Over the past few years, the global pandemic has highlighted many long-standing issues within medicine, and it sometimes appears that it’s a dying career or that all physicians are burned out and miserable. However, there are still many physicians leading happy and fulfilling lives who love their jobs, writes Dr Kevin Jubbal in Med School Insiders.
At least 60% of physicians report feeling happy outside work, and 73% report they would choose medicine again. Although this shouldn’t be used as an excuse not to address the issues within medicine, the situation is not as grim as some people make it out to be.
A 2020 report on physician lifestyle and happiness listed the specialities with the greatest proportion of happy physicians, and topping the list was rheumatology at number one, followed by general surgery, public health and preventive medicine, allergy and immunology, and orthopaedics.
The bottom five were neurology, critical care, internal medicine, gastroenterology and endocrinology.
In 2019, the top five happiest specialities were rheumatology first, followed by otolaryngology, endocrinology, paediatrics and general surgery; and the bottom five were neurology, infectious disease, cardiology and oncology.
Despite rheumatology remaining in the top position and neurology remaining in the bottom position, there was minimal overlap between the two years. Endocrinology, despite being in the top five n 2019, was in the bottom five on that list in 2020. Although significant year-to-year changes are possible, it’s more likely these reflected limitations of the study, which used survey data and self-reporting. So if speciality choice is not a reliable factor, what actually influences physician happiness?
Relationships
Many people gravitate to medicine because they want to help others – relationships are an important factor in physician happiness.
Research shows 27% of physicians report patient gratitude and relationships as the most rewarding part of their job, and 23% report knowing that they’re making the world a better place as the most rewarding part. A 2022 study found that patient connection and visible impact are common traits among happy physicians.
Doctors have the ability to significantly improve the quality of patients’ lives. Not only is this tremendously satisfying, but it also provides patients with something that’s difficult to find – purpose. Working for a larger purpose means you’re more likely to enjoy your work, more resilient to setbacks and challenging times.
Apart from relationships with patients, relationships with peers and colleagues are also important. Connection and belonging are universal human needs: doctors are no exception. Having a sense of community, connection, and belonging as a physician are key to a happy career.
Compensation
Although purpose and meaning are important for happiness, extrinsic factors (like money) still play a role.
Some 10% of physicians report making good money at a job they like as the most rewarding part of their job; 28% report insufficient compensation as a major source of burnout.
A physician compensation report lists the the top five highest-paid specialities in 2022 as plastic surgery, orthopaedics, cardiology, otolaryngology and urology. The bottom five were public health and preventive medicine, paediatrics, family medicine, endocrinology and infectious disease.
Your perception of your compensation is perhaps even more important than total compensation. If you feel there is a mismatch between the work you do and the salary you earn, you are more likely to feel unhappy. The top five specialties with the largest percentage of doctors who feel fairly compensated are public health and preventive medicine, oncology, plastic surgery, psychiatry, and dermatology.
Although total compensation factors into the perception of your salary being fair, it’s clear from the top five that how you earn this money also plays a role. Despite being in the bottom five for total compensation, public health and preventive medicine ranks number one for feeling fairly compensated.
This brings us to our next factor influencing physician happiness: work-life balance.
Work-life balance
Research shows 55% of doctors would take a salary reduction to have better work-life balance, the average physician willing to sacrifice between $20 000 and $50 000 annually to achieve it.
Work-life balance is influenced by various factors including the number of hours worked and how predictable or unpredictable these are, which is largely a function of being on call. This is why specialties like dermatology tend to rank highly for work-life balance.
Dermatologists typically don’t take calls and work fewer weekly hours than most other physicians. However, other factors, like time spent with patients versus the time spent charting and doing other administrative work, also influence physician happiness.
Burnout
Burnout has become a popular topic in medicine and can negatively affect happiness: issues like too much charting and admin, long hours, lack of respect, insufficient compensation, and lack of autonomy are major contributors.
The top five specialties with the highest levels of burnout are emergency medicine, critical care, ob/gyn, infectious disease, and family medicine; and the top five specialties with the least are public health and preventive medicine, dermatology, pathology, oncology, and orthopaedics.
It should be noted, however, that burnout that affects every speciality. Although these are the specialities with the highest rates of burnout, you will find physicians who are burned out no matter their speciality. Similarly, there are physicians who are enthusiastic and enjoy their job in every speciality as well.
Regardless, mitigating burnout is an important part of maintaining happiness as a physician.
Should this info influence your choice of specialty? How should these data influence a med student’s choice of specialty? Should everyone go into dermatology or preventive medicine? Of course not.
There are multiple factors to consider, and while knowing which speciality might be the happiest, on average, and help sway a decision, it should not be a primary consideration.
Instead of looking at other people’s happiness, it’s more important to examine your own. Find a speciality you enjoy, that speaks to your strengths, instead of just choosing the one you feel is the happiest.
Two factors people often don’t consider with these lists are sampling and self-selection biases. These data represent only a very small sample of the larger doctor population and may not be entirely representative. And just because 60% of general surgeons in that sample reported being happy doesn’t mean 60% of doctors would be happy becoming general surgeons. These are doctors who have already chosen their specialities. It’s an important distinction.
Additionally, lifestyle factors like compensation, hours worked, and administrative burden are variable. It’s possible to carve out your own niche and create the lifestyle you want no matter what you choose to specialise in.
Just don’t fall into the trap into which many succumb. I’ve met dozens of residents and even attending physicians who wanted to specialise in something different, but ultimately had to compromise to something less competitive because they weren’t strong enough for the speciality they truly desired.
Dr Kevin Jubbal graduated from UCLA magna cum laude with a BS in neuroscience and earned his MD from the University of California San Diego, and matched into plastic and reconstructive surgery residency at Loma Linda University Medical Centre.
Study details
What happy physicians have in common: A qualitative study of workplace perceptions of physicians with low burnout scores
Rivers Woodward, Tsaiwei Cheng, Jill Fromewick, Shelley Galvin, and Robyn Latessa.
Published in SAGE Open Medicine on 29 March 2022
Abstract
Introduction
Burnout is a phenomenon in the medical field that adversely affects patient care, physician retention, and physician well-being. The preponderance of burnout research has primarily focused on exploring what parts of medical practice and individual characteristics contribute to burnout. Our research aims to add to the growing body of evidence exploring what physicians who love their work have in common.
Methods
Physician participants in this qualitative study were recruited through their local medical society from those who indicated a willingness to share tips for joy in practice. Potential participants were then screened for low probability of burnout using a validated single-item burnout inventory. Nine primarily mid- to late-career physicians engaged in semi-structured interviews and thematic analysis was used to analyze data. Of the interviewed physicians, five were practicing in the primary care specialties of family or internal medicine and four in specialties outside of primary care.
Results
Six major themes arose from the nine interviews and included variety in work, a sense of empowerment, connection with patients, visible impact of one’s work, feelings of community with coworkers and colleagues, and experiencing a sense of calling.
Conclusion
While further research is needed to demonstrate the transferability of the themes from these interviews, an asset-rooted approach to physician wellness is a direction for research and intervention that deserves further attention. Focusing only on alleviating the factors that contribute to burnout is a worthy goal, but ignores the necessity of designing training systems and workplaces that are built to foster the elements of medicine that bring joy and fulfilment to practice.
Med School Insiders article – 5 Happiest Types of Doctors (Open access)
See more from MedicalBrief archives:
Clerical burden a huge driver of burnout in medicine
Exhausted junior doctors putting patients' safety at risk — NHS survey
Peer comparison among doctors can backfire, increase burnout – UCLA study
Physicians at small practices have considerably lower levels of burnout