Can Doctors Be Happy?

Happiness

ATTEO LOPREIATO, MD, Apediatrician now based inBerlin, Connecticut, admitsthere are trials and tribulationsaffiliated with being a doctor

nowadays, but he takes the hassles philosophi-cally. “Name me one profession that doesn’thave more regulations,” he says. “The job iswhat you make out of it and the fact is there are a lot of professionals who aren’t as fortunate as we are, getting to do what we want to do day in and day out.”

Where’s that philosophy?

Unfortunately, there are any number of indicators

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Are doctors still

finding it at work

and if not, can they?

The surveys and polls call it

“physician satisfaction,”

but the old-fashioned label

is “happiness.”

May/June 2005 Unique Opportunities® The Physician’s Resource www.uoworks.com 1-800-888-2047

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that too many physicians no longershare LoPreiato’s balanced outlookon their profession. The PhysicianWork Life Study published in 1998found a significant number ofphysicians—especially females—unhappy with their work. Amongthe most critical factors in their dis-satisfaction were increased timepressures, more complex patientcases, and lack of control overworkplace issues.

A 2004 survey of 50- to 65-year-old physicians by the nationalsearch firm Merritt, Hawkins &Associates was equally discouraging.It found that the number of physi-cians who were finding their jobs

“less satisfying” was a disheartening76 percent, up from 54 percent inthe year 2000.

The numbers are not only bad fordoctors, they’re bad for this coun-try. The Merritt, Hawkins surveyfound that a small majority of re-spondents were somehow going to

change their practices, with meth-ods ranging from not taking on newpatients to getting out of medicinealtogether. With 38 percent ofAmerica’s physicians in the 50-plusage group, the surveyors say thatcould leave the United States with asignificant physician shortage in lessthan 15 years.

While administrative and regula-tory changes could undoubtedlyhelp, the fact remains that doctorshave to find more personal paths tostaying happy in their work.LoPreiato seems to indicate it is stillpossible. Is he just an exception, oris there hope for other physiciansas well?

WHEN PHYSICIANS SAY

they’re “unhappy,” what

does that really mean?

Dr. Michael Myers, a clinical

professor of psychiatry at the

University of British Columbia

in Vancouver, Canada, says

that one of the problems in

helping physicians is trying to

ascertain the real problem.

“The chief complaint I hear is,

‘I’m confused. I don’t know if

I’ve burned out or slipped into

a clinical depression.’”

What’s the difference?

Myers says, “Burnout is quite

specific to their work. They’re

unhappy with their work,

there’s been an erosion of the

things that attracted them.

Even a vacation doesn’t help;

they’re dreading going back to

the office.” Depression, on the

other hand, pervades every

aspect of the doctor’s life.

Myers says it’s not always

easy to differentiate,

especially because doctors

put two obstacles into their

way. One is time. “I need at

least a month to six weeks to

truly make an accurate

evaluation,” Myers says, and

most doctors don’t want to

commit to that amount of time.

Understandably, many don’t

see where they can possibly

find it. “It’s just like their

physical health,” Myers says.

“Less than 50 percent of

physicians have their own

PCPs and go regularly for

check-ups, PSAs, bone-

density tests”—all the things

the doctors are telling their

patients to do.

Second, far too many

doctors, still suffering from

that god complex or the fear of

looking weak in some way,

refuse to seek help for mental

health issues. “I always say

that if there’s any doubt,

especially if your loved ones

are saying you need help, find

it. Go see someone and forget

about ‘stigmas,’” says Myers.

One way to get started might be

checking out Myers’ 30-minute

video, Physicians Living with

Depression from American

Psychiatric Publishing, Inc. at

www.appi.org/book.cfm?id=227

8. It contains two interviews

with doctors who’ve dealt with

the condition and comes with a

discussion guide that is geared

to families. Myers says the sad

part is that mental health

professionals have been much

more successful in reducing the

sense of shame associated with

counseling in the general public

than among their own peers.

That’s especially distressing

given the fact that medicine has

so many ways to treat

depression successfully.

