may also resort to unsafe practices such as self-prescribing, which has been found to be common [9–14] but is expressly discouraged by the American Medical Association’s ‘Code of Medical Ethics’ [15]. Reasons for physicians’ failure to obtain optimal health care may include being unaware of available specialized resources or being uncomfortable using them. One study found that respectively only 19 and 13% of physicians strongly agreed that they knew of resources that they would be comfortable using if they had either physical or mental health and substance abuse problems [10]. Since the nature of their job gives many physicians ready access to medical care, the cause of this is unclear. Some studies show that physicians who treat physicians may need special skills that are not routinely developed in training and that the barriers experienced by the physician patient can be mitigated by a skilled and trained physician provider when those barriers are well understood and addressed [7,16]. In addition, physicians’ health may affect their patients. Frank et al. [17] found that physicians who practise healthy behaviours and discuss these with their patients are better able to motivate patients to adopt healthy habits. It has been shown that physicians’ own health behaviour is a predictor of their counselling practices with patients [18,19].

Given the obvious challenges associated with caring for physicians, both from a primary care as well as an occupational health perspective, we surveyed physicians to identify their health care needs, common medical conditions that they have encountered and have affected their careers and perceived barriers to care, as well as the type of health services they consider to be needed and useful.

Methods

A literature review did not identify existing validated surveys addressing health care needs of physicians or other similar professional groups. Therefore, researchers with expertise in survey development methods developed a questionnaire based on input from physicians who work in an employee health clinic and regularly care for a cohort of physician–patients. Feedback was also obtained from reception and administrative staff about the frequency and patterns of appointments requested by physicians. The survey was piloted on a small group of physicians who provided feedback that led to refinement of questions. The survey was delivered in paper format to attendees of a large primary care continuing medical education conference in the USA. The survey was collected without personal identifiers in a collection box. This survey was part of a quality improvement effort aimed at improving physician health care and was deemed exempt by The Mayo Clinic institutional review board. It consisted of 11 questions (Table 1). Questions with response scales from 1 to 10 were summarized using means and standard deviation. The first four questions were also categorized into three groups based on the scores (1–4, low; 5–6, neutral; 7–10, high) and were analysed as a categorical variable. The rest of the questions were analysed as continuous variables. P < 0.05 was considered statistically significant.

Table 1.

Survey questions^a

Question	Mean	SD	1–4, n (%)	5–6, n (%)	7–10, n (%)
How well do physicians in general prioritize care of their own health?b	5.29	1.94	54 (38)	44 (31)	43 (31)
How would you prioritize caring for your own health care?b	6.69	2.15	28 (20)	33 (23)	80 (57)
How difficult is it for you to find time and get access to appropriate health care?c	6.38	2.81	46 (33)	19 (13)	76 (54)
How often do you or colleagues revert to self-diagnosis/self- treatment because of barriers to getting care?d	6.62	2.60	33 (23)	19 (13)	89 (63)
What do you see as the main barriers to physicians getting appropriate health care?e
Finding time	7.33	2.65	26 (18)	10 (7)	105 (74)
Confidentiality	5.48	2.76	53 (38)	27 (19)	61 (43)
Seeing someone I know	5.26	2.70	58 (41)	30 (21)	53 (38)
Cost of care	2.88	2.01	106 (75)	27 (19)	8 (6)
Cost of lost work time	5.39	2.91	53 (38)	27 (19)	61 (43)
Not encouraged by employer	3.72	2.88	86 (61)	25 (18)	30 (21)
Don’t believe in it	2.05	1.66	120 (85)	13 (9)	8 (6)
How would you rate the usefulness of these services to you?f
Rapid/walk in access to preventive care	5.35	3.04	57 (40)	29 (21)	55 (39)
Access to comprehensive care in a 1–2 day visit	6.93	2.72	26 (18)	24 (17)	91 (65)
Confidential phone consultation regarding health concerns	6.77	2.74	28 (20)	28 (20)	85 (60)
Rapid referral access for yourself of a colleague with a serious medical condition	8.65	1.66	5 (4)	9 (6)	127 (90)
Access to care during or adjacent to a CME course	5.56	3.03	49 (35)	32 (23)	60 (43)
Advising, counselling, training services related to career and work–life balance	6.81	2.67	32 (23)	25 (18)	84 (60)
A research programme dedicated to the health needs of physician	6.57	2.68	31 (22)	30 (21)	80 (57)
Question	Yes, n (%)	No, n (%)	NRg, (%)
Career-threatening illness and ability to practise
Have you ever had a career-threatening illness?	38 (27)	102 (69)	1 (1)
Have colleagues you know had a career-threatening illness?	118 (84)	20 (14)	3 (2)
Have you dealt with the situation of wondering whether a colleague is safe to practise?	59 (42)	81 (58)	1 (1)
Have you or your practice ever needed referral to assess an ill colleague?	50 (35)	85 (60)	6 (4)

CME = continuing medical education.

^aThe table showed only questions with numeric answers. The survey included one additional open-ended question.

^bThe scale used in each question is a 10-point scale (1–10) where 1 is very low priority and 10 is very high priority.

^cThe scale used in each question is a 10-point scale (1–10) where 1 is very difficult and 10 is very easy.

^dThe scale used in each question is a 10-point scale (1–10) where 1 is never and 10 is very often.

^eThe scale used in each question is a 10-point scale (1–10) where 1 is minor barrier and 10 is major barrier.

^fThe scale used in each question is a 10-point scale (1–10) where 1 is not at all useful and 10 is very useful. ^gNR = not reported.

