Physicians as Patients: Better Health, Less CV Prevention Among Ontario Doctors Than General Public
It’s likely that experience and training allow physicians to better control their risk factors and recognize any symptoms.
Compared with the general population, physicians in Ontario, Canada, have fewer cardiovascular risk factors, are less likely to have major adverse cardiovascular events, and are less likely to receive preventive services, according to new retrospective data.
“The way physicians interact with the healthcare system is quite different” from how their patients do, lead study author Dennis Ko, MD, MSc (ICES, Toronto, Canada), told TCTMD. Given the recent emphasis on physician wellness and burnout, he added, these findings are not only interesting but informative in terms of learning how to better deliver preventive care in general.
It might be that due to their experience, physicians are “more attuned” to certain symptoms and seek out the appropriate care, Ko suggested, and it’s possible that educational materials can be designed to improve this recognition for the general public. Additionally, he said, because the baseline cardiovascular profile of physicians was better overall, “I think there's a lot of work [to be done in terms of] primary prevention treatments—exercise, diet, and things like that—to lower the risk profile of the general public. I think that's quite important.”
With Experience Comes Knowledge
For the study, published recently online in JAMA Network Open, Ko and colleagues followed more than 17,000 physicians and 5 million nonphysicians in Ontario who were 40 to 75 years old and did not have known cardiovascular disease in January 2008; follow-up lasted through 2015. At baseline, physicians were less likely to have hypertension (16.9% vs 29.6%) or diabetes (5.0% vs 11.3%) or be smokers (13.3% vs 21.6%), and they had better cholesterol profiles compared with the general public. Physicians also had a slightly higher rate of A-fib (1.8% vs 1.1%).
Over 8 years of follow-up, physicians were less likely to see a primary care physician (88.1% vs 93.6%) and had fewer periodic health exams (58.9% vs 67.9%). They were also less likely to be screened for hyperlipidemia (76.3% vs 83.8%) or diabetes (79.0% vs 85.3%), but they were more likely to see a cardiologist (17.8% vs 13.0%; P < 0.001 for all). Echocardiography was used more often in physicians (34.0% vs 32.3%; P = 0.004), but electrocardiography was used less often (64.4% vs 74.4%; P < 0.001).
Ko admitted that it was “disappointing” that physicians received less screening because it has important implications for primary prevention.
Notably, the differences in use of health services were larger in men than in women. For instance, male physicians were 8.9% less likely to see a primary care physician compared with male nonphysicians; the difference was only 2.2% in females.
After adjustment for age, sex, socioeconomic status, and cardiac risk, physicians were 22% less likely than the general population to have a major cardiovascular event (defined as cardiovascular death or hospitalization for MI, stroke, heart failure, or coronary revascularization; HR 0.78; 95% CI 0.72-0.85). This finding maintained significance among a range of subgroups stratified by both age and sex.
“Our study . . . provides unique insight into how physicians encounter the healthcare system,” Ko and colleagues write. “Physicians had fewer visits to family physicians and periodic health examinations, but were more likely than the general population to have consulted with specialists. This discrepancy could be related to physicians engaging more in routine self-care and therefore not routinely seeing or consulting with a primary care physician as often as the general population. In addition, many physicians have encounters with specialists in their work environment that facilitate direct consultations with specialists, enabling bypassing of the traditional primary care gateway.”
Ko said “it's difficult to know” what all of these findings mean. While it’s likely that physicians control their cardiovascular risk factors better than the general population, the impact of this remains unknown, he observed. Also, it’s plausible to think that physicians seek help earlier, and this is evidenced by the fact that physicians had more A-fib but less hypertension in the study. “There are a lot of things that we're still not sure about, but all the hypotheses are reasonable, because I think that in general, physicians, having gone through medical school, do know a bit more than the general public.”
In addition to further examination of factors that can help explain these findings, Ko said future research should also look into the connection between whether healthier physicians beget healthier patients.
Ko DT, Chu A, Austin PC, et al. Comparison of cardiovascular risk factors and outcomes among practicing physicians vs the general population of Ontario, Canada. JAMA Netw Open. 2019;2(11):e1915983.
- This study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care.
- Ko reports no relevant conflicts of interest.