Burnout, on the other hand,

can be more difficult. It may

resolve with stress reduction

programs like Krasner’s, FMM,

or others.(See page 34.) It may

require rethinking how to

handle one’s professional life,

the way Krasner left the ER and

others turn to teaching or to

locums work. Or it may simply

mean acknowledging that

medicine is no longer the best

career option.

Myers offers one specific

piece of advice to doctors first

choosing their career path. He’s

met a lot of newcomers whose

true interest is something like

psychiatry or pediatrics, but

who feel they can’t go into

those areas because the jobs

are often low paying relative to

others. Myers offers this

warning: “I tell them, ‘Think

about that very carefully.

Remember, you’re going to be

doing this for the next 30

years.’” ■

Is it burnout or depression?

A 2004 survey of 50- to 65-year-

old physicians found that the

number of physicians who were

finding their jobs “less satisfying”

was at a disheartening 76

percent, up from 54 percent

in the year 2000.

www.uoworks.com 1-800-888-2047 Unique Opportunities® The Physician’s Resource May/June 2005


Acknowledge hurts and hassles

William J. Hall, MD, the director ofthe Center for Healthy Aging atHighland Hospital in Rochester,New York, admits that, “You ask doc-tors generically ‘Are you happy?’and many physicians respond nega-tively.” But if you dig a little deeper,he says you’ll find a much morecomplex series of responses.

Even seemingly mild issues cancause physicians to get discour-aged, depressed, even angry in oneway or another. Michael Krasner,MD, an internist in Rochester, NewYork, is now part of a larger grouppractice. “I can’t decorate the of-fice the way I want it. The employ-ees don’t answer to the partners,they’re responsive to the majormedical center.” In the grandscheme of things these are minor

annoyances—but enough “minor”annoyances and doctors find them-selves stressed, weary, even angryand depressed.

LoPreiato feels that the advent ofnurse practitioners has in someways been a detriment to physiciansatisfaction. It’s not that NPs aren’tgreat professionals, he emphasizes,but if they do most of the one-on-one work then “you don’t build arelationship with your patients.” Inpediatrics, for example, “The par-ent senses you don’t have a handleon their kid,” or at the very leastfeels you don’t care enough to treatthe child personally.

Part of the problem is finding away for doctors to balance doingenough themselves so as to keep intouch with the real work of medi-cine, versus emphasizing a God com-

plex that makes them believe theyhave to do everything. NancyChurch, MD, an ob/gyn based inChicago, points out, “You can’t knoweverything...but that’s the exact op-posite of what doctors are taught.”

And there are perhaps the great-est depressants, like one Churchhighlighted. She remembers find-ing aggressive ovarian cancer inone of her 37-year-old patients.The only thing Church could dowas to provide that patient withemotional support, such as ways totalk to her children about herdying. While Church was doingthat, however, she also found her-self grappling with de-energizingbusiness hassles, including mal-practice insurance that keeps sky-rocketing (more than 100 percentin the last two years).

Nancy Church, MD appreciates

the value of a note from a

grateful patient, the kind that

she says, “wipes out 10 nasty

things.” She also takes time to

truly appreciate the stunning

sunrises from her windows

overlooking Lake Michigan.

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HAPPINESS AT WORKContinued from previous page


Setting priorities

Yet for every doctor like the ob/gynChurch talks about who left medicineand went into teaching science, there arestill many like her who stay, and othersstill coming into the profession. Whatkeeps them optimistic and even happy?

Church admits she’s a natural optimist,but that alone isn’t always enough. Shetakes a variety of steps, from paying for amore expensive dry cleaner because itpicks up and delivers (thus reducing onestressor in her life) to going out regularlywith other female doctors to relax andtrade experiences. Friends keep her bal-anced, too. When she had to cope withthat young mother dying of cancer, shesays, “I called a friend and said ‘I’m sobummed. You have to come take me outto dinner.’” And that’s what happened.

