In 1973, a survey was conducted to evaluate physician satisfaction. Less than 15% of physicians reported any doubt that they had made the right career choice, with 3.7% stating that they were “not happy.”1 Twenty years later, surveys revealed a different story: Forty percent of physicians stated that they would not choose the medical profession if they had to choose a career again.2
Dissatisfaction in medicine has been reported in diverse age groups, different areas of the country, and various medical specialties.3 When dissatisfied, physicians often leave their jobs and, consequently, the patient-physician relationship is disrupted. This turnover is quite costly to the healthcare system. In primary care, the cost of replacing a physician is estimated at $250,000.4
Here are some of the factors that contribute to burnout, as well as solutions for ensuring job satisfaction.
Burnout is an interesting phenomenon in the medical profession. Unlike many other professionals, physicians often experience extreme fatigue and emotional exhaustion at an early stage in their careers—during medical school and residency. By midcareer, the momentum is maintained as colleagues recognize their hard work, and they continue to place service to others before themselves. Physicians who encounter burnout often experience emotional exhaustion, impaired job performance, relationship difficulties, and poor health, including irritability, sleep disturbances, headaches, depression, and drug addictions.
Increased rates of burnout have been linked to several internal and external factors. Internal factors—management style in a workplace, multiple demands at work, social support from colleagues, lack of control over the work environment—have been illustrated to correlate with higher rates of burnout. The ever-increasing demand on physicians’ time leads to higher rates of dissatisfaction. There are an exponentially increasing number of medications, tests, and procedures to discuss with patients and families. This is complicated by the rise of e-mail and the Internet, as some patients expect immediate responses to their concerns.
Some studies have shown that personality factors can lead to burnout. Compulsiveness, a trait often seen in physicians, is an adaptive behavior for the demands of medical education and practice. However, it can lead to chronic feelings of inadequacy, an exaggerated sense of responsibility, and difficulty setting limits. Furthermore, physicians often are conditioned in the psychology of postponement. It takes root in the early years of medical education and leads to habitually delaying various sources of renewal, such as vacations and relationships.
External factors include payment reductions, managing various insurers, and increasing malpractice cases.1,2,5 Evaluating the changing landscape of managed-care organizations reveals that while a small fraction of physicians are employed by them, more than 90% contract with them. Commonly cited reasons for dissatisfaction with managed care include “trafficking” of patients in and out of care, administrative paperwork, limitations on referring patients to specialists, financial incentives to curb medical workups, and pressure to evaluate increasing numbers of patients.6
Malpractice cases have increased in the past 30 years. The American Medical Association (AMA) has identified 18 states where providers are finding it challenging to purchase affordable insurance.7 An additional 26 states have been placed on “orange alert,” indicating a worsening situation in availability and affordability of insurance. Physicians who are not personally burdened by malpractice suits feel its repercussions. They practice “defensive medicine” by ordering increasing numbers of tests and procedures to avoid potential litigation. Physicians involved in lawsuits, regardless of the outcome, describe feeling shame, self-doubt, and disillusionment with medical practice.
What Makes You Happy?
In the December 2006 issue of The Hospitalist (see “Are You Satisfied?” p. 4), Mary Jo Gorman, MD, MBA, FHM, then president of SHM, pointed out five factors that contribute to physician satisfaction: