Why we aren't happier: The loss of joy in health care

Neil Baum, MD

Why are we so unhappy? When I go to the doctor's dining room or surgical lounges, I hear, "If I had to do it again, I wouldn't become a physician, and I would not recommend medicine for my children or grandchildren."

When I graduated from medical school in 1968, the doctor had a lofty position in America. Doctors were incredibly well-respected and enjoyed their work. We could become the kind of doctor who treats and cares for patients. After all, caring for people is why most doctors go into medicine. In the past four decades, American doctors have lost the status we used to enjoy. In the mid-20th century, physicians were the pillars of any community. If you were smart, sincere, and ambitious, at the top of your class, there was nothing nobler or more rewarding that you could aspire to become. In the past four decades, American doctors have lost the status they used to enjoy. In the mid-20th century, physicians were the pillars of any community. If you were smart, sincere, and ambitious, at the top of your class, there was nothing nobler or more rewarding than being a physician. We had an opportunity to regain our esteemed status after Covid 19 when doctors and other healthcare workers worked tirelessly and risked our own lives to care for acutely ill patients.

In the early stages of the pandemic, physicians were widely hailed as heroes for their tireless efforts in treating patients and containing the spread of the virus. However, as the pandemic progressed, public opinion became more divided. The public continued to hold physicians in high regard, while others began to question their advice on vaccination. There was widespread misinformation and conspiracy theories about the virus and the role of physicians in managing it. The pandemic also exposed systemic issues in the healthcare system, such as unequal access to care and disparities in health outcomes, which further eroded trust in physicians and the medical profession.

Despite these challenges, many physicians worked tirelessly to provide care and save lives, and their efforts have not gone unnoticed. The pandemic has also temporarily brought a renewed appreciation for physicians' important role in protecting public health.

American medicine went through a hallowed period in the 1950s. Doctors were not only incredibly well-respected, but technological innovations like coronary bypass surgery brought about many tangible improvements in medicine.

The advent of Medicare didn't cut into doctors' income; it skyrocketed. But that led to a backlash against fee-for-service, which led to managed care and all the restrictions we have now on doctors' autonomy.

As physicians, we are at the top of the income pyramid, with only 5% of the population earning more than $250,000. However, to earn a $250,000 salary, which is a healthy salary for doctors, we run like mice on a treadmill. That salary usually requires a doctor to see 25 to 30 patients a day.

A recent survey revealed that only 6 percent of doctors are happy with their jobs. They commit suicide at twice the rate of the general population. Over half of us are unsure if we would recommend the practice of medicine to young people.¹ Prevalence and professional impact of mental health conditions among cardiologists. Journal of the American College of Cardiology, 81(6), 574-586.) This blog will discuss why physicians are unhappy with the practice of medicine and a few suggestions for returning to those days when we were happy with our practice and left at the end of the day without going home to complete medical records.

The root causes of our unhappiness

There are a variety of aspects of our jobs that make us unhappy. The top issues are lack of control (72 percent), clerical burdens (71 percent), and being emotionally exhausted (69 percent), i.e., burnout. In addition, the survey also identified specific tasks that hindered their happiness at work. The two top responses were clerical duties and administrative issues (both at 28 percent). Other issues were time constraints and lack of staff support. Insufficient pay was the lowest on the list for hindering happiness.²

Lack of time with patients may contribute to physician unhappiness, as 55 percent of physicians reported that time available for individual patients has declined since they started practicing.³

Lack of purpose

Doctors are unhappy due to a growing lack of purpose and meaning in their work and personal lives. This lack of purpose is occurring for two reasons. First, physicians spend as much as two days entering data into the computer to meet hospital and insurance company requirements.⁴

Unsurprisingly, physicians said they were burned out mainly because of too many bureaucratic tasks.⁵ The second reason for physician burnout was too many hours at work. The massive workload, much of which is paperwork and non-clinical administrative activities, coupled with the long hours, can cause even the most resilient physicians to lose sight of why they became doctors.

Additionally, doctors lack the time to find purpose and meaning in their personal lives. With so many hours spent on the job, there's only so much time left to focus on personal hobbies and interests, practice mindfulness, exercise, and build quality relationships. In essence, their work-life balance scale was tilting in the wrong direction.

The pressure and risk physicians take seeing patients for eight to ten minutes per encounter, the educational debt, and the fear of getting sued have created a climate of dissatisfaction and unhappiness.

