The religious identities of academic pediatricians were significantly different from those of the American public, as indicated by the GSS (Pearson chi-square 161.62, P < .001). Most notably, a larger proportion of academic pediatricians (32, 27.6%) than members of the broader American public (396, 14.0%) reported having no religious preference (t = 4.086, df = 2,946, P < .001). Further, fewer academic pediatricians were Protestant (27, 23.3%; t = −6.5, df = 2,946, P < .001) than were members of the American public (1,524, 53.8% Protestant), and many more academic pediatricians were Jewish (20, 17.2%) than in the American public (50, 1.8%; t = 10.92, df = 2,946, P < .001).
Although 32 (nearly 28%) academic pediatricians reported no religious preference, more than one half believed in God: 35 (30.2%) had no doubt about God’s existence, 24 (20.7%) believed in God but had some doubts, 6 (5.2%) believed in God sometimes, and 8 (6.9%) believed in a higher power that is not God. Only 13 (11.2%) reported not believing in God, and 17 (14.7%) said they did not know whether God existed and there was no way to find out. There were notable differences between the pediatricians and the American public in whether or not they believed in God (Pearson chi-square 71.54, P < .001). A lower proportion of academic pediatricians compared with members of the American public believed in God without doubts (30.2% pediatricians, 60.4% of the public, t = −6.392, df = 1,398, P < .001).
When asked about the Bible, a few similarities were observed in the responses of academic physicians and the public, but the answers each group provided also revealed markedly different views (Pearson chi-square 51.15, P < .001). A large proportion of both physicians (46.6%) and members of the public (45.6%) believed that the Bible is the inspired word of God but that not everything in it should be taken literally (t = 0.205, df = 1,398, P = .839). Nearly one third of physicians (35.3%) instead described the Bible as an “ancient book of fables recorded by man.” A much smaller portion of the public (16.1%) described the Bible this way (t = 5.24, df = 1,398, P < .001). Likewise, only 2.6% of physicians, compared with 27.9% of the public, described the Bible as the actual word of God and believed that it should be taken literally, word for word (t = −6.037, df = 1,398, P < .001).
When responding to questions about spirituality more generally, academic pediatricians and members of the public gave somewhat similar responses (Pearson chi-square = 8.99, P = .061). The physicians differed very little from the general public when asked to describe their level of engagement in spirituality. Specifically, 37.1% of academic pediatricians and 39.5% of the public described themselves as moderately spiritual (t = −0.519, df = 1,559, P = .604); 33.6% and 25.3%, respectively, as slightly spiritual (P > .05 (t = 1.961, df = 1,559, P = .050); and 15.5% and 11.8%, respectively, as not at all spiritual (t = 1.17, df = 1,559, P = .242). On the other hand, only 12.1% of academic pediatricians described themselves as very spiritual, compared with 21.7% of the general public (t = −2.46, df = 1,559, P < .05).
As shown in Table 2, academic pediatricians and the general public seemed to attend religious services, outside of weddings, baptisms, and funerals, in different proportions (Pearson chi-square 32.93, P < .001). The physicians seemed to have attended less frequently than members of the general population. Only 40.6% of academic pediatricians reported attending services six or more times in the prior year compared with 58.2% of the public (t = −3.81, df = 2,946, P < .001).
Despite relatively low levels of traditional religious service attendance, though, academic pediatricians did report engaging in private spiritual or religious practices in the prior year. More than half (61, 52.6%) reported privately praying; other private spiritual practices included relaxation techniques (45, 38.8%), private meditation (34, 29.3%), reading a sacred text (31, 26.7%), yoga (22, 19.0%), and other spiritual exercises (10, 9.7%). Only 20 (19.4%) did not engage in any of these practices.
When asked whether their spiritual or religious beliefs influenced interactions with patients and colleagues, more than one half (68, 58.6%) of academic pediatricians believed that they do to some extent. Nine (approximately 8%) had no opinion, and 36 (31%) believed that religious and spiritual factors do not influence these interactions. To investigate the factors that might influence these perceptions, logistic regression analysis was performed and is summarized in Table 3. Controlling for gender, marital status, parental status, racial background, and religious service attendance, the odds of pediatricians thinking their spiritual or religious beliefs influenced how they interacted with patients and colleagues were more than five times higher for those who attended religious services monthly or more in the prior year when compared with those who attended less than once a month (P < .05).
