I marvel at a certain hospital employee's cheerful disposition and indefatigable smile. She works a full shift at the hospital every day, and I have known her for many years. No matter how lengthy her shift, she always seems happy.
But she does not work as a doctor -- she always makes sure my office as well as the rest of the hospital stays dirt-free as the housekeeper. In addition to her shift at the hospital, she cleans a convenience store in the evening. She left my office a few minutes ago, after a light conversation that brightened my day.
As she left, I swiveled around in my chair to check my email and found a link from Medscape Neurology that discussed the relative happiness of physicians. It told me something that I hadn't previously realized: as a neurologist, my peers count among the unhappiest of all physicians.
"Profiles in Happiness" summarized a survey of 30,000 U.S. physicians. Although the study ultimately concluded that doctors are not as happy as the general public, I believe that this generalization oversimplifies the statistics.
The recently-released Gallup U.S. Emotional Health Index noted that 85.6 percent of 30,000 Americans "experienced enjoyment a lot of the day yesterday." In fact, overall, Americans are happier today than they were a year ago. A staggering 88.7 percent reported that they "experienced happiness a lot of the day yesterday." Americans in general report less stress and increased joy.
The Medscape survey of doctors used a different grading scale, which the article I linked to describes. However, I would interpret the relative results of that scale to imply that approximately 75 percent of doctors are "very or pretty happy." So why do doctors report more unhappiness than the general public?
Why Are Doctors Unhappy?
The last few years have seen radical changes in the health care system. I suspect that many doctors report unhappiness because these changes mean that many doctors' careers do not live up to their expectations. Ten years ago, Dr. Marc Ringel noted that "there are endless hassles and plenty of bogeymen [for doctors] to battle: managed care, the government, administrators, insurance companies, non-physician providers, alternative medicine practitioners, other doctors, demanding or uninsured patients, and our perennial favorite, lawyers." These doctors' bogeymen have worsened with the recent health care changes, placing additional obstacles in the typical doctor's path.
For many years, physicians enjoyed the luxuries of answering primarily to themselves, doing as they pleased and living quite well. But the rules have changed and some doctors are having a hard time adjusting to new bosses and bureaucracies. The 50-year-old doctor may report unhappiness, but I don't know any of those unhappy doctors seriously affected by the recession, housing bubble, and unemployment rate. Unlike many of their patients, these doctors do not have to sell their cars or move into smaller houses. While it may sound a bit harsh, the tough economy has impacted the people we treat more than it has impacted us.
But therein may lie the problem. In a 2008 article titled "Unhappy Physicians," Dr. Edwin Leap points out that "the problem with making money is that we spend it. And when we spend it, we need more." He goes on to note that "It isn't what we make, but what we need that enslaves us. If physicians want to be free to enjoy life, free to move, free even to rebel, they have to need less." Perhaps if physicians resolved to "need less," their happiness numbers would correlate more closely with the general public's.
Then vs. Now
I want to make it clear that I'm not forgetting the reality of copious student loans and the fact that a young physician today will earn less on average than young physicians earned 10 years ago. Students entering medical school face challenges that my generation avoided. A recent article, "A History of Medical Student Debt" tells us that in the early 1960s family contributions accounted for 83 percent of a student's total income, making their debt manageable. However, over the last 50 years student debt has skyrocketed to the point where, at graduation, the average medical student owes $158,000. That number doesn't incorporate interest, so medical school could cost two or three times that number by the time the physician repays the loan. These costs negatively impact the eligibility of candidates who apply to medical school and which specialty they choose. At a time when the medical field needs greater diversity, we may be excluding minorities while discouraging other students from choosing lower-paying primary care specialties. Everyone loses: doctors, patients, and society.
Many experts have proposed various solutions to this problem, such as reducing the length of medical school to three years or expanding state and federal forgiveness programs, and including offers to work in underserved areas. Last year, an opinion piece titled "Why Medical School Should Be Free" examined these and other controversial ways to "bend the cost curve" of medical school. Something has to happen, for the current situation, like many things in our economy, is not sustainable.
As you may have guessed, I am not sympathetic to the 40- to 60-year-old physician who has spent him or herself into debt. The Medscape article reports a surprising statistic: that despite their incomes, 40 percent of doctors have no savings. The 50-year-old physician with no savings and a home he cannot afford has one thing that the factory worker or teacher does not have -- a job and the ability to find one at any time. Hopefully the newly-minted doctor will learn from the previous generation's mistakes and proceed with more realistic expectations.
My colleagues sound tone deaf when they complain out loud that their incomes have been cut in half. Many physicians became accustomed to an inflated lifestyle fueled by out-of-control Medicare reimbursement and unnecessary testing. It is now time to pay the piper.
Back to the Basics
I can hear some of my colleagues grumbling, "Easy for him to say, he got his." Yes, I have had a great career. But I would do it all over again -- new rules and all. There are easier ways to make a good living that do not require 12 to 15 years of higher education and frequent high stress levels, but none provide the reward of making a measurable difference in people's lives every day. It can be stressful to bear the constant responsibility for an individual's life and well-being, but one cannot place a monetary value on the smile and hug from a grateful parent or spouse.
Just as the public has to adjust to a health care delivery system that doesn't always meet their needs, so too will physicians have to adjust. In 1903, Sir William Osler noted that, "The times have changed, conditions of practice altered and we are altering rapidly, but the ideals which inspired our earlier physicians are ours today -- ideals which are ever old, yet always fresh and new."
This rang true during a recent visit to my dermatologist. I was telling him how unhappy doctors disturbed me, and he replied that what bothered him most was hearing an unhappy doctor tell an enthusiastic young person to choose any career but medicine. This is terrible advice. That doctor has no right to discourage another person from pursuing their dream just because he or she is unhappy. The well-known educator and writer Joseph Campbell met regularly with his students to provide counsel and encouragement. He is well known for his admonition: "Follow your bliss. Find where it is and don't be afraid to follow it."
Campbell's is good advice for the unhappy doctor.
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