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Abstract

Purpose: This study aimed to examine prevalence of loneliness among senior physicians and identify associations between high loneliness and other personal and social factors. Methods: This cross-sectional survey of physicians aged ≥65 was conducted between February 26 and March 12, 2024. Loneliness was measured using the 20-item UCLA Loneliness Scale. Information about demographics and personal, social, and health factors was collected. Results: Of the 10,090 participants the majority were male (74.0%), ages 65-72 (50.8%), white (81.3%), and heterosexual (93.3%). The mean loneliness score was 38.04. Nearly 1 in 5 (18.0%) experienced high loneliness, including 14.1% with moderately high loneliness and 3.9% with very high loneliness. Multivariable analysis, after controlling for social and personal factors, demonstrated that being divorced/separated (OR 2.78 [95% CI, 1.79-4.31]), widowed (OR 2.52 [95% CI, 1.60-3.97]), or single (OR 2.70 [95% CI, 1.66-4.40]) were associated with high loneliness. Participants with a chronic health condition (OR 1.26 [95% CI, 1.02-1.60]) or a chronic health condition and a disability (OR 2.18 [95% CI, 1.48-3.20]) had higher odds of high loneliness than those without either. Not having an annual wellness visit was associated with higher odds of high loneliness (OR 1.58 [95% CI, 1.21-2.06]), as was not spending time on hobbies (OR 5.45 [95% CI, 4.03-7.25]). Conclusions: Nearly 1 in 5 senior physicians experience loneliness, and high loneliness is associated with personal and social factors. Policymakers and organizations that employ, provide care for, or support senior-aged physicians should ensure policies and programs support the social and personal needs of this population.

Keywords

loneliness seniors physician well-being social isolation

Introduction

Humans are naturally social beings, inherently dependent on other humans for physical, emotional, economical, and social well-being. When people lose or avoid connection with other people to a degree that results in loneliness, the effects can be devastating; so profound, in fact, that nations across the globe have determined loneliness to be a national health problem. Loneliness and social isolation have been identified as a public health crisis in the United States,¹ marked by the 2023 release of a U.S. Surgeon General’s Advisory on the epidemic of loneliness and isolation, which describes in detail the threat and profound implications of loneliness for public and societal health.² In recent years a “Minister for Loneliness” has worked alongside the United Kingdom government to address the issue³ and in Australia, the national Ending Loneliness Together organization was formed to reduce the effects of loneliness and social isolation.⁴ In Canada, where loneliness has been identified as an epidemic,⁵ non-profits such as the Canadian Institute for Social Prescribing and the Canadian Coalition for Seniors’ Mental Health provide support, research, and guidelines for addressing social and structural factors such as loneliness and community connection.^6,7 In addition, the World Health Organization has also established the Commission on Social Connection to address loneliness as an urgent public health threat.⁸

Background

Loneliness, a subjective measure identified as the experience of not having one’s social needs met or experiencing connection to others to a lesser degree than desired, has increased in recent years.^9,10 Even prior to lockdowns necessitated by the COVID-19 pandemic, which exacerbated feelings of isolation for many, loneliness was a serious threat to the health and well-being of people worldwide.¹¹ In recent years, loneliness persists as a key social determinant of health, affecting 1 in 3 U.S. adults who feel lonely at least once a week¹² and 1 in 5 who feel lonely every day.¹³ Loneliness has been shown to affect between 37% and 43% of senior adults in the U.S.^14,15

Risk Factors for Loneliness

Evidence identifying risk factors for loneliness is mixed.¹⁶ For example, some studies show adults with higher levels of education are at greater risk of loneliness, while others find lower levels of formal education increase risk for loneliness.¹⁶ Studies show loneliness rates are higher among older adults, yet other research indicates younger adults experience loneliness at higher rates.^16-18 Survey data show that similar percentages of men and women experience loneliness (57% and 59% respectively).¹⁹ Existing literature shows that loneliness is greater among individuals who live alone or in a residential care/nursing home,¹⁶ which in the U.S. is 28% of older adults.²⁰ Loneliness is also more frequent among those who are divorced or widowed, or have physical and mental health problems.^16,21 Adults with low income are more likely to experience loneliness,^21-23 as well as individuals who identify as LGBTQ.²³ Recent evidence shows among older adults (ages 50-80), loneliness is most commonly reported among those who are not working.²¹ Older adults may be more at risk of loneliness due to life events like retirement, having a chronic illness or disability, experiencing sensory deprivation like hearing loss, or experiencing bereavement.¹⁵

Physicians are listed among the nation’s loneliest professionals.²⁴ Loneliness is common among family medicine physicians,²⁵ and is a major stressor for nurses and physicians.²⁶ For health care professionals, loneliness may in part be driven by the increase in technology, telehealth, and virtual visits^27,28 resulting in fewer hours spent in the company of colleagues and patients.

