Be Unhappy with Your Job; Be a Doctor

Why job dissatisfaction is so high among providers

by Suneel Dhand, MD

Becoming a physician is one of the most demanding and costly professions to go into. After 4 years of college, another 4 years of medical school, and then anything up to 7 years of residency training -- this path is not for the fainthearted. Average debt upon finishing school is around $200,000, so it's no surprise that doctors want a good salary when they are done with residency. Most of them first went into medical school with very altruistic intentions. Studies show that more than three-quarters chose medicine with the simple desire to "help people." Most new graduates after residency still have those very altruistic intentions and high ideals, yet after a couple of years in practice -- something seems to change.

A quick glance at medical print and online publications and the news will tell you it's no secret: we face an epidemic of physician job dissatisfaction and burnout. Some research shockingly suggests that this tops 50% for all doctors. So what happened? Over the last 20 years we have faced a perfect storm of factors coming together.

The corporatization of healthcare

Medicine is no longer about independent practice doctors who have (a certain degree of) autonomy and control. The current regulatory and reimbursement environment makes it very difficult for physicians in independent practice. The employee model may bring some benefits in terms of perceived "job security" -- but that comes at a great price as well. Physicians, by their nature, are very independent-minded and free-thinking souls, and this doesn't always sit well in a controlled employer-employee type relationship.

Increasing regulations and bureaucracy

Following on from the above, less and less time is being spent by physicians doing what they were actually trained to do, as they face a mountain of administrative tasks to deal with. For instance, some studies suggest that new interns are spending as little as 10% of their day in direct patient care (yes, just 10%). It goes without saying that if you change the essence of any trained professional's day so much from what they are supposed to be doing, they will not react well to this. Add to this mix the burden of electronic medical records (a whole different topic) and the massive data-entry requirements placed on physicians, which have seen them become more like data-entry clerks instead of highly trained doctors.

The financial squeeze is on

Let's be realistic: our healthcare system is unsustainable. As a nation, we spend almost $3.5 trillion on healthcare. To put that into perspective, that is more than the total GDP of every country in the world apart from China and Japan! Germany, next on the list, has an entire GDP of $3.4 trillion. If the brakes are not somehow applied, spending could reach over a third of entire GDP within 30 years: a figure that would quite simply destroy the American economy. Currently, at 18% of the economy, we spend almost double the OECD GDP average percentage of other western nations. Yet our outcomes are nowhere near what they should be. The population is aging, and our treatments are getting more expensive -- all against a backdrop of rising expectations. The pressure to reduce costs is filtering through to all levels of our healthcare system.

It is vital for any society to have good and motivated physicians to serve the public. If we are now in a situation where we just accept that all doctors are destined to dislike their work after only a couple of years in practice, this has huge consequences for the country. Every human being deserves the right to be happy and fulfilled in their vocation. Many physicians are now being forced into cutting back their hours, looking for alternative ways to work, additional income streams -- and yes, many are leaving clinical medicine altogether. This ship needs to be somehow turned around. And it needs to happen fast.

Suneel Dhand, MD, is an internal medicine physician, author, and speaker. He is co-founder of DocsDox, a service that helps physicians find local moonlighting and per diem opportunities, bypassing the middleman. Hear him talking about these issues in this presentation



I retired a few years ago, still in good shape, after 51 years of practice, including three years overseas in the Peace Corps. I was a psychiatrist for most of my career, and I felt I was at peak competence in my mid-70's.

I would have continued another 5 to 10 years, except for the usual complaints: drug companies and insurance companies run organized medicine, which now devalues physicians, especially experienced ones, by power loss, low pay, lawsuits, and, especially in my field, indefensible insistence on ultra-brief "therapy" based primarily on drugs and avoidance of dealing with the social, psychological and spiritual aspects of a patient's life.

If I were a Buddhist monk, none of this would matter. Alas, I am a mere Western mortal, who entered medicine because of my exposure to doctors in the 40's and 50's, when they had a certain amount of respect, autonomy and control. I understand physician "burnout": I left before it hit me, before I became a mere "provider".

I am not certain I believe all this. Perhaps MD burnout is a really poor selection of future doctors by medical schools and the wrong people going into medicine. I would have given an arm and a leg to become a doctor and the intrinsic value was always more important than the money. I worked in college, medical school and during my residency to control debt. The costs to be educated are more now that is for certain but delayed gratification reigned supreme which included no debt which was anathema. If doctors really wanted old fashion private practice and did not join the corporations, there would still be private practice.

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