A recent essay in the Wall Street Journal from Dr Sandeep Jauhar explores the decline in job satisfaction and happiness in American doctors. Adapted from his recent book “Doctored: The Disillusionment of an American Physician” Dr Jauhar’s commentary paints a bleak picture of discontent and low morale. Being in the WSJ, there is a strong economic slant, but the piece seems relevant, or at least of interest, to people in all health professions.
Why Doctors Are Sick of Their Profession
American physicians are increasingly unhappy with their once-vaunted profession, and that malaise is bad for their patients.
“It could be just a midlife crisis, but it occurs to me that my profession is in a sort of midlife crisis of its own. 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 and sincere and ambitious, at the top of your class, there was nothing nobler or more rewarding that you could aspire to become.
In surveys, a majority of doctors express diminished enthusiasm for medicine and say they would discourage a friend or family member from entering the profession. In a 2008 survey of 12,000 physicians, only 6% described their morale as positive.”
Are allied health professions similarly afflicted by this malaise? Perhaps having never enjoyed the lofty social status bestowed on doctors throughout history, allied health professionals have been somewhat protected from this decline?
Maybe not being able to use a prescription pad or scalpel has allowed allied health professionals and therapists to understand and experience more “Human Moments” – those encounters that often define moments of satisfaction and contentment as explained in Dr Jauhar’s closing thoughts:
“What’s most important to me as a doctor, I’ve learned, are the human moments. Medicine is about taking care of people in their most vulnerable states and making yourself somewhat vulnerable in the process. Those human moments are what others—the lawyers, the bankers—envy about our profession, and no company, no agency, no entity can take those away. Ultimately, this is the best hope for our professional salvation.”
Or maybe the job satisfaction rate is just as low and the burnout rate just as high?
Personal experiences and thoughts welcome in the comments below.
-Tim Cocks
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If you can’t make it to beuatiful Brisband or the glorious Gold Coast in September you can still get your think on and immerse yourself in some brainy books with Explain Pain 2nd Ed and The Graded Motor Imagery Handbook.
What i find that has happened in the past years with medicine in general, it has been machinalized instead of personalised…. Yrs ago doctors had to listen to their patients stories, know their backgrounds to assess a medical situation…. The doctor was a ‘friend in the house’…. Someone you told things you would not tell to family members.
Nowadays in medicine we don’t need that close contact anymore (so we think), the personal story is not of primary importance anymore, the labtest, the MRI, the EMG machine are.
With the increased machinalization, the satisfaction (a human trait) has disappeared with it?!
For all, we remain social beings!
There are problems in Medicine and Physiotherapy (in terms of retention and burnout) because those running the university courses have absolutely no clue what they’re doing, and so they don’t screen potential entrants adequately.
Potential entrants in physio commonly have the following problematic thoughts about the job. I hear these things from students:
1) “I really like sport, so physio would be a good job for me”.
2) “I want to help people”.
1) Physio is physio, whether you are working on Roger Federer’s shoulder or the local plumber’s shoulder. You are using the exact same techniques and you do NOT get to play tennis as part of your job. They are totally different occupations. Whilst it’s true that you may get a ‘contact high’ from hanging out with the Fed, leeching value in this way is not good for anyone. How do you think Federer feels when the guy that is supposed to be treating him is concerned about how cool it is to hang out with a star tennis player? What I’m saying is – Federer will choose his physio based purely on his ability to give such value, not take it. The value he is seeking will be in the relationship (not the technique used), and this is true for the local plumber as well.
2) ‘Wanting to help people’ – There’s a LOT in that statement. Why do you want to help? Does it make you feel good to help? Ok, so if it feels good when you help someone, so what happens when you fail to help? It’s not about you and your feelings of goodness or inadequacy as a therapist. This is a VERY basic mistake and it took me forever to realize it through my own work. It took me forever because… yet again…. those teaching this shit have no idea what they’re doing.
Entrance aptitude tests should assess:
– empathy
– congruence
– therapeutic presence
– motivation (real underlying motivation, beyond what the student *says*).
– intelligence and wisdom (not just intelligence alone)
EG.
I agree with you. I think the university should explain these issues to avoid maladaptive concepts in future physiotherapists.
But students are too young to assess these skills. Many times these are developed through clinical experience.
We can not know what kind of therapist will be a 20 year old student.