Effects of Loneliness

Loneliness is associated with serious problems including illness,^2,23 increased risk of stroke,^2,29 depression,^23,30 anxiety,²³ and suicidal ideation.³¹ The mortality effects of social disconnection have been compared to the effects of smoking 15 cigarettes per day.² Other data show persistent loneliness increases risk for all-cause dementia, Alzheimer’s disease, vascular dementia, and cognitive impairment.^2,32

Professionally, loneliness has been associated with poor occupational functioning and well-being among workers³³ and burnout,²⁵ which among health care professionals can lead to reduction in clinical effort or departure from practice.³⁴ High levels of loneliness are also associated with lower levels of meaning in life and purpose.³⁵ Loneliness may also have economic costs. In the U.S., workers experiencing loneliness may be less productive, costing an organization nearly $406 billion a year.¹⁷ In addition, annual Medicare costs associated with care provided to socially isolated beneficiaries are increased by $6.7 billion.³⁶

Study Aims

Despite the abundance of literature on loneliness, including that focused on older adults and health care workers, there is little to no evidence of the prevalence of loneliness among older physicians in the U.S. This study aims to fill this gap by investigating the proportion of physicians aged ≥65 who experience loneliness and the relationships between high loneliness and other personal and social characteristics.

Considering its relationships with burnout, health issues, and suicidal ideation, loneliness has serious implications for the physician workforce, clinician well-being, and patient care access. Understanding how prevalent the phenomenon is among senior physicians, and its relationships with risk factors, will help health care organizations, policymakers, and public health entities establish effective policies and practices to help protect and support this population. For physicians who have retired from practice or left clinical medicine, these findings may identify methods to help maintain connections and lifestyle options that can prevent loneliness and sustain well-being.

Methods

Study Design and Sample

This cross-sectional survey was conducted between February 26 and March 12, 2024. The sample was generated from the American Medical Association Physician Professional Data (AMA PPD), independent of AMA membership status. Email invitations with a link to the online survey were sent to 168,296 physicians aged 65 or older at the time of the survey. After 14,634 emails were returned undeliverable, email invitations were delivered to 153,662 physicians.

This study was reviewed by the University of Illinois Chicago Institutional Review Board and determined to be exempt from human subjects research review (Study ID 2023-1538). All participants provided consent to participate after reviewing an information sheet and before initiating the survey. Investigators followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guidelines in the presentation of this study.

Survey Instrument

The survey was developed by an interdisciplinary team including research staff and physicians. Survey items included demographic questions to collect information about gender identity, age, race, sexual orientation, practice status, geographical area, relationship status, and household status. Personal questions about social and health factors were also included. The survey included the 20-item UCLA Loneliness Scale³⁷ (used with permission from the creator of the survey, Dr Daniel Russell), a widely used survey instrument considered the “gold standard” for measuring loneliness.³⁸ The full survey can be found in the Supplemental Materials.

Survey Procedure

After clicking to provide consent, participants completed the self-administered survey using an online survey platform. There was no incentive for participation. Only complete responses were considered valid following a data cleaning process.

Statistical Analysis

Demographic, social, and personal characteristics were summarized using standard descriptive statistics. Loneliness scores were calculated by summing the scores of all 20 items in the UCLA Loneliness Scale, with possible scores ranging from 20 to 80. Bivariate analysis with two-sided significance testing was completed to calculate the mean loneliness scores across various sub-segments of the sample. In accordance with methods documented and recommended by the author of the UCLA Loneliness Scale, scores between 1 and 2 standard deviations (SD) from the mean were considered “moderately high” loneliness, and scores ≥2 SDs above the mean were considered “very high” loneliness.³⁹ Respondents with moderately high and very high loneliness scores were pooled and subsequently considered to be the respondents with “high loneliness scores.” Multivariable logistic regression analysis adjusting for age, gender, geographic setting, household, relationship, health status, caregiver role, wellness visits, and having hobbies, was completed to calculate the odds of experiencing high loneliness among certain sub-segments of the sample. Adjusted odds ratios were estimated by testing independent variables against the high loneliness scores (scores ≥1 SD above the mean). Statistical significance was set at 2-tailed P < .05 for all analyses. Responses from participants with high loneliness scores (≥1 SDs above the mean) were isolated and evaluated separately to observe the characteristics of that subset. All tests were completed in SAS/SPSS.

