Pamela Wible recently wrote a provocative article on KevinMD regarding physician suicide. In the seminal piece, she conducts “psychological autopsies” on 3 physicians in training who had taken their lives. She searches for answers and suggests solutions for what has become a problem of epidemic proportions. Whereas her focus on the individual is laudable and instructive, I would like to apply her technique to the profession as a whole. While some physicians are committing suicide or becoming addicted to drugs, others are leaving in less-devastating but still consequential manners: early retirement and nonclinical career paths. To many, it feels like a most-celebrated calling is laboring through its last breaths. I stand here today, scalpel in hand, ready to conduct an autopsy of an honorable profession. Are we witnessing the death of the modern-day physician?
Any postmortem of merit must start by differentiating the intrinsic and extrinsic causes of disease. Today’s doctor faces the same intrinsic stresses and disappointments that plagued prior generations. Namely, the practice of medicine stands in stark contrast to the expectations of those in the premedical arena. The glory and gore so often portrayed in movies and television are nothing like the average physician’s daily experience. The highs are much less common, and the lows are part of our moment-to-moment experience. Unlike most sitcoms, our patients die frequently. Diseases rarely follow patterns and rules. We lose many more battles than we win. This reality is difficult for the physician in training or young doctor no longer enamored by the artificial gleam on the surface of our shiny profession. Dysphoria often follows. One looks inward for answers, or much worse, blame. Many have been destroyed in this manner.
Whereas the intrinsic stressors to the profession have remained static over generations, the extrinsic factors are what appear to be changing the face of medicine and those who practice this weary art.
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The economic cost of education has exploded while salaries are taking a nosedive. Past generations gladly accepted the fear and stress of a most-challenging trade in exchange for economic security and prosperity. Our forefathers never worried that their journey through this tangled existence would lead to not only emotional but also economic exhaustion. Doctors are having trouble making ends meet. They are finding the cost of practicing is too great.
Respect in the community is waning. The Institute of Medicine’s study, “To err is human,” portrayed physicians and health care as sloppy and un-careful. As the press ran with the story, a new narrative regarding medicine grew among the population. This narrative, further buoyed by political wrangling over health care reform, has painted physicians as both greedy and dangerous. The morale of a profession is faltering.
Compliance is now more important than patients. Physicians are inundated with paperwork. Demonstrating meaningful use has overtaken providing meaningful care. The dictates of billing and coding suck precious seconds from the marrow of the clinical encounter. We are not only constantly being berated for our clinical care, but also the speed and veracity of our clicking of clicks and checking of boxes.
In conclusion, we have created a physician workforce that is physically and emotionally overwhelmed. The intrinsic stressors passed on from generation to generation are enhanced by a new set of extrinsic forces.
The pride and joy of a generation of physicians, in addition to the well-being of our community, hangs in the balance.
