Thursday, October 22, 2015

We need more happy doctors

Recently, my friend “Tim” told me that he no longer wished to become a doctor. He had already taken the Medical College Admissions Test (MCAT) and all his premedical course requirements. But a summer shadowing physicians whom he described as “always unhappy” convinced him to cut his losses.

“I worked hard the last three years," he explained to me. “But I don’t want to be miserable forever.”    Medicine is a demanding and often thankless profession. Long and stressful hours, years of training, little sleep, and heavy debt can all take their toll. One survey suggested that 9 out of 10 doctors are unwilling to recommend healthcare as a profession. Nearly 400 doctors commit suicide every year.  This comes at a time when the U.S. needs more physicians. The American Association of Medical Colleges (AAMC) projects that the U.S. physician shortage will balloon to 90,000 by 2025.
                                                                                                                                                            With stakes this high, medical schools look for candidates who convey with certainty their interest in medicine...

It is, therefore, no surprise that pre-meds must convey certainty when they apply to medical school. Like many other candidates, Tim did this by narrowing his academic and extracurricular involvements at university, sacrificing exploration to push through rigorous requirements and gain clinical experience...

Certainty is often the prerequisite for interest in medicine, rather than the logical product of exploration. At my university, pre-med classes, which are often designed to cull or “weed-out” students, are obstacles to be hurdled rather than opportunities for intellectual exploration.
I have pre-med friends who, in addition to attending classes, spend twice as many hours in the library as in their beds. There’s little incentive to step off the academic treadmill. Introspection and self-exploration, normal parts of a college education, mean falling behind the competition...

As a pre-med student myself, I worry that I have practiced burying self-doubt so often that I have lost the ability to think critically. Medicine is a messy and trying profession. Questioning whether it’s right for you is a sign of maturity, rather than a sign of weakness.

I believe my peers and I will have much to offer as physicians, but only if we are happy individuals. We cannot be happy by suspending doubt, by constructing facades of certainty, or by pretending to be individuals we are not.

Hip hop artist Kendrick Lamar writes, “Love is not just a verb, it’s you looking in the mirror.” The most successful doctors I know are also the happiest. They practice uncensored reflection and forgive themselves easily. They do not mistake their authenticity for deficiency. They allow themselves to feel helpless, vulnerable or uncertain.

It’s not easy, of course. Doubt requires the courage to admit you are imperfect or that you might be wrong. It requires the courage to say, “Despite it all, I still believe medicine is worth pursuing,” or “Perhaps I’d be happier doing something else.” It requires the courage to believe you deserve happiness no matter what you decide.

So when Tim told me he no longer wished to pursue medicine, I was happy for him. Doubting or even quitting medicine are not signs of failure. In fact, they are often the most productive things one can do. Tim will reflect on his last three years, take what he can, and leave the rest. Our country needs more doctors. But more importantly, we need more happy doctors.
Courtesy of Doximity


  1. The Doctors Company, the nation’s largest insurer of physician and surgeon medical liability, today announced results from the largest physician survey conducted to date on the future of health care in America. More than 5,000 physician members within The Doctors Company organization responded to the independent survey, and the overwhelming indication is that concerns surrounding a shortage of health care professionals may be exacerbated by current physician sentiment regarding the profession. Specifically, nine out of 10 physician respondents indicate an unwillingness to recommend health care as a profession. In addition, 43 percent of respondents indicate that they are contemplating retiring within the next five years as a result of transformative changes occurring within America’s health care system. A copy of the Future of Health Care Survey is available on The Doctors Company Knowledge Center...

    The result is an anticipated shortage of primary care physicians and nurses needed to care for the millions of newly insured individuals entering the health care system.ii This will necessarily increase the number of patients treated per physician, making it nearly impossible to maintain or improve the quality of patient outcomes. Sixty-five percent of respondents believe the current legislative initiatives designed to reduce health care expenses are insufficient to effectively address the underlying causes of costly defensive medicine. Furthermore, the physicians surveyed expressed concern that the increase in patient volume will reduce the attention they are able to give to each patient, with 60 percent of respondents indicating that the pressures to increase patient volume will negatively impact the level of care they can provide. Fifty-one percent of respondents feel their ability to grow and maintain patient relationships will be adversely affected. These concerns have led an overwhelming nine out of 10 physicians to actively discourage friends and family members from pursuing careers in medicine. Finally, 43 percent of respondents indicate that they are contemplating retiring in the next five years as a result of the immense change that the health care system is undergoing.

  2. Mata DA, Ramos MA, Bansal N, Khan R, Guille C, Di Angelantonio E, Sen S. Prevalence of Depression and Depressive Symptoms Among Resident Physicians: A Systematic Review and Meta-analysis. JAMA. 2015 Dec 8;314(22):2373-83.



    Physicians in training are at high risk for depression. However, the estimated prevalence of this disorder varies substantially between studies.


    To provide a summary estimate of depression or depressive symptom prevalence among resident physicians.


    Systematic search of EMBASE, ERIC, MEDLINE, and PsycINFO for studies with information on the prevalence of depression or depressive symptoms among resident physicians published between January 1963 and September 2015. Studies were eligible for inclusion if they were published in the peer-reviewed literature and used a validated method to assess for depression or depressive symptoms.


    Information on study characteristics and depression or depressive symptom prevalence was extracted independently by 2 trained investigators. Estimates were pooled using random-effects meta-analysis. Differences by study-level characteristics were estimated using meta-regression.


    Point or period prevalence of depression or depressive symptoms as assessed by structured interview or validated questionnaire.


    Data were extracted from 31 cross-sectional studies (9447 individuals) and 23 longitudinal studies (8113 individuals). Three studies used clinical interviews and 51 used self-report instruments. The overall pooled prevalence of depression or depressive symptoms was 28.8% (4969/17,560 individuals, 95% CI, 25.3%-32.5%), with high between-study heterogeneity (Q = 1247, τ2 = 0.39, I2 = 95.8%, P < .001). Prevalence estimates ranged from 20.9% for the 9-item Patient Health Questionnaire with a cutoff of 10 or more (741/3577 individuals, 95% CI, 17.5%-24.7%, Q = 14.4, τ2 = 0.04, I2 = 79.2%) to 43.2% for the 2-item PRIME-MD (1349/2891 individuals, 95% CI, 37.6%-49.0%, Q = 45.6, τ2 = 0.09, I2 = 84.6%). There was an increased prevalence with increasing calendar year (slope = 0.5% increase per year, adjusted for assessment modality; 95% CI, 0.03%-0.9%, P = .04). In a secondary analysis of 7 longitudinal studies, the median absolute increase in depressive symptoms with the onset of residency training was 15.8% (range, 0.3%-26.3%; relative risk, 4.5). No statistically significant differences were observed between cross-sectional vs longitudinal studies, studies of only interns vs only upper-level residents, or studies of nonsurgical vs both nonsurgical and surgical residents.


    In this systematic review, the summary estimate of the prevalence of depression or depressive symptoms among resident physicians was 28.8%, ranging from 20.9% to 43.2% depending on the instrument used, and increased with calendar year. Further research is needed to identify effective strategies for preventing and treating depression among physicians in training.

    Courtesy of Doximity