I recently spoke with the bright young son of a physician who is thinking about going to medical school. He spent a year in Peru after college helping people and thinks medicine would be a good life choice for him. He then spoke with several physicians his father knew who all advised him to look elsewhere for a career. There are much better options, he was told: don’t go to medical school. The young man was quite dismayed at this advice. What would you have told this bright young man about a career in medicine?
In 1973, only 15% of physicians had doubts about their career choice. It was a good time to be a doctor. However, surveys over the last decade have shown that 30-40% of physicians would not choose to enter the profession again and would not encourage their children to pursue a medical career.
An article in Family Practice Management in 2013 reported that over one third of physicians met burnout criteria, with female physicians far more affected than male physicians. How did these young men and women with a calling to service, excellence, compassion, and competence come to feel isolated, exhausted, and ineffective?
Is this how we feel? Is this why we tell bright young women and men to run the other way?
Feelings of burnout start early. A Mayo Clinic survey of 545 medical students in 2006 showed that half felt professional distress with emotional exhaustion, depersonalization, and a low sense of accomplishment. Another study of 2,248 medical students in 2008 found that half met the criteria for burnout. As a result, medical schools in the U.S. are now mandated to have student wellness programs in place. These programs attempt to bring out the compassion and wisdom in students who may be suffering in a competitive and exhausting environment.
There are many factors at play in physician dissatisfaction with their careers. Computer documentation and mounting workloads increase our time in the office but decrease face to face contact with our patients. We spend less time with our colleagues and we feel more isolated in our practices. This may be particularly true for rural or solo physician practices. We are taught in our training to cope with physical and emotional challenges, so we ignore our minds and bodies; we can go all day without going to the bathroom and we cannot admit to others, and even to ourselves, that we may be stressed or depressed. If we seek medical or emotional care, we often do it too late. We work long hours and we do not follow the advice we wisely give our patients.
Where do we go from here?
There are many programs available to medical students and residents to understand and cope with the stresses of a medical career. Nedrow et al in Family Practice Management (aafp.org/fpm Jan/Feb 2013) discuss an Oregon Health and Science University resiliency training program to understand and reframe the events in our day and increase our coping skills. The University of North Carolina developed the Taking Care of Our Own program for resident physicians to address and avoid burnout. For those of us out of residency, strategies may have to be locally grown (practice or hospital based) or individual self-awareness programs.
We are caring and compassionate people and we have proven our resilience by how we got here in the first place. Most of us went into medicine to help people and we excel at what we do when we are at the patient’s bedside. We did not go into medicine to get rich (don’t laugh too loud). Strategies that have been shown to be helpful to reduce physician stress may seem obvious: eating nutritiously and spending more time with family and friends; valuing our relationships with patients and our professional relationships with colleagues; clinical variety and time away from work. The common thread: taking care of ourselves and taking care of our relationships with those around us.
This is a time of great change in medicine and our profession will continue to evolve. Payment systems are changing and we will eventually be paid to care for populations of patients instead of the treadmill of fragmented episodic care. That should translate into more time with our patients to foster the relationships that remind us why we chose this caring career.
Many of the physicians in the PHC network practice in rural settings. This presents its own set of challenges. Replacement of retiring physicians is a real challenge. As you well know, it is not easy to attract physicians to a rural health setting. The best predictors for medical students choosing a rural setting include having lived for an extended time in a rural setting, interest in primary care or family medicine, having an altruistic mindset, and having participated in a rural scholar or rural practice experience. Offering your rural practices to medical students or residents and mentoring these young physicians may help them see the value of a rural medical career.
Back to the young man who is considering a career in medicine: I have a meeting set up with him and I will be honest about the challenges of a medical career, but I won’t take away his dreams. My daughter is a 3rd year family medicine resident right now, and yes, I do worry about her career. I want her to have the challenging, but intellectually stimulating and personally rewarding career I have had for the last 36 years. I cannot imagine having had a different career for myself than being a family physician.
Jim Cotter, MD