Quality relationships

Having no or few strong relationships also negatively impacts physician happiness.

Good social relationships are the most consistent predictor of a happy life. Social connections are the cornerstone of happiness. In addition to contributing to happiness, strong relationships are linked with improved health and longevity.⁶

A Harvard study found positive relationships were the top contributing factor to living a happy, healthy, and long life.⁷

Finances & debt

One of the most popular and conflicting statements is "money can't buy happiness." As it turns out, money is only one factor determining happiness worldwide and for medical professionals. There are three main reasons physicians are unhappy regarding their finances. Inflation continues to negatively impact physician salaries, which consistently need to keep up. Physician compensation rose 14% between 2017 and 2022 to around $391,000 from $343,000. However, accounting for inflation, the real average compensation in 2022 was less than $325,000, a nearly $20,000 decrease in purchasing power.⁸

On average, doctors leave medical school with over $250,000 of debt, which continues to rise while salaries decline. Educational debt can take years to pay off, especially for physicians with poor spending habits who didn't start saving early in their careers and benefit from compounding.⁹

A lack of financial education often leads to poor spending habits among doctors, making it difficult for them to get out of debt. Far too many residents and young doctors begin spending like they're making the big bucks when they should be focused on lowering their debt as soon as possible. They spend to their limits since they've lived for so many years as a poor student. They start living a fancy lifestyle before focusing on paying down their debt and making smart investments.

Healthy habits

A career dedicated to understanding how the body works and what it needs to stay healthy would mean physicians care for their own health. Sadly, this is not always the case.

According to the 2023 Medscape Physician Happiness Report, 43% of physicians admitted they only sometimes look after their health and wellness, and 17% admitted they rarely or never look after their health.¹⁰

If you've ever experienced a health scare or chronic illness, you know how much health directly affects your happiness. So why do so many physicians neglect their health when they are so familiar with the negative impacts?

It all goes back to the rising impact of physician burnout and the stigma in healthcare around overworking to succeed. Getting into medical school is extremely competitive, and the pressure doesn't let up once you're in medical school and residency; it just intensifies.

Physicians continually neglect their health, and these bad habits continue into their medical careers with a lack of sleep, nutrition, and physical activity.

In 2022, Medscape found that 47% of doctors suffered from burnout, up from 42% the previous year. As mentioned above, a main contributing factor to physician burnout is too many hours at work, so it's not surprising that doctors struggle to prioritize time for their own mental and physical health.

Physicians are notorious for neglecting their sleep, and research shows that less sleep is associated with lower happiness. Getting quality sleep leads to a healthier life.¹¹

According to Medscape's happiness report, 10% of doctors reported they never exercise, and 20% said they only manage to exercise once a week.

Physicians know the impact physical activity has on health and recommend regular exercise to their patients, yet a third of physicians neglect exercise, and another 36% only exercise two to three times a week.¹²

Exercise is a direct determinant of physician happiness and has been linked to decreased depression, anxiety, and even mortality. Going from low fineness to below average equates to a 50% reduction in mortality over a decade. However, going from low to above-average fitness is a 60% to 70% reduction in mortality.¹³

The World Health Organization (WHO) recommends weekly 2.5 to 5 hours of moderate-intensity aerobic exercise or 1.25 hours of high-intensity physical activity. The best way to exercise regularly is to build it into your daily habits and hobbies. For example, you could bike to work or commit to always using the stairs in your office or the hospital. If there's a show you never miss, roll out your yoga mat and stretch instead of just sitting on the couch, and instead of turning to your phone during your scheduled breaks, do planks, pushups, or yoga. I have a rebounder in my bedroom, and when watching a program such as the news or a football game, I jump on the rebounder during commercials. The rebounder is an excellent aerobic exercise with less stress on your lower extremities' joints.

Bottom Line:

Many doctors today are unhappy and burned out. The truth is that we have a lot more to be happy about, and we should focus on being happy to be doctors. In the second part of this two-part blog, I will discuss solutions for becoming a happy doctor.

Neil Baum, MD, a Professor of Clinical Urology at Tulane University in New Orleans, LA. Dr. Baum is the author of several books, including the best-selling book, Marketing Your Medical Practice-Ethically, Effectively, and Economically, which has sold over 225,000 copies and has been translated into Spanish.