Results

Of the 153,662 physicians invited to participate, 10,090 physicians completed a survey (6.6% response rate). Survey participants were predominantly male (74.0%), between ages 65 and 72 (50.8%), white (81.3%), and heterosexual (93.3%). Half of the participants were fully retired (50.2%) and 49.8% practiced part- or full-time. More than 4 out of 5 of respondents were married or partnered (81.0%); of those that were not married or partnered 70.7% reported living alone. Of those who still practice clinical medicine, 32.5% were primary care physicians and 67.5% were in other non-primary care specialties. Survey participants comprised a higher proportion of female, fully-retired, and non-primary care physicians than the initial senior physician sample and a lower proportion of international medical graduates. The median age of the survey sample was similar to that of the overall senior physician population. (Table 1)

Table 1.

Participant Demographics and Characteristics.

Demographic Characteristics	Survey Participants^a		Study Population^b
	N = 10,090		N = 168,296
	Count	%	Count	%
Gender
Male	7023	74.0%	134,091	79.7%
Female	2349	24.7%	34,189	20.3%
Genderqueer, Nonbinary, Other	36	0.4%	-
Prefer not to answer	84	0.9%	-
Missing	598	-	16	-
Age in years
Median^b	72	-	72
65-72	5129	50.8%	86,398	51.3%
73-80	3374	33.4%	58,305	34.6%
81-88	1345	13.3%	17,927	10.7%
>89	242	2.4%	5666	3.4%
Practice status
Fully retired from medical practice	5059	50.3%	54,679	32.5%
Practicing part- or full-time	5002	49.7%	113,299	67.3%
Missing or unclassified	28	-	318	0.2%
Primary care vs non-primary care specialty
Primary care^c	1578	32.4%	87,874	52.2%
Non-primary care	3285	67.6%	80,422	47.8%
Missing	167	-	-	-
Practice setting (5030 not fully retired)^a
Academic medical center	1086	21.6%	-	-
Community clinic/health center	268	5.3%	-	-
Corporation or research facility	86	1.7%	-	-
Federally qualified health center	101	2.0%	-	-
Government	184	3.7%	-	-
Hospice, SNF, Urgent care, or Home health agency	117	2.3%	-	-
Hospital/health system (Non-teaching)	485	9.6%	-	-
Hospital/health system (Teaching)	584	11.6%	-	-
Multi-specialty group	229	4.6%	-	-
Single specialty group	487	9.7%	-	-
Solo practice	752	15.0%	-	-
Telemedicine/Telehealth	109	2.2%	-	-
Other	375	7.5%	-	-
Missing	167	3.3%	-	-
International medical graduate
Yes	1459	14.5%	48,933	29.1%
No	8459	83.8%	119,363	70.9%
Missing	172	1.7%	-	-
Geographical setting of residence
Urban	2866	28.4%	-	-
Rural	1336	13.2%	-	-
Suburban	5302	52.5%	-	-
Missing	586	5.8%	-	-
Race and ethnicity (Multiple selection)
White	7743	81.3%	-	-
Asian or Asian American	460	4.8%	-	-
More than 1 race	335	3.5%	-	-
I prefer not to provide this information	274	2.9%	-	-
Hispanic or Latina/Latiné/Latino/Latinx	235	2.5%	-	-
Other race or ethnicity	221	2.3%	-	-
Black or African American	181	1.9%	-	-
Middle Eastern or North African	51	0.5%	-	-
American Indian, Alaska native, Indigenous, or native American	14	0.1%	-	-
Missing	567
Sexual orientation
Heterosexual	8739	93.3%	-	-
Not heterosexual^d	440	4.7%	-	-
Prefer not to answer	191	2.0%	-	-
Missing	720
First generation immigrant
No	8150	85.9%	-	-
Yes	1277	13.5%	-	-
Prefer not to answer	58	0.6%	-	-
Missing

^aSource: Self-reported survey response unless otherwise noted.

^bSource: AMA Physician Professional Data; Not all fields collected in survey are equally available in AMA PPD.

