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Unhappy Doctors, The Illusion of Happy Doctors

Unhappy Doctors Outnumber Happy One

In larger medical groups, there are often local and regional meetings where most doctors get to interact with each other in a more social setting. Some of the leadership attends as well. Doctors go up on stage and give talks and put on thick smiles.

As doctors we may even tune into a few medical podcasts or watch some notable physicians on the screen. We read books by amazing physician authors and hear stories about doctors who retired happily in their 90’s.

The rest of the time we have jovial medical students and eager residents rotating through our departments. It can be easy to get the impression that medicine is just one big happy orgy, interrupted occasionally by coughs and protruding bones.

In this post I want to just draw some attention to the two extreme groups of physicians dispersed among us. It’s not a traditional bell curve distribution but rather a skewed one.


Those in the trenches

There are those doctors who are in the trenches nearly every day. They are seeing patients, dealing with complaints, fighting lawsuits, handling inbasket patient messages and being told by a non-MD manager what they should be doing differently.

These doctors may not have the time management skills, the bubbly personalities nor the charm of those more visible doctors. These are the worker bees and they work hard, eagerly waiting for the signal to kick their feet up and relax from medicine.

When these doctors find a moment to look up, they aren’t seeing their fellow trenchmen up on a podium or leading a new innovative charge. Their comrades have their heads buried in computers or lost in a sea of emails and patient messages.

Instead, when they look up they see those vocal, sparkling, and seemingly untroubled doctors who are singing the praises of medicine. These doctors are often put in charge of giving lectures, leading other doctors and helping boost morale. They hog the majority of the spotlight on medicine and I am reluctant to say that they are in those positions because of high clinical competency.


Of course there are genuinely happy doctors, as well

There are construction contractors who get up at 4am 6 days a week, work well into the evening sweating away in hot backyards, on steep rooftops or squeezed under rafters. They love what they do, they are happiest when they are solving a contracting problem, leading a group of construction workers and when they see smiles on the faces of customers.

Just like there are happy baristas, restaurant servers, new mothers and contractors, there are also happy doctors. The profession isn’t an easy one to adjust to for the average person but some do amazingly well and are elated to be practicing medicine.

I can see the faces and demeanor of 5 specific doctors in my head right now, 2 primary care and 3 specialists, who were flowing over with excitement when it came to practicing medicine – not just giving lectures, or holding a title, but actually being in the trenches with patients.


Some doctors are good at Putting On A Front

I worked with this older doctor in the urgent care for 5 years, Dr. T. He was in his late 70’s and didn’t need the money but was still working because he would always say “I’ll just drop dead if I don’t work”. He had been practicing medicine for 53 years when I left and said he actually loved it.

Let me tell you, working with this man was something else. He was good, no doubt about it. But he would have 2-3 meltdowns a week, sometimes per day. He would grumble and yell and get frustrated something wicked. Patients would run him up the wall and every new email from management was the apparent end of his life.

Perhaps Dr. T was the exception but I have met many other doctors who claim that they love medicine and that they wanted to practice it until they drop. But when practicing next to them it’s apparent that they are more miserable than in love. Perhaps it’s the love-hate thing that people always mention – though at least I expect the person seem happy.

We are physicians, we are the masters at putting on fronts. We know how to hide all sorts of emotions. We can hold a fart in for a 3-hour morning round, we can get through an OR day with a descending kidney stone and we can return to work after the death of a loved one without our patients ever knowing.


How the seemingly happy can mess up your compass

Naturally, it’s best to make our own decisions regarding our feelings towards our careers. It’s possible to find the right niche that minimizes distress and maximizes pleasure. Perhaps this is why some doctors become professors, others open their own private offices, some become attendings and others take on CEO positions for startups.

One problem I see is that the doctors who are suffering on the inside while practicing medicine don’t seem to be able to gain the proper perspective. They look around and see all these medical pundits who are showing their pearly whites, grinning cheek to cheek.

The only other doctors whom they interact with who share similar emotions are “trouble makers”, “slackers” or “rebels”. Some can’t even hold down a job and keep failing their reviews and have to find per diem gigs to fill their income need.


Hiding Feelings

Doctors who are unhappy are good at keeping it to themselves. Few will understand them outside of medicine because they are doctors – an amazing profession with a ton of income, on the surface.

These unhappy physicians drown their feelings creating dependency on their careers just in case they might wake up one day and be like, no, fuck no, I’m not doing this shit! They get into more debt, they buy a bigger home, they create long commutes to find a moment of peace, they buy vacation homes and boats and fill their time by planning vacations – anything to get their minds off of living a life they aren’t really wanting to live.

They are caught in no-man’s land, too fearful to quit and too painful to keep up the charade. Nevertheless, they will keep it up, they will keep it up for decades and finally pay off that house, get rid of their student loans, and pay for everything expensive you can imagine. They then come to the awakening realization in their 60’s that the ends didn’t justify the means. There is no gold at the end of the medical career rainbow. When medicine stops and the retirement investments come flowing in to the tune of $150k+/year, there isn’t much else – just the next morning when the sun comes up, broken up by a few errands, followed by the sunset.


Avoiding Regret

It would be a shame to end our careers wondering whether we should have gotten out sooner or cut back or switched positions when we had the chance. Whether we could have pursued our dreams had we left at a younger age.

I am convinced that too many doctors find themselves with way too much money at a traditional retirement age. I don’t think there is a lot of blatant regret by that time, decades of suppressing our emotions tend to numb the mind. It’s more a subtle undercurrent of wondering whether maybe they worked a little too hard, worked a little too long, suffered a bit too much and neglected things they shouldn’t have.

Medicine pays enough that most doctors have a way out. It does require us to live below our means, way below our means and often even below the means of the average income household. In return, we will achieve financial freedom sooner and have a world of options open up for us.

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