I wrote the following article last year and submitted it to The Minnesota Medical Journal for consideration for publication as part of a writing contest. I’m learning how to accept rejection graciously as it was not published. Anyway, this article is directed toward doctors, which is why I never posted it on my blog. But now, I’m working with the American Ass’n of Prolife OB/GYN’s (AAPLOG) helping recruit prolife medical students, residents and doctors in order to encourage, network and stay informed. Since I now have more MD readers, or soon-to-be MD readers, I’ll post it.
Those of you in medical school may recognize the cynicism, those in residency I know will recognize the cynicism and those in practice may be inspired to re-evaluate their perspective on medicine (I hope and pray).
Enjoy the read.
The Joy of Doctoring
I told my wife first. The letter from the medical school admissions committee landed in my college pigeon-hole mailbox on a January day in 1974. I opened it with my heart about to beat out of my chest. “We are pleased…” is all I read. I ran all the way to our apartment. I was in! Medical school! I couldn’t believe it. I would join the long line of doctors stretching from antiquity to the present, men and women who provided the most intimate and difficult and special care to human race. Men and women highly esteemed by society. What an opportunity! What an honor!
But a funny thing happened to me on the way to actual medical practice. “Funny” meaning tragic. I became a cynic.
I adopted a jaundiced, unsatisfied view of medicine. Since I was the first in my family to embark on a medical career, medicine and medical practice was a big unknown. So I reflected the attitudes and thinking of the attendings, residents, other students I encountered. And everywhere I went I ran into cynical and dissatisfied students, residents and attendings. To my discredit, I found myself becoming cynical and dissatisfied as well. Only my faith, which constantly reminded me of the worth of each individual life, kept me from embracing cynicism as a way of life.
Cynicism—it was contagious. Stereotyping the overweight, the poor, the unwashed, the uneducated, the non-compliant and the belligerent became easy and fun. Cutesy, degrading monikers for different classes of patients, none of which I will repeat, elicited sniggers and outright laughter from other doctors and doctors-in-training.
But the cynicism I encountered went beyond patients and their unpleasant characteristics and into the everyday activities of medical school, residency and then practice.
In medical school, we complained that teachers graded unfairly, organized classroom material poorly and required us to learn material which was irrelevant in nature or overwhelming in amount. In residency, we complained that scut and clerical work occupied too much valuable time and lazy attending staff unnecessarily burdened us with work so they could leave early. Brutal hours, low pay and constant criticism added to our angst. We longed for the nirvana of private practice which would yield fair compensation for our work, no more tests to take and schedules under our own control. Our patients would love us and would all have insurance and be thin and clean and intelligent.
Well, guess what.
Private practice just re-routed the cynicism.
As private practitioners, we discovered unfair insurance companies, high overhead expenses and surprisingly low paychecks. Call duty now seemed even more burdensome and our hours were still too long. Patients who experienced complications returned to us, not our attendings or our institution. And they asked, “Why did I have this complication, doctor?” We faced the real burden of patient care with the responsibility of our patients’ outcomes all our own. Many doctors in private practice worked with greedy or unreasonable partners, a problem I was spared. I now work for a large health care company and the complaints continue, principally that the corporation keeps us from receiving our just compensation. In our hospital, a nurse with a cookbook can now trump our reasoned clinical judgment. The unwashed patients are ever with us.
Furthermore, home life stress did not lessen as we expected. Nirvana never appeared. Husbands or wives who delayed gratification and sacrificed for our medical career now suddenly realized that the new doctor was still too busy, still detached, still not happy, still not a good communicator and still spending too much time at the office or the hospital. Private practice did little to improved one’s spousal relationship, and, in fact, often made it worse as raised expectations went unmet. Those who helped many survive the “hard times” realized that there was no end to the “hard times” and wanted out.
JAMA in January, 2003, reported 18% of physicians nationwide were somewhat or very dissatisfied with their careers with higher dissatisfaction in physicians practicing in areas with higher proportions of managed care. Women fared lower on the satisfaction scale.1
Archives of Internal Medicine in July 22, 2002 reported 70% of physicians satisfied or very satisfied with their careers and about 20% dissatisfied. Specialties of pediatrics, perinatal medicine, neonatal care, geriatric internal medicine and dermatology showed the highest level of satisfaction and specialties of OB/GYN, ophthalmology, orthopedic surgery, internal medicine and otolaryngology showed higher levels of dissatisfaction. New England and the West North Central areas of the country were more satisfied. Older age, longer hours, specialist in solo practice and foreign medical graduates showed lower satisfaction scores.2
My own observations of physician satisfaction are somewhat at odds to those statistics.