Sometimes the answer to restoring anupbeat attitude is simple: Take a vaca-tion—a real one. That means not tappinginto your e-mail every few hours or call-ing into the office regularly, both ofwhich doctors say have become major ob-stacles to re-energizing. W. Lee Wan, MD,an ophthalmologist with Coastal EyeSpecialists in Oxnard, California, says thattaking family vacations (he’s married 22years, with two children) helps. Europewas a good spot because, even with all thetechnology, he says, “with the time differ-ences it was harder to reach me!”

Other times restoring contentment re-quires more radical approaches. For Wanand his group, it meant no longer accept-ing managed care patients. He says man-aged care caused too much of a “discon-nect with the patients” which he believesis one of the leading causes of unhappi-ness among physicians. “Patients camehere because they had to see us insteadof someone else, or we had to administera certain treatment whether or not we be-

Continued

Matteo LoPreiato, MD says that the old diseases of pediatrics

are no longer a problem. “We’re coping with new morbidities:

ADD, drug abuse, asthma.” Some doctors eschew this as a sad

diminishing of their profession, but LoPreiato prefers to see it

as giving him new challenges to tackle.

PHOTO ©2005 / JEFFREY YARDIS



lieved it was best for our patient.”LoPreiato is also making a pretty

major move—literally. At the time wespoke he was getting ready to relo-cate from his established practice inPittsford, New York, to Berlin,Connecticut, where he’s starting withno income, no practice. Why?Because it’s nearer to his family,which not only helps him personally,it gives his daughter the extra sup-port of grandparents and cousins. “Ifin 10 years her life isn’t what I’dhoped it would be, my consciencewill be clear,” that at least he dideverything he felt he could.

Family matters

Having a stable and happy life out-side the office is critical, experts say.For male doctors that may be easier.Church says, “The majority of maledoctors have a wife or partner whotakes care of their daily needs,” likegetting the clothes to the cleaner,sending out the birthday cards, andso on.

Women doctors aren’t so fortu-nate. A 2000 Case Western Universitystudy looked at 1200 physicians intheir 30s. More than 60 percent weremale physicians, and 22 percent ofthem were married to a doctor. Ofthe women, 44 percent were marriedto physicians and were still primarycaregivers for the children. ThePhysician Work Life Study found fe-male physicians were 50 percentmore likely to suffer burnout com-pared to their male counterparts.

Michael Myers, MD, is a psychiatristand a clinical professor in that field atthe University of British Columbia inVancouver, Canada. He’s also an ex-pert on physicians’ health. He’s beenin practice for 30 years and for 15 of

them he has been treating doctorsand their families. “When I lecturephysicians I tell them I couldn’t domy work if I didn’t have access totheir partners or spouses. That way Iget the complete picture. SometimesI only meet with the spouse. Theyhave tons to say about medicine” andwhat makes it hard for them to main-tain a satisfying home environment.

Myers has been married to a nursefor 35 years. They work at the samehospital and he remembers yearswhen one of them worked nights, theother days. You’d think that wouldhave been a strain on their relation-ship, but they looked at it as a posi-tive. “We didn’t have paid child careand this way one of us was alwayshome.” To put aside personal timefor each other, Myers and his wife de-cided that every two weeks they’dhire a babysitter and go out. These“dates” not only helped reinforcetheir relationship and kept themhappy, it was one of many ways theyconveyed to the kids that their rela-tionship as husband and wife was im-portant.

LoPreiato admits that while hisfamily helps him keep his center, it’snot always easy for them, especiallywith his erratic hours as a pediatri-cian. There’s no doubt in his mindthat “physicians’ spouses and familyhave to understand the sense of dutydoctors have,” but the doctor has togive somewhat, too. “You have totreasure your family.” Here’s one waythe LoPreiato family stays togethereven when he’s seeing patients on aSunday: “We go out to breakfast to-gether. They come back to the officeand wait for me and then we all goout together to do the shopping, seea movie”

Jennifer Virmani, DDS, actuallyspends an inordinate amount of timewith her husband, Mohit—he’s herdental partner in Maryland. You’dthink they’d get on each other’snerves being together day and night,but Mohit Virmani says, “When we’reat work we don’t see each other thatmuch, so we get together at lunch.”Both he and his wife say that playingto each other’s strengths at work andat home enhances both relation-ships. Mohit says, “I’m better at or-dering supplies, for her it’s office de-sign.” Jennifer agrees, saying “Helikes researching on the ‘Net anddoes the accounting on the comput-er. I actually pay the bills and domore of the creative work.”

