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Are Today's Physicians Less Satisfied Than In The Past?

In the August issue of the GME e-Letter, we asked whether today's physicians are less satisfied with their careers than doctors in the past

In 1976, the Association of American Medical Colleges (AAMC) assessed the satisfaction of physicians who had graduated from medical school in 1960. Over 95 percent agreed that their jobs were interesting, and only 4 percent expressed disappointment with their careers in medicine. In fact, 86 percent believed they were happier in their work than most other people, and 42 percent noted that they enjoyed their work more than their leisure time!

Thirty years later, a survey found that 83 percent of physicians over 50 years old, but only 75 percent of physicians under 50, were satisfied with medicine as a career.

It's not only US physicians. The British Medical Association followed the career paths of medical graduates from 1995. Ten years later, three-quarters were satisfied with practicing medicine, but one fifth reported a “lukewarm” or no desire to practice, with lack of an acceptable work-life balance a key factor.

Certainly, advances in medicine have given each successive generation of physicians a greater capacity to provide benefits to their patients. But this has not resulted in greater professional satisfaction.

So what makes medicine less satisfactory now? Are other careers more attractive? Are we admitting the wrong students? Are the training and practice environments more toxic? Are patients more needy or less appreciative? Or is it just the factors many of us complain about—long hours, administrative hassles, regulatory hurdles, medical liability, and the growing desire for work-life balance.

Below are the responses we received from readers of the GME e-Letter, with identifying information removed.

When reports come out about US physicians feeling disgruntled, it's usually hard for me to attribute it to variables beyond physicians' strong sense of entitlement and inflated expectations. More than three quarters of people being satisfied with their careers seems like a high percentage to me, not something that merits concern.

And what, exactly, are these sources of dissatisfaction—too little money? This goes back to the entitlement question—what do my colleagues expect? That they deserve the 99th percentile of income vs. the rest of the country (and the world), instead of only being at the 95th percentile?

And if one feels one is working too much, work less! For example, our national data on women physicians (n=4,501) showed that radiologists made the most of any specialty, and were most likely to feel overworked. It doesn't take a fellowship to figure out how one can work fewer hours, and have those hours be happier.

-Erica Frank, MD, MPH

I believe we may be admitting the wrong kind of people to medical school, who get into medicine for the wrong reasons, and these doctors then become more quickly frustrated with routine hassles than others. And it goes without saying that the practice of medicine is not the same as it once was, with less autonomy for doctors and more practice hassles and paperwork.

“Certainly, advances in medicine have given each successive generation of physicians a greater capacity to provide benefits to their patients. But this has not resulted in greater professional satisfaction.

“So what makes medicine less satisfactory now? Are other careers more attractive? Are we admitting the wrong students? Are the training and practice environments more toxic? Are patients more needy or less appreciative? Or is it just the factors many of us complain about—long hours, administrative hassles, regulatory hurdles, medical liability, and the growing desire for work-life balance?”

This is a profound paradox, and as with many a paradox, therein lies the answer. The key to work-life balance and satisfaction in medicine comes from integration, not segregation; embracing "both-and," rather than ever more intensely pursuing "either-or." And, without abandoning our pursuit of efficiency, we need to accept the limits of our own human condition, individually and communally.

The harder we try to protect, the more we lose our time and our equanimity.

Please do not go by US or British consensus—they always seem to have similar opinions no matter what.

I refuse to practice American medicine—it is way too political! I was forced to be educated outside my own country. I went to Rome to study and I am very happy that my destiny took that course. Shame on this country for not giving its own students a chance to study here. It had to import a bunch of money-hungry doctors from other countries, and now I believe that the consequences are being paid!

During my internship in the 1950s, I remember surgeons doing work gratis if I assisted gratis, and the hospital would accept non-paying patients. Now there are no GPs, and family practitioners aren’t allowed in the hospital. The insurance of most family practitioners won’t allow them to perform even the most minor surgical procedures. Paperwork, billing, liability concerns, etc, make the business of medicine aggravating, and the goal of many physicians is simply to make enough money to retire. In the past, many used to work part-time to keep their hands in; now they want to avoid lawsuits and get out ASAP.

If this keeps up, we will lose intelligent people to other professions.