Our findings about the differences between the personal religious identities and spirituality of academic pediatricians and the general public will have several implications, if they are replicated in future studies. These physicians described themselves as more spiritual than religious, much like the physicians Curlin and colleagues studied.9 Although a much lower proportion of academic pediatricians cited a personal religious identity compared with the public, they were quite similar to the public in how they described themselves spiritually. Of interest, both the American public and a random physician sample differed notably from the academic pediatricians we surveyed on the question of religious identity.9 As evident in Table 2, despite often being raised in households where religion was important, more than one in three academic pediatricians rejected a religious identity compared with 14% of the public. Our survey questions did not address why these academics did not integrate their childhood religious identification into their adult identities. One possibility is that an academic career attracts researchers and scholars whose individual strengths may not include the emotional, spiritual, and psychological skills of caregivers who self-select to practice medicine in the community. Another is that an academic career socializes physicians in these ways. Whether frequent confrontation with suffering and dying children makes a religious or spiritually based worldview seem incompatible for some academic pediatricians awaits future study. Another interesting finding is the relatively stable proportion of Jewish identification. Given the fact that self-identification as Jewish is not only a religious but deeply held cultural identity, the stable proportions measured for childhood and adulthood were not unexpected.
The finding that the academic pediatricians who most regularly attended religious services felt religion/spirituality influenced their clinical practice stands out. Integration of one’s religious/spiritual beliefs into clinical encounters may occur in relation to personal spiritual development, but our data did not include an analysis of spiritual development. Whether physicians with more secular belief systems feel that nonreligious self-identification influences their practice of medicine will be of interest in future studies.
The results of our survey of the spiritual and religious identities, beliefs, and practices of some academic pediatricians raise many questions relevant to medical education, other health care professionals, patient-centered care, and integrative medicine. We are aware of two existing programs, one offered in two medical centers, and the other ongoing in 130 hospitals nationwide. Both have been created for health care providers to facilitate spiritual and religious understanding and growth which is one part of integrative medical practice. Clinical Pastoral Education (CPE) for Health Care Providers is a fully accredited program; at the Massachusetts General Hospital it is supervised by a coauthor (A.A.Z.). Here, clinicians learn about fundamental aspects of spirituality and religiosity especially as they may apply to the care of hospitalized patients. Two important goals of the CPE for Health Care Providers program are (1) to raise clinicians’ awareness of religious and spiritual beliefs and values, as these may impact patient care and decision making, and (2) to nourish clinicians’ ability to empathize with religious traditions or secular beliefs different from their own. As such, practitioners may find our data useful in assessing similarities and differences between their spiritual and religious beliefs and those of their patients. The other program, Schwartz Center Rounds, is an interdisciplinary conference regularly occurring in multiple U.S. hospitals. One patient is the focus for each discussion; an emphasis is placed on all issues related to providing compassionate care.
The survey data and analyses from our study present a first descriptive portrait of spirituality and religion in the lives of academic pediatricians, but they are limited in several ways. This sample of academic pediatricians is small, so population estimates are imprecise, as are measures of association with the broader American public. The sampling frame included only academic pediatricians at specific highly ranked institutions. These respondents may be somewhat different from academic pediatricians at other institutions and from pediatricians more broadly, making the results not easily generalized. However, as opinion leaders, teachers of pediatricians-in-training, and authors of original research and textbooks, the beliefs and practices of these pediatricians are relevant. Nonetheless, detailed study of larger numbers of pediatric generalists and subspecialists are a necessary next step in refuting or supporting the findings presented.
Dr. Catlin received grant support from the Louisville Institute, Louisville, Kentucky. Dr. Cadge was supported by the Robert Wood Johnson Foundation Scholars in Health Policy Research Program at Harvard University. This data collection was funded by grant #11,299 from the John Templeton Foundation, Elaine Howard Ecklund, PI.
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© 2008 Association of American Medical Colleges
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