OK, so the "I want out" thread in the physicians forums is seriously bumming me out. Anyone want to talk about it?
I have a question for the unhappy docs floating around mommd: do you have any advice for those of us already in training? Specific specialties to consider? Academic practice v. private practice? Group v. solo practice? Rural v. urban practice? Particular kinds of contract details to negotiate for? Saying "Don't say we didn't warn you!" is fine, I guess, but it's not very helpful, espcially for those of us who are in the middle of training, and already deep in debt.
The cure for anything is salt water: sweat, tears, or the sea. -- Isak Dinesen
Yes, this depresses me, too! I want to know what needs to change! I am only a medical student, and still in my basic sciences years, so I haven't had much clinical experience. I don't know what goes on behind the scenes. I do know that my father-in-law had to quit his private practice because of his lack of reimbursement. He now works for the state medical school residency program. So, what do we do? People need physicians. Someone has to do the job. We can't just all quit. Then what? So, I want to know what you all think would be a realistic solution.
I've been thinking about this, and it seems to me that every single profession where you care for other people has the strong potential for burnout and, over the last N years has gotten progressively less desirable for its practicioners.
Nursing? Perhaps even more so.
Education? Have you seen what urban school districts have to do to get teachers who will stay more than 2 years? Or been around 50-something year old teachers counting how many days till they can gather their pensions?
Social work? Almost every social worker I've met over 35 is burnt out.
I'm not sure what less people-focused careers are like, since they were never really an option for me, but as a humble first year medical student, I feel that I'm getting a reasonable eyes-open picture of medicine between here and my non-science lectures. (I'm not going to pretend that my shadowing experiences are representative, since unhappy people are generally not going to have people shadow them.)
Perhaps all that will change. But I really believe that I would've burnt out on anything else that would pay the bills much faster.
(I'll preface this with the statement that I do believe that I would have the definite potential for rapid burnout in primary care especially, but private practice particularly.)
I would like to open up the questions to the unhappy physicians of: where do you think things went wrong for you personally? Why did you go into medicine, and how has that expectation remained unmet? Given our current health care system, or one closely resembling it, how can real, messy people get good medical care? (Because, clearly, things would be even worse if no women went into medicine.)
I am neither a physician nor a medical student at this point (I wish...), however here are a few things I have learned from friends, family members, acquaintances, professors who are physicians.
Among the most important factors contributing to physician dissatisfaction are amount of debt, lifestyle expectations, specialty, degree of understanding of the health care system as a whole (not just medicine as a small part of the system), initial motivation for pursuing a career in medicine, professional liability laws and regulations in the particular state (and the liability burden on the particular specialty). There also seems to be a strong correlation between the degree of unhappiness with medicine and the age at which the physician began his/her medical training - a traditional student is more likely to be unhappy later on in their career than his/her non-traditional counterpart.
So, I would love to have some data to substantiate or refute any association and/or correlation between some of these factors and career dissatisfaction. Of course, this is a tiny, self-selected sample with all sorts of selection bias issues, but we are not planning on publishing this in JAMA, rather it might help many of us put things in perspective.
Here is a potential pseudo-questionnaire:
2. Number of years in practice
3. Marital status
4. Children (yes/no, or number of kids, if people are comfortable giving this info)
5. Responsible for the care of a child or adult with special needs (yes/no)
6. Career before entering medicine (yes/no)
6a. Previous career in a health care field (yes/no)
7. Began medical school before age 24 (yes/no)
9. Number of hours worked per week
10. Call (yes/no), how many days per week/month
11. Amount of debt (we can categorize this into - less than $10K, $10K-$30K, etc.)
12. Malpractice insurance premium (annual)
13. Named in a lawsuit (yes/no)
14. Practice setting (urban, suburban, rural)
15. Motivation for medicine [btw, no value judgements here]
a. My family wanted me to go into medicine (direct/indirect pressure, and/or conditioning
b. My parent(s)/sibling(s) are doctors, so I chose to follow in their footsteps
c. I enjoyed intellectual challenges and found it easy to interact with people who were ill
d. I really enjoyed helping people in a palpable, physical way
e. I liked the idea of having the power to affect people's lives in a positive way
f. I was really smart kid/good student and thought medicine would be a good fit for me
g. I thought medicine was a respectable, secure and lucrative career
h. I enjoyed science but did not like lab work, so medicine seemed like a better choice
i. I felt like medicine was my calling
16. If you did not have to work to support yourself/your family (you won the lottery today), what would you do?
I just typed this at break-neck (or break-finger :hyper: ) speed (I should really be studying right now... :boxedin: ), so feel free to imrpove/ammend/augment/abrdige.
I read the posts in the Physician forum and, while it is upsetting, I think it's important that we hear what they have to say. It's an undeniable fact that there are a lot of women who are or become unhappy with medicine as a career. I'm sure there are as many reasons as there are people but here are a few themes I've heard from other women doctors I've worked with recently.
1-Time- there's no way around the fact that medicine is one of the more demanding and time-consuming careers out there. There's no getting around the 80 hour work weeks as a resident (with few exceptions) and then there's the fact that there's no 80 hour limit on attendings' work weeks. I see residents get reminded of that alot by attendings when they leave post-call at 1pm. Once in practice, you may be able to find a 40 hr/week job, but chances are you'll be working many more hours than that. Where does that leave a doctor with a family?
2-Money- med school means debt and residency means being barely solvent enough to buy your food and pay for the place you live in for most trainees. 6 figure debt does not get paid off in a year or two. Add to that the fact that most women physicians have children in residency or shortly after and it's even harder to pay off that debt.
3-Personal Life- This ties into time, of course, but it's also a separate issue in a way. So many docs don't have time outside of all the obligations of working and family to do things like exercise and relax and have hobbies. It's a strain on marriages, a strain on families, and a strain on the health and happiness of the practioner.
Now, as someone who used to do casework and education, I can tell you that this is not the only career path that has high burn-out, low appreciation for the amount of time invested, and less pay than might be desireable. But no, I never worked 80+ hrs a week as a caseworker or teacher. Not even close. Of course, I also never got paid more than $25,000/year.
I think what I'm trying to say is that we need to be honest with ourselves and open-minded about all the information we receive. This is not an easy career path. It seems to be especially difficult for women who also wish to be mothers who are actively involved in their families' lives. For all the optimism and encouragement I give, I can honestly say that this is not the career for most people. You've got to really, really want it. You've got to be driven to a certain degree. And, you've got to know that even with all that, you may still wind up disappointed in the outcome.
I think if you polled moms in a variety of careers you would find a whole bunch of them who hated their jobs. What you wouldn't find as much of is women who went into 6 figure debt to acquire that job and who now feel trapped by the financial obligations. That's a significant barrier to happiness.
Now, all that being said, I know quite a few women physicians moms who love their careers. It's a very individual thing.
"All you have to decide is what to do with the time that is given to you."