Unhappy Physicians

Edwin Leap, MD, for HealthLeaders Media, May 8, 2008

What makes physicians so unhappy? I ask myself this when I end angry phone calls with frustrated physicians or when a surgeon walks through the emergency department at my hospital spouting a tirade of profanity that makes the paint peel off the wall. And I wonder about it when I hear a potential medical student talk to a physician, who tells the bright eyed young man or woman, “Don’t do it!”

I have my theories. That’s because the ER is a great place to watch, listen, and learn. I trained in a large urban teaching center and have practiced in a busy, semi-rural community hospital for 15 years. What I’ve seen is a lot of frustration. The question is, what can we do to ease that frustration and create a happier, more functional medical workforce?

First of all, I don’t think that physician unhappiness has to do with patients. Every physician has his or her favorite story of the nightmare patient—like the one who calls at all hours for Viagra refills, the patient the who insisted to my partner that she be admitted for her bad perm, or the drunks who play with rattlesnakes. But patients have been difficult as long as anyone has pretended to be a healer. And frankly, they entertain us; the weirdness we see keeps us coming back, voyeurs of human silliness that we are.

Physicians are sometimes unhappy because we’re busy. We belong to committees, go to meetings, attend CME conferences, educate students and residents, see patients, volunteer in the community, and still try to squeeze in family time (often as an afterthought). We don’t often say no; certainly not often enough for our own good.

And, as always, there’s money. With reimbursement falling and the number of uninsured patients rising, turning a profit in medicine can be very hard. The costs of regulatory compliance, filing insurance, and paying malpractice alone are enough to make medicine unprofitable for many physicians; so they become more and more dissatisfied with their careers and lives. Some people think that’s the essence of physician unhappiness.

Breaking the cycle
Making money isn’t exactly the problem. For all our problems with reimbursement, physicians can still make a fair amount. The problem with making money is that we spend it. And when we spend it, we need more. And the battle is joined.

The cycle is understandable. Physicians start their careers in debt—the average medical student graduates with a burden of educational debt that is currently somewhere around $120,000 and starting residency salaries are only around $40,000. After residency physicians need to make an immediate income boost to catch up and cover debt. But he or she also wants to enjoy the money that’s finally in that bank account. So, doctors start to spend money like. . . doctors.

When we’re not careful, we throw money around like Columbian drug lords in Vegas. The problem is, their money does not depend on hours worked or patients seen; physician income does. We get our cash by seeing patients and performing procedures. We make money on effort, not on money itself. We more resemble factory workers or building contractors than bankers or investors.

So, in order to maintain wealth, we have to keep working hard. And if we spend more, we have to keep working harder to pay off debts. Working harder is tiring, and keeps us away from our families and hobbies. And the cycle goes on and on.

Then, if we wake up unhappy one morning, or realize our families are dissolving before our eyes, or if we feel a desire to cut back, we simply don’t have a choice. We are enslaved to a certain level of income. However miserable the practice may be, we’re stuck. If the partners are hard to work with, or the administrators won’t listen to our problems, we have to smile and keep coming back. If the patients are more and more complex and less rewarding, we have to continue seeing them. If the depression is overwhelming and we actually consider suicide (doctors have the highest suicide rate of any profession), we feel guilty admitting it or seeking help; after all, there’s work to be done and money that needs to be made! So we go on and on, falling deeper and deeper into misery.

In our unhappiness, we also mess up our relationships. This can be an expensive problem; just ask any physician who is now working twice as hard to pay for wife one and wife two, along with child support.

My point is this: 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 or quit, they have to need less. And perhaps the wisest thing that our directors, partners, or even employers can do is to remind us of this. Frequently. Rather than encourage lifestyles that require large infusions of cash, we should encourage reasonable lifestyles that allow large infusions of time-off and happiness.

If we physicians can just learn, we’ll find that the happiness and contentment we want may be easier to attain than we think. If you’re just starting out on your medical journey, don’t spend money you don’t have in anticipation of how much you’ll make. Because if you do, the act of getting that money will be harder and more painful with every passing year. And the things you purchased as part of the ‘doctor life’ will give you less and less joy.

My friend Robby said it best, in his finest South Carolina accent. “Grandpa always said that the key to happiness wasn’t to get what you want, but to want what you have.” It doesn’t get any simpler than that, does it?

Edwin Leap is an emergency medicine physician and writer living in South Carolina. For more information, visit www.edwinleap.com.
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