Are physicians drinking to cope with stress and burnout?

With physician stress and burnout at all-time highs, a meta-analysis published in JAMA Network Open looked at whether they are turning to alcohol in order to cope.

Researchers note that historical evidence suggests problematic alcohol use may reflect that of the general population, this may be changing over the last few decades as the demographic makeup of physicians shifts. An increase in the reported proportion of problematic alcohol use by physicians in the last 15 years has increased from 16.3% to 26.8% was noted in the report, but researchers say this may be due to increased transparency by physicians self-reporting problematic use.

While males are more likely to have problematic alcohol use than females, there was no clear differences in use by age, specialty, or career stage, according to the report.

However, researchers say that available data surrounding the extent of problematic alcohol use in physicians have historically come from license and disciplinary actions, known or registered problematic users, mortality rates, hospital admissions, and treatment populations, and surveys of selected groups of physicians. As these are highly select groups, the prevalence of problematic alcohol use in physicians remains unknown.

“Self-reported alcohol consumption has been shown to amount to approximately 40% to 60% of total alcohol sales in the general population, which highlights the high likelihood that the extent on problematic alcohol use using self-reported data and is likely a vast underestimation of its true prevalence,” the report reads in part.

Most of the studies analyzed had low response rates, possibly indicating physicians may be hesitant to participate in studies about alcohol use, or may be familiar with alcohol-screening questionnaires and may shift their answers so they screen negative. There may also be fear of reporting because of possible reprisals by colleagues and licensing boards. As a result, researchers note that the levels of problematic alcohol use identified in the meta-analysis likely underestimates the scale of the problem and the consequent harms.

Trends in drinking patterns in the general populace also likely indicate that sex-based differences may be narrowing, researchers say. In the United States, the prevalence of high-risk drinking between 2001 and 2012 increased by 57.9% in women, relative to a 15.5% increase in men.“Stress-related drinking has been noted to be a unique factor in alcohol use in women, and given the stressful nature of the profession of medicine, female physicians may be at an increased risk,” the report reads in part.

There is also a dearth of information on the extent of problematic alcohol use by specialty, with the two studies available reporting that surgical specialties are more likely than nonsurgical specialties to screen positive for problematic alcohol use.

Researchers say that cultural changes minimizing stigma and reducing obstacles to seeking help may encourage physicians to seek help. Future research could aim at better understanding factors that limit physician disclosure of problematic alcohol use and ultimately deconstruct these factors to promote care-seeking behavior in physicians.