When do I see happy doctors? That’s easy. In a social setting where mere mortal human beings are holding the doctor in high esteem, hanging on his or her every word. At medical meetings when hobnobbing with other immortals, meetings generally held in beautiful areas of the country with warm weather, usually near some attraction or in an interesting city and always in a very expensive hotel. When they get a big paycheck or buy a new car or move into an expensive house. When a health care team member of the opposite sex fawns over them. When they have time off to pursue expensive fun. Doctors like those parts of doctoring. I see them smile and watch their animated conversation when discussing such times.
When do I see them unhappy? That’s also easy. When they look at a very busy schedule. When they look at a not busy schedule. (It means the paycheck will be less.) When a nurse tells the doctor about a patient with an obvious problem and wants the patient worked in that day. When an emergency presents and threatens to make the doctor stay late. When the hospital calls about a patient with a problem, especially if the call is after-hours, even if the doctor is on call. When a doctor receives any call after 9:00PM. When a doctor receives any call that requires the doctor to go to the hospital. When a doctor sees a patient who talks too much, requires too much time in the office, is too complicated, is dirty or smelly or mean or non-compliant or belligerent. When a medical helper doesn’t have all the right equipment RIGHT NOW. When slow lab or X-ray turn-around occurs. When a doctor has to deal with employee issues. When a doctor feels ignored by administration. Even when facing the open-ended encounter, just walking into a room and saying, “What brings you to the office today?” causes unhappiness for many physicians.
You notice that the happy things have little to do with the practice of medicine. The unhappy things sound like a normal day.
So, who is satisfied with their career? I would contend that many, if not a majority of physicians are profoundly unhappy about medicine. But to admit unhappiness would mean that all that work and all that sacrifice maybe wasn’t worth it. It would mean that they really are in it for the money and status and not for caring and helping, which is what they told everyone starting with the admissions committee for medical school.
I believe telling if someone is happy about a career choice is just not that hard. People who like what they are doing, really like what they are doing and it shows, even through the hassles and difficulties of any job.
A satisfied physician might look like this: Busy day? A challenge I can handle. Pt takes too long? That is just how medicine is. Explain to the waiting patients that I’m late, but I will also give them the time they need. Or the waiting patients can reschedule. Need to add someone in? The clinical indication, not the schedule, dictates the yes or no. Stay late? If needed, OK. Caring for the unpleasant, the unwashed, the belligerent, the non-compliant? That’s why I’m here. Illness is not a respecter of persons and all God’s children need health care. On call? It’s my calling. Unnecessary nurse calls at night? A response with a pleasant demeanor and education, not an angry bark. Partner needs help? No questions asked—help is on the way. Hassles of managed care and electronic medical record, lack of autonomy and insurance companies? An inconvenience to the greater goal of patient care.
I read in journals how to improve physician satisfaction. They all talk about money, physician autonomy, hours worked—things like that—which do have validity.
But real joy from medical practice originates in the heart, from within. This joy transcends the hassles of patient care and finds fulfillment in relieving suffering in all its forms and improving the health and well-being of patients. What a glorious goal! This joy from doctoring comes from understanding and even meditating on the calling. It takes realizing that medicine, daily patient care and all it involves, satisfies more than the material rewards and accouterments of medicine. It takes realizing the honor of the job. It takes realizing that patients and their care are the point, not the problem. It takes realizing that a busy schedule does not translate into a burden, but into the satisfaction of being needed. (Unless the schedule is motivated by greed.) It takes realizing that normal medical practice means dealing with add-ons and emergencies at inconvenient times. It takes realizing that call means someone out there is desperate enough to seek your service at inconvenient hours, inconvenient for you and for them. It takes realizing that what medicine has to offer outweighs trying to wrestle the medicine monster to the mat forcing it fit your own ideal. The real satisfaction with doctoring comes from…actual doctoring. The hands-on, active-listening, emergency-seeing, patient-adding, medicine-embracing, call-taking, detail-attending and always-caring doctoring. Find someone practicing like that and you will find someone living the joy.
Trust me, I understand that medical practice is a difficult life. A busy OB/GYN practice, which I have, stresses the most satisfied of us. Hours, call, clinic, surgery, deliveries, partners, administration, liability, unhappy patients—all can be and often are sources of major stress and unhappiness. But I’ve found the joy of medical practice—all of medical practice—is a rock, a home, a calling, a mission and a blessing from God which provides stability and contentment through those times and keeps me excited and satisfied, supremely satisfied with where I am and what I am doing.
I would encourage you, if you are a physician, to embrace all of medicine—the good, the bad and ugly. The joy in your calling is there.
Matt Anderson, MD
- JAMA. 2003;289:442-449.
- Arch Intern Med. 2002;162:1577-1584.