^cFamily medicine, general medicine, internal medicine, ob/gyn, pediatrics.

^dPooled due to small sample sizes among subgroups.

Mean Loneliness Scores

Of the 10,090 respondents, 9098 completed all 20 items of the UCLA Loneliness Scale. The mean loneliness score was 38.04. Respondents with high loneliness scores comprised 18% of the sample (Figure 1). The majority of participants (68.9%) scored within the middle range, indicating most experienced neither moderately high nor very high loneliness.

Figure 1.

Percentage of respondents with moderately high or very high loneliness.

Mean scores by respondent characteristics are shown in Table 2. Female senior physicians (mean score 39.95, P ≤ 0.001) and those identifying as nonbinary, genderqueer, or other identity (mean score 42.59, P ≤ 0.001) have higher loneliness scores compared to males (mean score 37.29, P ≤ 0.001). Physicians ages 65-72 scored higher (mean score 39.09, P ≤ 0.001) than those ages 73-80, 81-88, and >89 (mean scores 37.22, 36.14, and 37.27 respectively, P ≤ 0.001). Participants who identified as not heterosexual had higher loneliness scores compared to heterosexual physicians (mean score 40.22 vs 37.83, P ≤ 0.001).

Table 2.

Mean Loneliness Scores.

Group	N (%)^a	Mean LS	SD	P-value
Total sample	9098	38.04
Gender identity				≤.001
Female	2236 (24.9)	39.95	12.43
Male	6637 (73.9)	37.29	12.06
Genderqueer, Nonbinary, Other	34 (0.4)	42.59	13.49
Prefer not to answer	75 (0.8)	39.31	12.93
Age				≤.001
65-72	4678 (51.4)	39.09	12.65
73-80	3038 (33.4)	37.22	11.95
81-88	1180 (13.0)	36.14	10.9
≥89	202 (2.2)	37.27	11.54
Race and ethnicity				0.37
White	7343 (81.5)	37.91	12.21
Asian or Asian American	426 (4.7)	37.24	12.04
More than 1 race	313 (3.5)	38.32	12.33
Prefer not to answer	256 (2.8)	39.04	12.89
Hispanic or Latina/ Latiné /Latino/Latinx	220 (2.4)	39.06	12.32
Other race or ethnicity	208 2.3)	38.26	11.87
Black or African American	174 (1.9)	38.67	12.45
Middle Eastern or North African	49 (0.5)	38.73	10.08
American Indian, Alaska native, Indigenous, native American	12 (0.1)	42.00	11.95
Native Hawaiian or Pacific Islander	8 (0.1)	44.00	16.15
Sexual orientation				≤.001
Heterosexual	8739 (93.3)	37.83	12.16
Not heterosexual^b	418 (4.7)	40.22	12.79
Prefer not to answer	177 (2.0)	39.21	13.18
Practice status				0.84
Fully retired	4567 (50.2)	38.07	12.08
Practicing part- or full-time	4530 (49.8)	38.01	12.37
Specialty (of those practicing)				0.26
Primary care^c	1473 (32.5)	38.32	12.32
Non-primary care specialty	3054 (67.5)	37.87	12.40
Practice setting				≤.001
Academic medical center	1034 (22.8)	36.54	11.56
Solo practice	680 (15.0)	38.62	12.62
Hospital/health system (Teaching)	545 (12.0)	37.73	11.99
Single specialty group	460 (10.2)	37.93	12.67
Hospital/health system (Non-teaching)	446 (9.9)	40.76	13.46
Other	349 (7.7)	37.54	12.27
Community clinic/health center	246 (5.4)	38.55	12.41
Multi-specialty group	208 (4.6)	37.53	11.41
Government	176 (3.9)	39.49	13.76
Hospice, SNF, Urgent care, Home health agency	113 (2.5)	37.36	12.02
Telemedicine/Telehealth	96 (2.1)	38.93	12.96
Federally qualified health center	94 (2.1)	38.27	12.83
Corporation or research facility	80 (1.8)	37.04	11.05
Relationship status				≤.001
Married/partnered	7288 (81.0)	36.62	11.63
Single	348 (3.9)	45.39	13.74
Divorced/separated	696 (7.7)	43.84	12.87
Widowed	620 (6.9)	42.69	12.43
Prefer not to answer	45 (0.5)	44.64	13.15
Household status				≤.001
Lives alone	1465 (70.7)	43.74	12.96
Does not live alone	555 (26.8)	40.23	12.55
Prefer not to answer	53 (2.6)	45.66	13.65
Geographical setting of residence				0.002
Suburban	4996 (55.5)	37.91	12.21
Urban	2735 (30.4)	37.61	11.88
Rural	1264 (14.1)	39.07	12.87
Primary caregiver				≤.001
Yes	940 (10.4)	40.39	12.96
No	8047 (89.0)	37.71	12.11
Prefer not to answer	51 (0.6)	40.84	12.41
Hearing loss				0.55
Yes	3288 (36.3)	38.13	11.97
No	5712 (63.1)	37.92	12.38
Prefer not to answer	48 (0.5)	39.35	10.81
Children				≤.001
Yes	8009 (88.6)	37.52	11.98
No	1008 (11.1)	41.77	13.29
Prefer not to answer	25 (0.3)	45.92	13.17
Grandchildren				≤.001
Yes	6029 (75.1)	36.98	11.84
No	1968 (24.5)	39.15	12.25
Prefer not to answer	29 (0.4)	43.59	13.34
Health				≤.001
Chronic health issue	3328 (36.9)	38.34	12.21
Disability	301 (3.3)	40.52	12.95
Both	570 (6.3)	40.54	12.64
Neither	4679 (51.9)	37.21	12.03
Prefer not to answer	144 (1.6)	41.05	13.00
Regular annual wellness visit				≤.001
Yes	7632 (84.5)	37.49	11.93
No	1355 (15.0)	40.87	13.44
Prefer not to answer	41 (0.5)	39.34	12.28
Hobbies				≤.001
Yes	7979 (88.6)	36.82	11.6
No	986 (11.0)	47.19	13.05
Prefer not to answer	39 (0.4)	46.64	11.73

