Blog | Monday, March 11, 2019

Be a happy physician and don't do it full time

Talk about physician burnout and job dissatisfaction is everywhere right now. If you are a doctor, you cannot escape the news. Within the last couple of weeks, organizations in Massachusetts (a mecca of health care and hospitals) declared physician burnout a “major public health crisis”. This all sounds rather dramatic. On the surface, physicians are reasonably well paid, still enjoy a good degree of autonomy (certainly compared with many other professions in 2019), and have a job market where many specialties can pick and choose. So what's gone wrong? The problem lies in the nature of the job itself and how a model of physician employees in a corporate environment, has replaced the traditional autonomous small practice model—within a sea of regulatory burdens and administration. Not to mention how health care information technology and the need to spend large chunks of the day on a computer, instead of with patients, has taken doctors so far away from why they went into medicine in the first place. This has happened relatively quickly in just over a decade.

I came to the United States a while back with a specific goal in mind: I wanted to do my residency and then start my own practice. That was my American Dream. I came from a very different health care system—the United Kingdom, where the concept of “starting your own practice” doesn't really exist. Although I really do think the National Health Service (NHS) is a noble and fine concept, and am grateful for the care my family and friends receive, working in it is a different matter. Many of my medical school friends have left medicine completely in the UK, and the rest are very unhappy working in a centrally controlled system with the government as the sole employer (way beyond any level of dissatisfaction we have here). I'm glad I came to America.

By the time I graduated from residency though, it was almost impossible to go into private practice. The mass movement to employed physicians had begun, and health care became less about good old Dr. Johnson's office around the corner that would serve you and your whole family, and more about mega-mergers, conglomerates, hostile takeovers and CEO bonuses. Since my first employed job, I've worked up and down the East Coast in every type of hospital—urban, rural, academic, community. I've met thousands of doctors of all specialties, and heard so many stories of how medicine has changed over the years.

After years of trying different things (including even a stint in administration, which was painful!), exploring various creative ideas of mine, I think I'm finally at a place where I'm truly happy with where I am. I work part-time as a physician doing a mixture of inpatient and outpatient work, independently contracting with facilities—and have other ventures, including a health care-related business and consulting, the rest of the time. I love clinical medicine and patient care—and have absolutely no intention of ever leaving the front lines. I am at my best when I'm serving patients. However, in this environment, I simply cannot do it full-time.

Considering the statistics on physician burnout, I think it's really sad if any doctor ever feels unhappy in their job or like there's no way out. You can move to another similar job and switch hospitals or clinics, try a new way of practice like direct primary care or concierge medicine (which several of my colleagues are doing, and have given glowing reviews for), move to academic medicine in a more protected and less intense environment (as long as you can take the salary sacrifice), or get credentialed in several institutions and make your own schedule (also a great option!). Many physician colleagues of mine are even doing completely different things on the side while still in practice—like getting involved in startups, restaurants, hotels, or travel companies! And that's okay. Life is oh too short, and if anyone wants to do something that makes them happier, go for it. We are also lucky enough to be living in America, where entrepreneurship is welcomed and encouraged. And heck, if any doctor can't stand the thought of clinical practice and doesn't have an entrepreneurial streak, just start searching for jobs in one of the many other industries that may employ you (including pharmaceuticals or biotechnology), and leave medicine completely. But be happy!

Let me not mince words here. I believe all this talk that's happening about “wellness officers” and “daily physician burnout tips” delivered to your inbox by physician organizations—is lipstick on a pig (if I could capitalize “lipstick on a pig”, I would). It will do nothing for any physician who is burned out. In any case, the last thing we need is more administrators in medicine (see this graph), or for physician burnout issues to become yet another “bumper sticker”. The fundamentals of the system are wrong, and searching for long term job satisfaction as an employee of a corporation is like searching for fool's gold (as I wrote about in this article). I'm sorry to say that, but it's true. Doctors are simply way too smart, independent-minded and frontline-focused, to be widgets in a corporate style system, and derive happiness from that. Ultimately—practicing medicine full-time in America is very difficult for most physicians as things currently exist. That's why we have to think outside the box.

So if there's any doctor out there considering how their clinical practice is not what they expected it to be—and still likes the practice of medicine, going part-time and figuring out a way to make it financially viable is something you should seriously think about.

Suneel Dhand is an internal medicine physician, author and speaker. He is the founder of DocSpeak Communications and co-founder at DocsDox. He blogs at his self-titled site, where this post first appeared.