Rethinking the profession

It’s also critical for physicians to takestock regularly of how they’repracticing medicine. There are oftenthings they can change that willdecrease stress and increase theirsense of contentment andsatisfaction.

LoPreiato says that in pediatrics,“Many of the traditional illnesses—polio, measles, mumps—have beeneliminated.” Instead of treating ill-nesses we can throw a pill or vaccineat, he says, “We’re coping with newmorbidities: ADD, drug abuse, asth-ma. Many of these don’t have easy so-lutions, or can’t be treated using thepure scientific method.” Some doc-tors eschew this as a sad diminishingof their profession, but LoPreiatoprefers to see it as giving him newchallenges to tackle.

Krasner says, “Take a very goodlook at what you’re doing versus whatyou’re willing to do.” That may meandoing some serious rethinking as to






the kind of work you’re doing.Krasner didn’t start his career as aninternist. He was in the ER. “I wasn’tfeeling like I was really helping peo-ple,” at least not in the long-term wayhe wanted. “There was no continuityin the relationship, whereas now Iwork with them through all the timesof their life.” He adds that this rela-tionship energizes him: “The ener-gy’s not just flowing in one direction;I meet their needs and they meetmine.” For another doctor the solu-tion may be exactly the opposite:Work in the quick pace of an ER, sowhen the patient moves on, that’s it.

Other types of support

One way for doctors to get re-ener-gized about work is to make the pa-tient an ally. Too many physiciansstill see the educated (and demand-ing) patient as a competitor. Krasnersees the knowledgeable patient as agood thing. “They start understand-ing the complexity of your job.”Those who come in with an articleare often more motivated to dowhat’s needed for their treatment.

As a pediatrician, LoPreiato facesconfrontations regularly, as parentscome in demanding an inappropri-ate treatment because of somethingthey read or saw; for example, seek-ing an antibiotic for their child’scold. Rather than getting into an egomatch, LoPreiato says,”I get them ac-tively involved in the decision. I’ll say,‘I tell you how I think we should han-dle this,’” and he suggests the “plentyof fluids, watchful waiting” scenario.Then he adds, “If at the end of a fewdays you truly think he hasn’t im-proved, bring him back and we’ll re-consider our options.” Most parentsagree and of course the child usually

does improve. The crisis passes be-cause the parents feel they’ve been apart of the decision.

Regularly it is emphasized that thata good staff is critical to helping doc-tors stay sane and allowing them todo the work they truly love doing.Wan says that he couldn’t keep hisschedule (which includes not only 40hours a week for his practice, butalso work with the local hospital andmedical society) if he didn’t “havestaff I’m really proud of.”

Church agrees. “While dealing withlife-threatening situations for my pa-tients I also have to fight the insur-ance companies, but how much ener-gy does one have? I had a patientbleeding profusely and then youcome back to that nonsense” in theoffice. A good staff saves her sanity,which is why, she says, “A goodamount of my income goes to pay mystaff salary so they stay stable,” andshe isn’t retraining every two weeks.

A more formal approach

More and more there are programsto help physicians rekindle their hap-piness with their career choice. Wanis the chair of the physician well-being committee at St. John’sPleasant Valley Hospital and St.John’s Regional Medical Center inVentura County, California. Onething the hospitals are using to in-crease physician satisfaction is a“physician complaint line.” He says,“A doctor often has a valid reason forbeing upset, such as certain lab testsnot being ready.” But if the doctorsimply rants, it often makes the situa-tion worse and becomes detrimentalto patient care when the lab or nurseis afraid to call an easily-upset doctor.“When the complaint line gets a call,

it’s triaged to the person who can getthe problem fixed or find out why itcan’t be done. Then, a supervisor isrequired to call the doctor and sub-mit a written follow-up, so the physi-cian knows there’s been some ac-tion.”