^aDenominator varies since not all participants answered every question.

^bPooled due to small sample sizes among subgroups.

^cFamily medicine, general medicine, internal medicine, ob/gyn, pediatrics.

Senior physicians who were not married or partnered have significantly higher loneliness scores (mean scores 43.84 (divorced/separated), 45.39 (single), 42.69 (widowed)) than married/ partnered senior physicians (mean score 36.62, P ≤ 0.001). Senior physicians who live alone also scored higher than those who do not (mean score 43.74 vs 40.23, P ≤ 0.001). The mean score of physicians with children (37.52) and with grandchildren (36.98) were lower than scores of physicians without children or grandchildren (mean scores 41.77 and 39.15 respectively, P ≤ 0.001). Those living in rural areas have a higher mean score than those living in urban or suburban areas (39.07 vs 37.61 and 37.91 respectively, P ≤ .002).

Senior physicians who are the primary caregiver of another adult had higher loneliness scores than those who are not (mean score 40.39 vs 37.71, P ≤ 0.001), and those with a chronic health condition, a disability, or both (mean scores 38.34, 40.52, 40.54 respectively, P ≤ 0.001), had a higher mean score than those without either of those conditions (mean score 37.21, P ≤ 0.001). Respondents who do not have an annual wellness visit each year had higher loneliness scores than those who do (mean score 40.87 vs 37.49, P ≤ 0.001). In addition, those who maintain hobbies outside of work experience lower loneliness than those who do not (mean score 36.82 vs 47.19, P ≤ 0.001), No significant differences in mean loneliness scores were observed between race or ethnicity, specialty, practice status, first-generation immigrants, or experiences of hearing loss. Of note, the mean scores of participants who selected “prefer not to answer” for several questions were significantly higher than the other subgroups of participants.

Responses from the participants with high loneliness scores (≥1 SDs above the mean) were isolated and evaluated separately to observe the characteristics of that subset. Similar to the overall sample, the majority of this cohort were aged 65-72 (59.4%). Slightly more than half were still practicing either part- or full-time, compared to slightly less than half in the overall sample (51.2% vs 49.7%). A higher proportion of the high-loneliness participants did not have an annual wellness visit compared to the overall sample (22.6% vs 15%). Finally, those that did not regularly spend time on hobbies represented a greater proportion of the high-loneliness sample than the overall sample (27.3% vs 11%). Supplement Table 1 shows the distribution and mean scores for this subset of the overall sample.

Multivariable Logistic Regression

On multivariable logistic regression analysis, after adjusting for age, gender, geographic setting, household, relationship, health status, caregiver role, wellness visits, and having hobbies, many relationships observed in the means test remained (Table 3). While the ANOVA test revealed significant differences in scores across sexual orientation, gender identity, children, and household status, multivariable logistic regression did not show a significant association between these variables and the dependent variable when controlling for other factors.

