Whether your primary care doctor keeps fit can determine the quality of your own care. Here are eight charts that explain the state of physician fitness in the United States.
Your doctor's job is to make sure you stay healthy. But what about his own well-being? If your physician isn't in shape, it's a sign you may be receiving inferior care. In a recent Johns Hopkins University study, physicians were found to be much less likely to talk to their patients about weight if they were overweight themselves. Ninety-three percent of primary care doctors admitted diagnosing obesity only when it was clear that the patient was heavier than the physician. Overlooking the weight issue might make for a happier doctor-patient relationship -- but then, politeness never reduced anyone's risk of diabetes.
If the quality of your doctor's care fluctuates with his own fitness, it's worth asking just how healthy America's physicians are. Do they exercise more than the rest of us? Have heart disease and diabetes at greater rates? Suffer from depression and commit suicide with the same frequency that we do?
The good news first: doctors are good at avoiding risky behavior. Compared to everyone else, they almost never smoke, they rarely drink, and they lack many of the obesity-related chronic illnesses that are threatening to overwhelm the country's health-care system. Those data come from the Physicians' Health Study II (PHS-II), a 10-year clinical trial involving over 14,000 middle-aged male doctors that concluded in 2006.
The bad news, though, is that those same doctors suffer from problems that are harder to detect at a glance. They often have high blood pressure and cholesterol. Many suffer from depression -- and attempt suicide -- at greater rates than the rest of the country. It's hard to say whether the job has much to do with it, although studies also show that students in medical school also report feelings of depression in remarkable proportions.
Comparable polls of female physicians are less exhaustive, unfortunately - they're limited to a handful of minimally-informative metrics.
For male and female doctors alike, the most recent statistics available mainly date to the late 1990s. Due to the variance across studies, not all of the numbers allow for an apples-to-apples comparison. Still, even a rough matchup reveals that doctors differ vastly in many ways from the rest of us -- but in other ways, we're just the same.
The clinical definition of obesity is having a Body Mass Index (BMI) of 30 or greater. Among male physicians, the obesity rate is only 11 percent. That's pretty impressive, especially when more than a third of all Americans are considered obese. Meanwhile, 41 percent of doctors have a "normal" BMI of less than 25, outpacing comparable middle-aged Americans by 18 percentage points.
But just because doctors aren't obese doesn't mean they're all slim. Another 47 percent of male physicians suffer from excessive weight, according to the baseline survey -- about three and a half percentage points higher than the average male American in middle age.
Americans on the whole actually exercise a bit more than doctors do. In 2009, a Gallup-Healthways poll found that just over 68 percent of Americans exercised at least once per week. Only 60 percent of male physicians could say the same. Thirty-one percent of Americans admitted to not exercising at all, compared to 38 percent of doctors participating in PHS-II.
The only representative data we have in terms of diet is a measure of sufficient intake of fruit and vegetables. Despite advances in some states, Americans nationally still aren't meeting targets. Just 26 percent of us manage three to five servings of vegetables per day, and 14 percent of us get three to five servings of fruit. That means as many as 86 percent of Americans are missing out on some of their necessary fruits or vegetables daily. Data on female physicians don't seem to paint a prettier picture: about 15 percent of doctors surveyed said they got five or more fruits or vegetables in their diet per day.
More than half of male physicians say they've never smoked. Forty percent say they used to, but have since quit. Only four percent still smoke on a regular basis. That's compared to 23 percent of Americans aged 45-64 who say they smoke. Of course, members of older generations come from a time when smoking was more prevalent; overall, the rate of smoking among the entire adult U.S. population stands at 19.3 percent.
Doctors admit to having hypertension at far greater rates than other Americans in their cohort. Forty-two percent of those participating in PHS-II said they had high blood pressure. By contrast, among all men aged 40-59 in 2006, only about a third said the same. And among all men over the age of 18, the rate of hypertension was 28 percent in 1999. By 2005, that figure had risen to about 30 percent.
In 1999, a quarter of all middle-aged men in America had high cholesterol. People in the same age bracket today have high cholesterol at a rate of about 17 percent. Both numbers are actually more promising compared to middle-aged male physicians, 35 percent of whom admitted in 1997 of having high cholesterol or that they were being treated for it. Of all American men, just 12 percent had high cholesterol as of 2010.
Male physicians suffer from diabetes at remarkably low rates compared to the rest of us -- just six percent. Last year, nearly 14 percent of men aged 45-64 and 12 percent of men older than 20 carried a diabetes diagnosis.
According to data from PHS-II, 95 percent of doctors were heart disease-free in 1997. Just five percent reported a history of cardiovascular disease (including non-fatal heart attacks and strokes). By comparison, among the general population (see page 16), 12 percent of men of all ages had some type of heart disease in 2010. Roughly the same was true for Americans of both sexes aged 45-64 (the report doesn't break the data down for middle-aged men, unfortunately).
Regrettably, this is one of the only subjects in which data on women physicians is actually more readily available than information about male physicians. Estimates suggest that some 20 percent of female primary care doctors have a history of depression, and as many as 1.5 percent have attempted suicide. Among U.S. women as a whole, just over 3.5 percent reported feelings of perpetual sadness in 2010. About 2.3 percent said they felt hopeless all the time, two percent said they felt worthelss all or most of the time, and six percent said everything they did was an effort all or most of the time.
CAUSES OF DEATH
All of these health conditions raise the risk of death. But what actually ends up killing most doctors? Turns out, they're a lot like the rest of us in that respect:
Compared to the rest of the population, doctors die of heart disease just a little bit less, cancer a little bit less, and flu a lot less. The key numbers are under the "proportionate mortality ratio" column, where figures above 100 indicate a greater likelihood of death from a given cause relative to the average citizen, and numbers below 100 indicate a reduced likelihood. As the data on depression might suggest, doctors are far more likely to die by suicide than the average American.
Here's a different breakdown of the data, ranking the causes of doctor death by the things that are most likely to knock them off relative to non-doctors:
- Brian Fung is an associate editor at The Atlantic. He has written previously for Foreign Policy, The Washington Post, and Talking Points Memo.