Everyone knows that doctors love golf. But a new Harvard Medical School study challenges this stereotype.

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Every Christmas The BMJ publishes articles on topics in the left field of research, answering questions that readers had never even thought of. Over the years The BMJ has looked at such vital topics as the side effects of sword-swallowing, the most popular type of chocolate eaten in hospitals, and whether skipping your "beauty sleep" actually makes a difference.

Many people believe doctors go through life with a stethoscope in one hand and a golf club in the other. So this year, researchers from the Harvard Medical School’s Department of Health Care Policy decided to find out whether the stereotype of golf-playing doctors is actually true, and if so, which doctors make the best golfers.

So is the stereotype par for the course? In their paper “Golf habits among physicians and surgeons: observational cohort study”, the Harvard research team led by Gal Koplewitz, analysed doctors’ golfing patterns by examining US doctors listed in the Doximity physician database who have logged their scores in the Golf Handicap and Information Network (GHIN) - a handicap system for amateur golfers. 

Contrary to the popular stereotype, not all doctors love to play golf. In fact, only a small percentage of doctors actually spend time on the course. Of the 1,029,088 doctors listed, only 4.1% appear to be golfers. And when it came to specialised doctors, the researchers saw that fewer than 3% took an interest in the sport.

When considered by specialty, orthopaedic surgeons, urologists, plastic surgeons, and otolaryngologists were best represented among the golfing ranks, with respective participation rates of 8.8%, 8.1%, 7.5%, and 7.1%. By contrast, internal medicine and infectious disease specialists were far less likely to play, with participation rates at 2.9% for both specialties.

But the team did not stop there. They wanted to know which medical specialties generated the most golfers and how likely physicians are to play golf, considering their age and biological sex.

"We analysed the proportion of physicians who regularly play golf, both overall and according to physician sex, age, and specialty. We also analysed the frequency of golf rounds in the previous 6 months," they write. Of the 41,692 physicians in the Doximity database linked to the GHIN database, men aged 61 to 70 years were the most likely to play golf (6.9%). "It is unclear whether this is a generational preference or simply a matter of having more leisure time later in one's career," the authors state. Women aged 31 to 35 years were the least likely to play golf (0.8%, respectively).

So who plays the best game?

The researchers said that "to determine which specialties had the best golfers we analysed how players' handicaps varied across physician specialty."

It turns out it's surgeons, specifically those in vascular, thoracic and orthopaedic specialties. They were the best golfers, or at least they said they were, with the best respective average handicaps of 14.7, 14.8, and 14.9. "This reflects substantially better golf skills on the part of the [these] specialties," the authors write. The average handicaps of endocrinologists, dermatologists, and oncologists were greater than 17.0.

Still, even the most accomplished golfers among doctors do not seem to hold a candle to professional players. Doctors have an average handicap of about 16 (15 for male doctors, 25 for female doctors), whereas professional players have an average handicap of zero or less.

"Overall, physicians are, at best, average golfers," the researchers write.

The researchers warn that theirs was an observational study, which only took into account US-based doctors, so it can’t offer a solid overview of Australian doctors' golfing prowess. However the authors said that "[it] is likely that more physicians play golf than estimated by our study. We also have no reason to believe that physicians from different specialties would systematically differ in reporting to [the golf players'] database, which suggests our relative rankings of participation in golf between specialties should be accurate."

Perhaps not surprisingly, the more golfers in a given specialty, the lower the average handicap for that specialty (correlation coefficient, −0.5; P = .002). Similarly, better performance was observed in golfers who played more (correlation coefficient, −0.2; P = .004).

When considering the doctor's gender, in the first 6 months of 2018, men played an average of 14.8 games and had an average overall handicap of 15.0, and women played an average of 12.1 games and had an average overall handicap of 25.2.

"Given research that suggests male physicians spend almost 2 hours less than female physicians each day on household responsibilities, even among dual physician couples who have similar reported work, does the substantially greater time spent by male physicians on the golf course explain some of this discrepancy?" the authors ask.

The association between golf and patient outcomes remain unknown.

There is limited scientific evidence that has assessed the association, if any, between the amount of time a physician plays golf and patient, physician, and organisational outcomes, the authors note. Although the current study provides insight into doctor’s golfing habits, "the association between golfing and patient outcomes, costs of care, and physician well-being remain unknown," the authors write.

"Is patient mortality associated with the amount of time a patient's physician plays golf (either negatively, because physicians release stress on the golf course, or positively, owing to decreased availability and time spent away from developing clinical skill)? Do costs of care increase and patient outcomes worsen in the days after a physician has had a bad round of golf?" ask the authors. Research into these considerations may be warranted, they conclude.