Hobbies and Leisure Activities in the Mitigation of Physician Burnout

Joel Popkin, MD, MACP

During internship in 1974, when we often worked more than 100 hours per week – including the infamous 60-hour shifts – there was no burnout in any training program. After all, the term “burnout” wasn’t “invented” until 1975 [1]. Freuenberger initially defined burnout as “failure or exhaustion because of excessive demands on energy, strength, or resources.” But even in retrospect, while we interns were often terribly fatigued, we weren’t “burned out,” per se, by those “excessive demands.” The difference is that in 1974 our punishing workloads were largely meaningful, while today’s mandated “less excessive” work is degraded by ever escalating technology-based demands – e.g., the EHR, bureaucratic tasks, regulations, etc. – all resulting in painful distancing from our patients [2].

What follows is a look at a single potential mitigation of burnout: The utilization of hobbies and other leisure interests. In contrast to mostly casual comments in the literature that hobbies are good things to do, our group performed a quantitative study on this topic [3].

Burnout among physicians is a worldwide burden. Clinician burnout dramatically impairs physicians, with extension to their patients, peers, students, staff, and families [4]. The burnout epidemic is now internationally recognized (International Classification of Diseases, Eleventh Revision), and its cost is in the billions of dollars [5]. The overall

prevalence was reported between 40-75%, even before COVID-19 devastated hospitals and private practices.

In an online survey we received responses from more than 3000 US-based physicians (512 residents/ fellows) about their participation in our devised list of 117 individual hobbies, which we sub-grouped into 15 categories for analytic purposes (Fig 1). Examples of “categories” included team sports, non-team/ individual sports, playing musical instruments, reading for pleasure, writing, visual arts, playing games, etc. Respondents were asked to describe their personal activity status for each of the 15 categories in the last six months as “currently active” “formerly active”, or “rarely/never participated.” Additionally, we categorized the 117 hobbies into three perceived levels of social interactivity – 36 as “social,” 47 “isolated,” and 34 “indeterminate.” We used the “Oldenburg Burnout Inventory” to quantitate burnout as well as disengagement from work (the latter a topic for another day).

Significant differences were seen across age groups, genders, and physician specialties in the level of burnout. Younger providers (age < 60), women and trainees had higher levels of burnout. North American graduates reported slightly higher rates of burnout and disengagement than international graduates. Nearly 94% of physicians felt it was important or extremely important to have outside interests.

In each of our 15 major categories of hobbies, burnout was significantly lower in those who were active in that category vs. those who were not. The highest levels of burnout, however, were directly associated with discontinuance of hobbies and proportionately to the number of hobbies given up (Fig 1). Across all demographic groups, lower burnout was associated with a higher number of active hobbies and leisure activities, as opposed to higher burnout being directly proportional to the number of hobbies given up (Figs 2a and 2b).

Fig. 2a. Burnout negatively associated with the number of active hobbies

Fig. 2b. Burnout directly associated with the number of former (given-up) hobbies

As shown in Fig 3, despite being among the top favorite hobbies by the majority of respondents, listening to music (C4) and watching TV, movies, internet, video games or other media at home (C11) were associated with the highest level of exhaustion. On the other hand, participating in team sports (C1) and group games/role play (C12) were associated with the lowest level of exhaustion. In other words, the least burnout was associated with the subsets of the 15 categories that we defined as the most “social”.

The bubble colors correspond to hobby categories, while the height represents burnout level (mean exhaustion score), and the size of the bubbles represents reported hobby frequency.

Music listening and home entertainment registered highest on the burnout scale of associated hobbies, but perhaps these findings reflect more of a compensatory mechanism secondary to levels of stress that initially led to the pursuits. Recent articles have addressed the potentially isolating nature of these passive digital-based activities [5].

Socialization is a remarkably powerful factor in mental and physical health, with loneliness and isolation linked to heart disease, cancer, depression, diabetes and suicide [5]. In pre-COVID 2018 – when our survey was conducted – former Surgeon General Vivek Murthy had already described a “loneliness epidemic [6],” in which nearly a quarter of physicians reported suicidal thoughts or even attempts. Indeed, social isolation has always been injurious; COVID-19 only proliferated the psychosocial/ medical/economic risks of seclusion.

Although this study identified associations rather than causality, emphasizing hobbies and non-medical outside interests might well prove useful to temper epidemic burnout among healthcare professionals. We especially encourage those hobbies with stronger social underpinnings.

Who has time for hobbies, particularly overworked residents? Probably no one. But lifelong interests don’t develop at age 65, so time must be made. A study from Germany, in which 200 physicians were interviewed about resilience strategies, put this in perspective: “Respondents did not simply pursue hobbies when they had time to do so. Rather, they made sure to find the time they needed to pursue the hobbies that were important to them [7].”

I hasten to emphasize that the objective here is not to address the fundamental system issues (see above) that relentlessly afflict practitioners. But we must be especially mindful to avoid placing blame on providers for “inadequate coping skills” that invite burnout. Dean et al. [8] remind us that this pseudo-culpability may be likened to “gaslighting” – i.e., system-induced self-doubt, rather than the system-inflicted “moral injury” that is truly responsible for these crises.

As to comments about the importance of hobbies and interests, please note: Share them with family and friends. And with current recommendations of “social prescribing,” it seems time to get out our prescription pads. +

References

1. Freudenberger HJ. The staff burn-out syndrome in alternative institutions. Psychotherapy: Theory, Research & Practice 1975; 12(1):73–82.

2. National Academies Press (US). Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being. Washington (DC); 2019.

3. Li Y, Lai C, Friedrich B, Liu C, Popkin J. The Association of Hobbies and Leisure Activities with Physician Burnout and Disengagement: Journal of Wellness 2023; 5 (1): 1-13

4. Yates SW. Physician Stress and Burnout. Am J Med 2020; 133(2):160–4.

5. Klinenberg E. Is Loneliness a Health Epidemic? The New York Times

Feburary 9, 2018 [cited 2019 Mar 20]. Available from: URL: https://www. nytimes.com/2018/02/09/opinion/sunday/loneliness-health.html.

6. Schawbel D. Vivek Murthy: How To Solve The Work Loneliness Epidemic. Forbes 2017 Oct 7 [cited 2020 Mar 12]. Available from: URL: https://www. forbes.com/sites/danschawbel/2017/10/07/vivek-murthy-how-to-solve-thework-loneliness-epidemic-at-work/?sh=748ae2997172.

7. Zwack J, Schweitzer J. If every fifth physician is affected by burnout, what about the other four? Resilience strategies of experienced physicians. Acad Med 2013; 88(3):382–9.

8. Dean W, Dean AC, Talbot SG. Why ‘Burnout’ Is the Wrong Term for Physician Suffering. Medscape; 2019. Available from: URL: https://www.medscape. com/viewarticle/915097.

Joel Popkin, MD, MACP is a Professor Medicine at UMass Chan Medical School and a Program Director Emeritus at St. Vincent Hospital.