Table 3.

Multivariable Logistic Regression Analysis of Association Between Loneliness Score and Personal, Health, and Social Characteristics.

Predictor	aOR (Range)	P-Value
Age (vs 65-72)
73-80	0.76 (0.60-0.97)	0.03
81-88	0.48 (0.33-0.69)	≤.001
≥89	0.43 (0.21-0.84)	0.01
Geographical setting (vs Urban)
Rural	1.55 (1.11-2.17)	0.01
Suburban	1.38 (1.09-1.74)	0.01
Gender identity (vs Male)
Female	0.94 (0.76-1.18)	0.61
Genderqueer, Nonbinary, Other¹	1.62 (0.51-5.11)	0.41
Prefer not to answer	1.33 (0.44-4.07)	0.62
Sexual orientation (vs Straight/Heterosexual)
Not heterosexual^a	1.08 (0.72-1.63)	0.70
Prefer not to answer	1.19 (0.63-2.25)	0.59
Household status (vs Does not live alone)
Lives alone	1.21 (0.91-1.62)	0.19
Prefer not to answer	1.61 (0.72-3.61)	0.25
Relationship status (vs Married/Partnered)
Divorced/Separated	2.78 (1.79-4.31)	≤.001
Widowed	2.52 (1.60-3.97)	≤.001
Single	2.70 (1.66-4.40)	≤.001
Prefer not to answer	2.24 (0.89-5.63)	0.09
Having children (vs Have children)
No children	1.09 (0.81-1.46)	0.57
Prefer not to answer	0.99 (0.22-4.38)	0.99
Health status (Neither a chronic health issue or disability)
Chronic health issue	1.26 (1.02-1.60)	0.03
Disability	1.47 (0.88-2.47)	0.14
Both	2.18 (1.48-3.20)	≤.001
Prefer not to answer	1.67 (0.83-3.38)	0.15
Primary caregiver (vs not a primary caregiver for another adult)
Primary caregiver	1.61 (1.07-2.44)	0.02
Prefer not to answer	0.88 (0.25-3.17)	0.85
Annual wellness visits (vs Yes)
No	1.58 (1.21-2.06)	≤.001
Prefer not to answer	1.14 (0.22-5.99)	0.87
Hobbies (vs Spending regular time on hobbies)
No hobbies	5.45 (4.03-7.25)	≤.001
Prefer not to answer	1.03 (0.26-4.41)	0.93

^aPooled due to small sample sizes among subgroups.

Living in a rural region (OR 1.55 [95% CI, 1.11-2.17]), being divorced or separated (OR 2.78 [95% CI, 1.79-4.31]), widowed (OR 2.52 [95% CI, 1.60-3.97]), or single (OR 2.70 [95% CI, 1.66-4.40]) were all associated with high loneliness. Senior physicians with a chronic health condition (OR 1.26 [95% CI, 1.02-1.60]) or both a chronic health condition and a disability (OR 2.18 [95% CI, 1.48-3.20]) had higher odds of high loneliness than those without either of these. Not having an annual wellness visit was associated with high loneliness (OR 1.58 [95% CI, 1.21-2.06]) and not regularly spending time on hobbies or interests was associated with higher odds of experiencing high loneliness (OR 5.45 [95% CI, 4.03-7.25]).

Discussion

Nearly 1 in 5 senior physicians experiences high loneliness and several subgroups show higher propensity for high loneliness than others. Several important risk factors for high loneliness were identified. Among the at-risk groups are those who live in rural areas, are divorced, widowed, or single, suffer from disability and chronic illness, do not have an annual wellness visit, and do not have outside hobbies or interests. Our findings suggest that attention should be given to providing these groups with tailored support systems and greater opportunities for meaningful interpersonal interactions and community involvement. This may be especially important for those physicians who are part of additionally marginalized communities, such as individuals who are not male, not heterosexual, or have a chronic illness or disability.

Although there were no significant differences in mean scores among retired physicians and physicians practicing full- or part-time, it is notable that nearly half of participants still practiced medicine at the time of the survey, and that more than half of the high-loneliness cohort still practiced medicine. Considering this, it is evident that loneliness is not just a “retired physician” concern. Lack of meaningful connection with colleagues and patients, possibly a byproduct of the transactional relationships associated with the production-driven environment of U.S. health care, can lead to loneliness even for people regularly surrounded by people. This could also be a signal that the support systems in place, if any, are not sufficiently providing opportunities for physicians to establish and maintain strong connections.

