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Last Word: The real reason doctors are unhappy


With all our status and money, you'd think we doctors would be a happy lot. But we're not.



The real reason doctors are unhappy

By Marc A. Ringel, MD

With all our status and money, you'd think we doctors would be a happy lot. But we're not.

I've long noticed that way too many of my colleagues are miserable in their careers. That observation was given some weight by pieces published last year in two consecutive issues of Medical Economics. The first, "Are you sorry you went into primary care?" (Sept. 23, 2002), reported that 73 percent of the primary care physicians polled answered "Yes." Why are they sorry about a career that pays pretty well compared to many others? For 63 percent of the respondents, the compensation doesn't make up for the hours and stress.

That probably doesn't surprise you. After all, there's a huge income discrepancy between the so-called cognitive specialties, whose practitioners (known to those in the trade as "fleas") spend most of their time figuring things out, and the procedural specialties, whose practitioners (called "blades") are paid handsomely for doing stuff with their hands. I'm paid much more for spending 15 minutes lopping a little skin lesion off a patient's forehead than for devoting an hour to interviewing, examining, diagnosing, counseling, and prescribing for a patient who has chronic back pain.

Compounding that problem is the fact that primary care doctors tend to spend more time on the front lines, working more hours than their procedure-oriented friends. No wonder training programs in cognitive specialties have a hard time attracting enough applicants.

Still, a Practice Beat item in the very next Medical Economics ("Medical Careers: How dissatisfied are doctors really?" Oct. 11, 2002) suggests that there's more to this issue than envy of proceduralists' financial status. A study published in the Archives of Internal Medicine, it notes, found that proceduralists are even more likely than physicians in cognitive specialties to be dissatisfied with their careers. The main reason for this discontent is managed care, the researchers concluded.

As a family doctor, I wonder whether part of the problem is that physicians who make their living doing things to people are missing out on what makes my career worthwhile—the opportunity to talk at length with patients and develop a close relationship with them over time.

Nothing in life—certainly not money, status, or lifestyle—guarantees happiness for any type of doctor. The best bet is to find meaning in what you do. But many of us have forgotten why we went into medical practice in the first place. That's why so many physicians are so unhappy.

Sure, there are endless hassles and plenty of bogeymen to battle: managed care, the government, administrators, insurance companies, nonphysician providers, alternative medicine practitioners, other doctors, demanding or uninsured patients, and our perennial favorite, lawyers.

But there's still the calling of healing, and that should permeate a doctor's job no matter what the specialty. We physicians have lost sight of what a privilege it is to care for our patients.

To be sure, the American health care system is a huge, inefficient, expensive, abusive mess. But that's not the real reason for our misery. To heal ourselves, we must get back in touch with our role as healers.


The author is a family physician in Brush, CO.


Marc Ringel. Last Word: The real reason doctors are unhappy. Medical Economics Nov. 21, 2003;80:78.

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