A nationwide survey of the religious beliefs and practices of American physicians has found that the least religious of all medical specialties is psychiatry. Among psychiatrists who have a religion, more than twice as many are Jewish and far fewer are Protestant or Catholic, the two most common religions among physicians overall.

The study, published in the September 2007 issue of Psychiatric Services, also found that religious physicians, especially Protestants, are less likely to refer patients to psychiatrists, and more likely to send them to members of the clergy or to a religious counselor.

"Something about psychiatry, perhaps its historical ties to psychoanalysis and the anti-religious views of the early analysts such as Sigmund Freud, seems to dissuade religious medical students from choosing to specialize in this field," said study author Farr Curlin, MD, assistant professor of medicine at the University of Chicago. "It also seems to discourage religious physicians from referring their patients to psychiatrists."

"Previous surveys have documented the unusual religious profile of psychiatry," he said, "but this is the first study to suggest that that profile leads many physicians to look away from psychiatrists for help in responding to patients' psychological and spiritual suffering."

"Because psychiatrists take care of patients struggling with emotional, personal and relational problems," Curlin said, "the gap between the religiousness of the average psychiatrist and her average patient may make it difficult for them to connect on a human level."

In 2003, to learn about the contribution of religious factors on physicians' clinical practices, Curlin and colleagues surveyed 1,820 practicing physicians from all specialties, including an augmented number of psychiatrists; 1,144 (63%) physicians responded, including 100 psychiatrists.

The survey contained questions about medical specialties, religion, and measures of what the researchers called intrinsic religiosity—the extent to which individuals embrace their religion as the "master motive that guides and gives meaning to their life."

Although 61 percent of all American physicians were either Protestant (39%) or Catholic (22%), only 37 percent of psychiatrists were Protestant (27%) or Catholic (10%). Twenty-nine percent were Jewish, compared to 13 percent of all physicians. Seventeen percent of psychiatrists listed their religion as "none," compared to only 10 percent of all doctors.

Curlin's survey also included this brief vignette, designed to present "ambiguous symptoms of psychological distress" as way to measure the willingness of physicians to refer patients to psychiatrists.

"A patient presents to you with continued deep grieving two months after the death of his wife. If you were to refer the patient, to which of the following would you prefer to refer first? (a psychiatrist or psychologist, a clergy member or religious counselor, a health care chaplain, or other)."

Overall, 56 percent of physicians indicated they would refer such a patient to a psychiatrist or psychologist, 25 percent to a clergy member or other religious counselor, 7 percent to a health care chaplain and 12 percent to someone else.

Although Protestant physicians were only half as likely to send the patient to a psychiatrist, Jewish physicians were more likely to do so. Least likely were highly religious Protestants who attended church at least twice a month and looked to God for guidance "a great deal or quite a lot."

"Patients probably seek out, to some extent, physicians who share their views on life's big questions," Curlin said. That may be especially true in psychiatry, where communication is so essential. The mismatch in religious beliefs between psychiatrists and patients may make it difficult for patients suffering from emotional or personal problems to find physicians who share their fundamental belief systems.

The Greenwall Foundation and the Robert Wood Johnson Clinical Scholars Program funded this study. Additional authors include John Lantos, Marshall Chin, Ryan Lawrence and Shaun Odell of the University of Chicago, and Keith Meador and Harold Koenig of Duke University.