Physicians of all ages may be at risk for loneliness, so it is important for stakeholders to ensure their programs and policies are created with this in mind. Here we make recommendations for actions that various stakeholders can take to reduce experiences of loneliness and improve well-being for senior physicians.

Organizations that employ physicians can establish employee resource groups which provide opportunities for physicians to meet others who may be facing similar situations or life events. This may be especially beneficial for senior physicians who are not male, do not identify as heterosexual, are recently widowed or divorced, or are a primary caregiver for another adult. Organizations can design team structures and physical spaces to enable opportunities for interactions with others. Scheduling longer visits so physicians have adequate time with patients could be advantageous for all. Sponsoring social or physical activities for physicians may contribute to feelings of collegiality and inclusion. Investing in conference attendance or organized medicine involvement, and providing coverage for the time away from work, can allow physicians to connect with colleagues and engage in meaningful interactions across the profession.

Policymakers also have opportunities to help reduce loneliness for physicians and the general population. Investing in infrastructure designed for humans, rather than cars and buildings, could improve walkability and invite more community facilities and green spaces, helping to foster connections.⁴⁰ Similarly, improving public safety would help seniors feel more comfortable walking around in public areas and socializing within their communities. Federal and state governments can issue guidelines for social connection and provide health care workers with guidance on how to screen for loneliness among patients. State and local governments can invest in intergenerational programs, which have been shown to strengthen social determinants of active aging among seniors and promote positive physical and mental health.^41,42 Finally, policymakers can invest in further research to better understand loneliness, its risk factors and contributors, and its long-term effects on population health.

For individuals experiencing loneliness or trying to prevent it, seeking opportunities within the community, such as athletic or social clubs with group programming, to engage in non-work-related activities is a way to build connections and prevent isolation. Regular exercise, in natural settings when possible, can boost mental health and help combat loneliness and depression.^43-45 Regular visits to a primary care physician for an annual wellness visit can ensure senior physicians manage their conditions, prevent new health issues, and maintain open communication with their health care team about potential psychosocial risks.

Conclusion

In this cross-sectional study, high loneliness was reported by 1 in 5 senior physicians. Certain cohorts have greater odds of high loneliness, including those who are 65-72, live in rural areas, don’t have annual wellness visits, don’t engage in hobbies or interests outside of work, and those with a chronic illness and disability. Institutional and community investment in programs and policies that support senior physicians in these groups may increase opportunities for social connectivity and help reduce risk for loneliness. Individual awareness and self-care can also ensure senior physicians can maintain healthy, balanced lifestyles that promote social connection and well-being. Further research is needed to observe potential causes of loneliness among senior physicians and potential associations with sense of purpose or loss of meaning-making activities. Additional study could also explore associations with financial security, depression, suicidal ideation, efficacy of interventions and programming for preventing loneliness, and to compare loneliness among physicians to the general public.

Reflecting on the sentiments expressed in the Surgeon General’s Report,² and considering the far-reaching consequences of loneliness, it is clear that there is a need—perhaps an obligation—to invest in addressing loneliness as the nation has invested in other critical public health issues. Given the implications for the physician workforce, access to care, and other significant human and economic costs, it is imperative to recognize and address loneliness as part of broader physician and population well-being initiatives.

Limitations

Our study is subject to limitations. The self-reported nature of the survey and the sensitivity of the issues being addressed can lead to bias in the responses. The cross-sectional design of the study allows us to observe correlations and not causation. The study population is not representative of all physicians in the U.S. so our results cannot be extrapolated to the national physician population. This study did not include a survey of the general population so direct comparisons are not advised.

Supplemental Material

Supplemental Material - Loneliness and Associated Factors Among Senior Physicians in the U.S.

Supplemental Material for Loneliness and Associated Factors Among Senior Physicians in the U.S. by Lindsey E. Carlasare, Samuel Lin, Purva Shah and Ved Gossain in American Journal of Lifestyle Medicine.

Footnotes

Acknowledgments

The authors would like to acknowledge and thank Alicia Johnson for her contributions to the data analysis and Alice Reed for her contributions to the conceptualization of the study.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Ethical Statement

ORCID iD

Lindsey E. Carlasare

Supplemental Material

Supplemental material for this article is available online.

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