Robert Rufsvold, MD, is the direc-tor of the “Finding Meaning inMedicine” (FMM) program for physi-cians and med students that comesout of the Institute for Study ofHealth & Illness (ISHI) atCommonweal in Bolinas, California.(www.meaninginmedicine.org) “It helpsthem remember the core values ofthe healing profession: caring, com-passion, reverence for life,” and oth-ers. Rufsvold says too often todaythose values are being replaced bywhat he calls “marketplace values,”for example, being rewarded for car-ing more about cost-efficiency thanthe patient.

According to Rufsvold, one of thesad things is how quickly young resi-dents become disillusioned in waysthey didn’t expect. Take the financialissue: Many older physicians haveseen dramatic income cuts sincemanaged care, but Rufsvold saystoday’s students grew up with thatsystem. “If you have conversationswith first-year students, they reallywant to serve, it’s what has drawnthem into medicine. They knowthere are better ways to make moneynow.” So they’re going into medicinefor the same reasons their elders did:to heal and provide care.

Yet six months into med school, hesays, “They’re becoming more de-pressed and cynical” as they find adissonance between theirHippocratic values for healing andwhat they’re truly allowed to do for


patients.Many doctors take FMM workshops

and then go out and found their owngroups. There are from 60 to 100around the country, plus a “HealingArts” program being given at medicalschools. Others log onto the Web sitewhere they can find all the resourcesfor beginning, plus on-line discus-sions. (Rufsvold calls the FMM groupprocess “simple and easily replicable”through the on-line resources.)

He emphasizes that group meet-ings are not gripe sessions about in-surance problems or daily hassles.Instead, participants come to addressa topic that’s been chosen—compas-sion, spirituality, joy, privacy, evenfear. They bring stories from theirown lives to convey their feelings onthe topic in ways that connect withthe deeper meaning of day-to-daydoctoring experiences. Rufsvold says,“We lead far more meaningful livesthan we often know...it just needs alittle teasing to remember it. Thatcan help strengthen the doctor’scommitment to service,” even whenthe work is tough and sacrificesgreat.

Several years ago Krasner started asimilar stress reduction program. Hisis based on one developed by JonKabat-Zinn, PhD, at the University ofMassachusetts’s Center forMindfulness in Medicine, HealthCare, and Society(www.umassmed.edu/cfm/). It’s stilltaught there and Krasner says it’snow used around the world. Krasneroriginally developed the program tohelp his patients, but more recentlyhe has modified it for physicians.“It’s a six-week course with 22 CMEcredits.” In it doctors learn and prac-tice together mindful meditation and

learn to bring it into as many aspectsof their life as possible. Many of thegraduates have continued to meetcolleagues every other month out-side the seminar. In this forum,based partly on the FMM model, theycombine meditation with discussingtopics such as mistakes, loss, andcompassion.

Hall took part in Krasner’s seminar.“It’s meditation, focused thoughts,centering yourself.” He admits itmight have been easier for him to ac-cept since he was already into Zen, butadds such sessions, “create a very safeenvironment in which to think aboutone’s personal values.”

Other tips

Krasner highly recommends medita-tion, but if that’s not your thing, fine.“Exercise, find a hobby,” anythingthat clears your mind so that you canremember “why you went into medi-cine in the first place.” For the radi-ologist who dreads looking at onemore mammogram, instead remem-ber the miracle that gives you thatfilm and how you can help some-one’s life with it.

Church refers to a note from agrateful patient, the kind that shesays, “wipes out 10 nasty things.” Shealso takes time to truly appreciate thestunning sunrises from her windowsoverlooking Lake Michigan.

Concludes LoPreiato, “Too manyphysicians focus on their trials andtribulations. You have to focus on thejoy of a kid’s face when he sees you,the trust of your patients. That’spriceless.” ■■

Wendy J. Meyeroff is a regular contributor to

Unique Opportunities. A nationally published med-

ical writer since 1981, she lives near Baltimore, MD.




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Can Doctors Be Happy?