Hi Encarna,
Yeh, maybe if the universities said something like this to potential students:
— Effective Physiotherapy requires the following skill sets – congruence, presence, etc…
— Please note that the required skills sets are all psychological
— These skills can come naturally, or they may be learned
— Physical skills play very little or no part in helping clients
— Most of the physical treatments that are commonly in use in private practice are either 1) improperly tested by research, or 2) proven by research to be ineffective in helping people with pain and stiffness.
— A high level of intelligence is not required.
How would that fly?
Would anyone apply to become a Physio if they knew the truth?
I’m assuming the Uni of SA is different, what with all the avant-garde researchers they have on staff. Dave?
EG
I just thought of something else. I used to work with a GP who at Christmas would receive an enormous load of expensive gifts from his patients. The amount of stuff would have filled a large car boot twice over. One grateful patient gave him a return flight for two to Tasmania. Another gave him a day’s hire of a prestige sports car. I read through some of the cards because I was fascinated.
Things that were never mentioned by his patients:
– treatment technique
– diagnostic ability
Things that appeared over and again:
– care
– support
– attention
As Meerkat would say… “simples”.
EG.
Thanks to all for their thoughts and comments.
Wouter, your thoughts about the local doctor being a “friend in the house” really echo the sentiments from the author of the piece in regards to the medical profession becoming just another profession. It’s interesting to ponder whether this change has been perhaps driven by more people seeking to become medical practitioners because it had become established as a high prestige, high paying profession – i.e. the motivation was *more* about the financial rewards and prestige rather than the profession of helping people, or, whether insurance/government policy has driven the profession away from its core values, or, whether societal and cultural expectations has shifted and changed over time. It’s probably a complex interaction of these and many other factors of course. Perhaps in the future there will come a time when the technology (tests, scans etc) is no longer at the forefront of the interaction between therapist/clinician and patient, but is instead there to support the human moments?
EG, I believe that the schools of medicine and dentistry (in my neck of the woods at least) have moved away from pure academic achievement entrance, to a combination of academic achievement with the UMAT test and an interview process. The UMAT (Undergraduate Medical and Health Sciences Admission Test) proposes to test “logical reasoning and problem solving, Understanding People, Non-Verbal Reasoning”. Whether this has led to any improvement I’m not sure.
Not only is expectation in physiotherapy a major issue, but also the numbers of schools, and the number of graduates that they produce each year.
I can see you point on the entrance aptitude tests, but i reckon that if i had been required to sit those tests i probably would have failed each one!!! I hope that i have learnt a bit about these things over time.
In answer to your question (which i suspect you know the answer to anyway) about flying – probably like the proverbial lead balloon – whatever change occurs will be very slow i think.
Encarna, great points. But i think there is a bind for universities in regards to how honest they are when explaining courses/professions versus attracting students to pay fees to keep the uni running.
Thanks again to all, hope you enjoy human moments every day.
Tim
Hi Tim,
Great video on the other thread! I’ve often thought it would be nice to have a dog wandering around work. A Border Collie or Weimaraner maybe…
I take Encarna’s point, and yours, that the testing of such traits at *entrance* would not work, because very few 18-20 yr olds would pass them. I would have failed also. But to know in advance that Physiotherapy is not like fixing a car – that’s really important for potential entrants. To know that the body actually heals damaged tissues and bones without any physio/medical input in the majority of cases. To know that what is observed in clinic (physical techniques) is what professional magicians would call ‘misdirection’. To know that the real work is in 1) the quality of the relationship and 2) fear reduction. All this is crucial, in my view.
Anyway… now that I have some sort of a handle on how things work, I can see that the new model has infinitely more depth and potential than the old biomedical model. The possibility of cross-disciplinary research and learning is huge. I’ve taken and used information from hypnotists, con men, psychologists, philosophers and meditation experts. It’s a whole new learning curve. And it’s all good stuff. Useful in a practical sense.
EG
Interesting reading:
http://en.wikipedia.org/wiki/Misdirection_%28magic%29
Thanks EG
Love the “not like fixing a car” analogy, which i think is very apt. I know that i got into, and left University with a very mechanistic mindset. There was a lot of BPS, psychology and sociology content on offer, but i ignored and dismissed it in favour of anatomy and physiology. Looking back, i missed the best bits. I think i missed them not based on how the University promoted the Physio course, but because my own experiences (and therefore beliefs and expectations) of physiotherapy were VERY much in line with this mind set. I guess I’m saying that while the university has a role to play, the profession at large does as well (perhaps a greater role?) in changing the expectations of the public at large and hence prospective students. Perhaps through blogs and other social media…
Tim
PS: “con men” – brilliant!