Medicine is a career with many stresses and many rewards. Some stressors are not too different from other careers, but many appear to be unique to the practice of medicine.
Young people enter the field of medicine for many reasons. Some are natural healing personalities. Some are enthralled with understanding the mysteries of human anatomy and physiology and a have a burning passion to know how the body works. Some have had personal experiences with illness and recovery as a personal motivator to become a doctor and cure disease. Some are born overachievers and want to prove themselves or rise to the top in a very competitive and prestigious arena of human endeavor. Some are consummate technicians who delight in performing a procedure to near perfection, over and over again, while others are deep and creative thinkers, who delight in putting all the pieces of a puzzle together to discover a rare diagnosis or a novel treatment approach. Almost all have a natural temperament that is not terribly upset by the sight of blood or open wounds, which it makes it seem natural to go into medicine. So let’s take a look at some salient features of this high-stress, high-reward lifestyle.
To be sure, for most the rewards far outweigh the stresses. So let’s get the stresses out of the way first:
- The long length and high expense of training and internship. Learning medicine is the consuming focus of one’s life for virtually the entire third decade of life, which involves massive frustration tolerance, delay of gratification in other areas of life, and the mental stress of incurring significant indebtedness.
- Constant state of uncertainty and anxiety; pre-meds fear they won’t get into medical school; once admitted, medical students are afraid of failing out of medical school; interns and residents are afraid of not passing their boards and other exams, and young doctors are afraid they’re going to kill someone. It requires a lot of faith in oneself and one’s teachers to counterbalance the years of constant fear and anxiety.
- Medical boards, licensure regulations, certification and recertification requirements: risks of board complaints or malpractice litigation leave many doctors feeling like slaves to regulatory bodies and practicing defensive medicine. As an inexact science, poor outcomes are inevitable in the practice of medicine and lawsuits against doctors are in fact poorly correlated with whether actual malpractice truly occurred or not.
- Working long hours, on-call shifts, and sleep deprivation are stressful in and of themselves, and often result in neglect of family, friends, and life outside of medicine.
- Dealing with insurance companies, prior authorizations, EMR’s, and reimbursements; while some doctors are also natural entrepreneurs who thrive on mastering financial systems and ownership of clinics and real estate, most doctors, well, we just want to be doctors. For the latter group, the insane labyrinth of insurance and the hassles of getting patients reimbursed and getting themselves paid are major stressors. It is almost no exaggeration to say that a surgeon is not stressed by an arterial bleed, an ER doc not stressed by a patient having a cardiac event, a psychiatrist not stressed by a suicidal or psychotic patient; rather, we thrive when we get to use the skills we’ve been exquisitely trained with, to successfully intervene in a significant illness episode. On the other hand, we’re completely stressed out by dealing with insurance companies and the maddening, time-consuming, cognitively draining modern electronic medical record (EMR) that is designed for billing and bean-counting but not for aiding the doctor’s clinical work and sometimes succeeds in grinding the very soul of the physician down into a fine, powdery, ethereal dust.
- Corporate practice of medicine (CPOM), mergers and acquisitions, takeovers by private equity: doctors are small players in a vast system of corporate management and finances. A secular trend in healthcare is that private equity groups are buying out medical practices and even veterinary practices, squeezing short-term profit out of the system, characteristically by demanding more “productivity” from doctors (i.e., less time spent with each patient encounter) and wherever possible hiring lower-trained, cheaper personnel in place of more highly trained and licensed personnel. CPOM and private equity takeovers are major drivers of health care provider burnout in some medical specialties.
- Daily exposure to human suffering and pain; think about the last time you visited the Apple store: everything’s clean, new, shiny, lots of intriguing and clever and fun gadgets to make you smarter and make your life better. Nobody’s hurting, bleeding, oozing malodorous exudates, despairing, or dying. Now think about the clinic or hospital setting; constant exposure to human suffering and pain can take a toll on the psyche.
- Psychological isolation from the non-medical world: based upon training, vocabulary, public and social perceptions of acceptable physician behaviors, medical professionals develop a unique mentality that changes one’s perspective on life and death and sets the mind of the physician apart from those who do not regularly deal with sickness, suffering, or death. To maintain balance, doctors must avoid retreating into medicine and maintain robust ties with the outside world whether through hobbies, social contacts, the arts, or community involvement.
Balancing these stressors, there are many powerful rewards in the life of a doctor, including the following:
- More than just a job: many careers are more than just a job, but especially so in the field of medicine, which has a noble tradition going all the way back to Hippocrates, a life-long devotion to study and practice, and a sacred covenant of trust and service to society. The opportunity to serve others meaningfully, which medicine offers, is a great source of life satisfaction.
- Trust, respect, and gratitude: although in general the public’s trust in traditional institutions has eroded in modern times, doctors largely continue to enjoy the trust of society and the gratitude of their individual patients. To be given such trust and respect is a great honor and privilege and a rich source of personal fulfillment.
- Personal accomplishments: getting that “M.D.”, passing the boards, earning a place on a medical school faculty, publishing a scientific paper, practicing good medicine day after day, all provide an ample sense of personal accomplishment for the ego of the individual physician.
- Intellectual gratification: learning how the body or mind work, understanding factors that contribute to healing or disease, health and longevity, or sickness and death; medicine is a life of constant, life-long learning and study. For those who value life-long learning, there is no shortage of satisfaction and gratification.
- A brotherhood or surrogate family: to some extent, only other doctors know what it takes and what it feels like to be a doctor; one feels a sense of brotherhood and kinship and feeling ‘at home’ when one encounters another initiate to the small and selective “Cult of Asclepius”, as medicine was originally known.
- Low worries about unemployment: doctors with valid licenses and up-to-date training rarely have serious worries about not being able to find work.
- Ample compensation: although offset by astronomical student loans, nonetheless doctors enjoy ample remuneration for their skilled and valuable services.
- Meaning and purpose: although the practice of medicine can be frustrating as disease often wins out and patients are often reluctant to change unhealthy lifestyles, in general the very direct sense of helping others and relieving suffering fulfills the basic human need for a sense of meaning and living a purposeful life.
- Insight into human nature: doctors treat all patients who come our way, the high and mighty, the lowly and humble, the entire cross-section of humanity. Our patients trust us and talk to us and share their stories. In learning about human suffering and resilience, faith and despair, protest and acceptance, we get to see the commonalities in all people despite differences in race or gender or background. These insights can form the beginning of wisdom and charity and love for our fellow man if we are open and paying attention.
- Learning to be good in a crisis: in order to pass courses and certifications, doctors learn to analyze complex and urgent situations, often with other people such as family members and hospital personnel standing around watching us, and under time pressure, in order to devise treatment strategies or perform urgent medical interventions. Doctors must act under pressure when tired, stressed, distracted, or in the middle of the night. The eventual result is the power to feel confident, competent, and composed in crisis situations. The result of this acquired skill is self-confidence and a sense of great personal efficacy for the experienced physician. If there’s a dire emergency unfolding in a meeting room, a hotel lobby, or out on the street, the odds are high that the people screaming their heads off in panic or frozen with fear, are not medical doctors.
So there you have it, eight major stressors and ten major sources of reward and gratification in the high-stress and high-reward life of a doctor.
Larry H Pastor, MD
December 2024
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