Burnout remains pervasive among European physicians, and many say they would accept lower pay for a better work-life balance, according to a Medscape survey of nearly 6000 doctors in six countries.

“A particularly notable finding in the Medscape survey is the percentage of doctors willing to accept pay reductions in exchange for improved work-life balance,” said David Berhanu, MD, PGDip, a neuroradiologist at the Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal, and chairperson of the European Junior Doctors Association (EJDA).

“The results of the survey are very interesting and portray a scenario aligned with our own findings,” he added. An EJDA study released earlier this month reported junior doctors “work well beyond their legal and contracted hours” — averaging 57 hours per week despite the European Working Time Directive (EWTD) limit of 48 hours.

Long Hours Drive Dissatisfaction

“While satisfaction with their work is still relatively preserved, significant proportions of doctors are dissatisfied with their work-life balance,” Berhanu continued.

Among physicians working more than 48 hours per week, dissatisfaction “skyrockets,” rising fourfold compared with colleagues working fewer than 48 hours, he told Medscape News Europe. Long hours and insufficient rest, he noted, are driving dissatisfaction and burnout — and demand policy action to stem attrition from European health systems.

Physician shortages intensify workload, stress, and burnout, said Alessandra Spedicato, MD, an anesthesiologist and intensive care physician at Sandro Pertini Hospital in Rome, Italy, and president of the European Federation of Salaried Doctors.

“The most demanding specialties are precisely those suffering from the most severe staff shortages and, therefore, report higher dissatisfaction and fatigue,” she said.

The results of the Medscape survey may also reflect broader contextual factors — including uneven implementation of the EWTD (particularly in Spain and Italy), salary dissatisfaction (notably in Italy), and cross-country differences in how happiness is perceived.

Italy: Most Unhappy, Vacation Gap Widest

Italian doctors responding to the Medscape survey were the least satisfied with their lives both at work and outside it and gave the lowest ratings for mental well-being. Although 84% rated vacations as important to mental health and happiness, only 23% took 5 or more weeks of holiday per year — the lowest proportion among all nations surveyed.

A majority (61%) said they were unable to take as much vacation time as they would have liked, and 55% said their legally entitled days off were insufficient for real recovery or productivity.

“Many doctors report difficulties in taking the leave they are legally entitled to, again due to staff shortages,” Spedicato said. “There is often a gap between the number of days theoretically available, especially consecutive ones, and those actually taken.”

While 37% of Italian doctors said they would give up part of their salary in exchange for better work-life balance, 33% said they would not.

“Given that doctors’ social and economic status is no longer as high as it once was, a reduction in income could significantly impact their personal and family life,” Spedicato noted — which may explain the large proportion (29%) who were undecided.

France: Strong Leave Benefits, Stigma Around Depression

Salaried French doctors generally receive 5 weeks of paid leave plus 4 weeks of reduced working hours, said Ariel Frajerman, MD, PhD, a psychiatrist at the Institute of Psychiatry and Neuroscience in Paris, France. French physicians responding to Medscape’s survey were generally happy in their work and reported the lowest levels of job fatigue, yet 15% reported feeling burned out, with an additional 7% saying they were both burned out and depressed. The share reporting depression (11%) was among the highest.

“The fact that doctors are more likely to report burnout than depression is partly due to social acceptability,” Frajerman said. “Burnout is common, whereas depression is a psychiatric illness and therefore more stigmatized.” He believes both alcohol use — cited as a stress-coping strategy by just 10% of French doctors — and psychotropic drug use among doctors are underreported.

Germany: High Satisfaction, but Red Flags 

Physicians in Germany were the most likely (16%) to report drinking alcohol in response to stress. They also were most likely to say they get sufficient sleep, and most were happy with their lives at and outside work.

“This aligns with our own research, which yielded nearly identical figures,” said Tobias Esch, MD, director of the Institute for Integrative Health Care and Health Promotion at Witten/Herdecke University in Witten, Germany. “The situation of German physicians in international comparisons is generally positive.”

Even so, more than 1 in 3 reported burnout, with most attributing it to their profession. That mirrors Esch’s 2021 study of 548 German general practitioners, in which 26.5% reported work-related burnout symptoms. Few German physicians used physical activity to cope, possibly due to “a perceived lack of time,” he suggested. And 54% said they didn’t have enough time to maintain close friendships — the highest proportion other than in Portugal — with lack of energy the most frequently cited reason (23%, the highest share of all nations).

“Overall, German physicians are quite satisfied with their professional and private lives, but there is a sharp divide,” Esch said. “Among those who are dissatisfied, we see high rates of reported burnout. The comparatively high overall consumption of alcohol and the neglect of exercise — and especially of close friendships — could be considered alarming.”