For the most common diseases, answers were divided into six main groups: (i) psychiatric illnesses including depression, anxiety and schizophrenia; (ii) abuse of substances including alcohol, cocaine and other drugs and illegal substances; (iii) cognitive problems including Alzheimer’s disease, memory disturbance and dementia; (iv) cancers of any kind; (v) neurological disorders including paralysis, stroke and Parkinson’s disease and (vi) heart disease including coronary artery disease, angina and myocardial infarction. We considered responses from 1 to 4 on a Likert scale to be negative, 5 to 6 to be neutral and 7 to 10 to be positive. The survey was analysed using STATA 12.1.

Results

The survey was distributed to 346 conference attendees affiliated with 184 different medical centres, the majority of which were in the US Midwest. Sixty-eight per cent of attendees practised family medicine and 8% practised general internal medicine with the remainder practising in a variety of other sub-specialities. One hundred forty-one completed the survey, an overall response rate of 41%. Table 1 summarizes the survey results.

Over 53% of respondents felt it was difficult to find time and access to care and over 63% reported that they or others reverted to self-diagnosis and treatment because of barriers to care. Respondents who were less likely to prioritize caring for their own health reported more difficulty in finding time and getting access to appropriate health care (P < 0.001) and were more likely to report that they or their colleagues reverted to self-diagnosis and/or treatment because of barriers to getting care (P < 0.05). Nearly 27% of respondents reported having had a career-threatening illness and over 83% knew a colleague who had one. In addition, 42% had experienced situations where they wondered about the ability of a colleague to practise safely. The survey asked ‘What illnesses seem to be most likely to affect a physicians’ ability to practise?’ and responses were grouped into six categories, shown in Table 2. Overall psychiatric illness was the most common answer given by primary care providers (52%), followed by substance abuse (48%) and cognitive problems (21%). Other illnesses considered most likely to affect physicians’ ability to practise are listed in Table 2.

Table 2.

Illnesses perceived to affect physicians’ ability to practise

Illness category	n (%) (n = 141)
Psychiatric illness	73 (52)
Substance abuse	68 (48)
Cognitive problem	30 (21)
Cancer	28 (20)
Neurological disorder	27 (19)
Heart disease	25 (18)

Figure 1 presents responses concerning barriers to care on a scale from 1 to 10, where 1 is a minor barrier and 10 is a major one. Finding time was the most commonly cited barrier followed by confidentiality and cost of lost work time, with 74 and 43%, respectively, finding these to be major barriers (i.e. a response of 7 or more).

Figure 1.

The main barriers to physicians getting appropriate health care.

Figure 2 represents responses concerning the usefulness of services, where 1 is not useful at all and 10 is very useful. Rapid referral and access to comprehensive care in 1–2 days were most commonly cited as very useful, with 90 and 65%, respectively, finding these to be very useful (a response of 7 or more).

Figure 2.

The usefulness of the services to physicians.

Discussion

The results of this survey found that physicians reported it difficult to access health care and often resorted to self-diagnosis due to a variety of barriers in receiving care. Finding time was the main barrier identified. Concern about confidentiality and the cost of lost work time were jointly the second most commonly cited barriers. Respondents reported that the most useful services for them were rapid referral access, advice regarding work–life balance, comprehensive care provided in a short time and confidential phone consultation about health concerns. The types of illness that respondents most frequently reported as affecting physicians’ ability to practise were psychiatric illness and substance abuse, which is consistent with previous studies [16].

In the USA, physicians access health care services in a similar fashion to the general population. There are no special clinics, established systems or unionized coverage or access specifically designed for physicians. US physicians’ health care is mostly covered by private insurance, except for those aged over 65 who have Medicare benefits. Insurers’ health care plans may take the form of a health maintenance organization or preferred provider organization that restricts access to a certain group of providers and mandates starting with a primary care provider, or they may offer open access to any provider [20].

In our study, a large number of respondents either had or knew a colleague who had had a career-threatening illness and nearly 42% had dealt with a situation where they were concerned about a colleague’s ability to practise safely. This finding is of concern given that DesRoches et al. [21] found that only 69% of physicians are prepared to deal with an incompetent colleague and that only 67% of those who had direct knowledge of an impaired or incompetent colleague had reported their concern to a relevant authority. In common with previous research on the subject [9–14], respondents in this survey reported a high level of self-diagnosis and treatment, although respondents in this survey specifically related this to barriers to accessing care. This practice has been linked to misuse of prescription medications [22].

This study has several limitations, including a response rate of 41% and the fact that to preserve anonymity, we did not collect data on physicians’ characteristics. Therefore, we could not further stratify results by age, gender, geographic location of respondents, employer type or size. Inferences that can be drawn from this study apply to attendees at a primary care conference in the US Midwest, with no other data on the demography of respondents (e.g. gender, medical practice in rural versus urban areas, etc.). These characteristics could affect the responses and caution should be exercised when extrapolating these findings to physicians in other specialities or geographic locations. Other inherent limitations relate to the cross-sectional nature of the study.

This survey also found that career-limiting illness was reported as not being uncommon among physicians, and physicians faced significant barriers when seeking health care and that unsafe behaviours such as self-treatment and self-diagnosis were common. Given the significant impact of these findings on physicians’ health, which may in turn affect the well-being of their patients, there is a clear need to address physicians’ health in a systematic fashion. Our data provide the basic components for developing programmes, which address what physicians need and perceive as important. Further research is needed to define physician health care needs more fully and to test different approaches. Our data suggest the need for better programmes to provide health care to physicians.

• Physicians in this study in the US Midwest reported challenges in accessing health care, which they perceive to be appropriate to their needs.

• Physicians in this study population commonly reported experiencing career-limiting illnesses in themselves or colleagues and frequently resorted to self-diagnosis and treatment.

• Programmes tailored to providing health care appropriate to physicians’ needs and wishes are needed to improve the health of physicians and thereby protect the welfare of their patients.

Conflicts of interest

None declared.