Though there are few subjects as immediate to my experience as that described in Gardiner Harris's article in The New York Times, "More Doctors Say No to Endless Workdays," (April 1st, 2011), perhaps the truest indication of my opinion on the matter may be the fact that, upon first glance at the headline, I didn't feel much need to read the rest of the article. More doctors say no to endless workdays? Well, of course we do. Duh.
For those who (like me initially) read little more of the article beyond the first few sentences, it details, in the context of a three-generation medical dynasty, the "sweeping cultural overhaul of medicine's traditional ethos." Today's generation of physicians is choosing to limit their work-hours, altering the scope of their practice, and deciding to concentrate of medical specialties based on lifestyle choices as much as interest in the medicine itself. In essence, the current crop of young doctors is recalibrating the personal and professional expectations set by our predecessors, taking the radical stance that the work-life balance applicable to all other professionals might possibly be applied to us as well.
Not surprisingly, the original article sparked an outpouring of discussion, with viewpoints as polarized as the face of healthcare itself. "Who can blame young physicians for choosing a more flexible work-life balance?" one reader from Austin, TX writes, citing the long hours and sacrifice inherent in medical school and residency. Another commenter opines that she would rather be cared for by a physician "...who is not overwhelmed, not heading towards burn out, someone who can still love their job because they have time to have a life."
On the opposite end, a reader from Philadelphia, PA chides, "I am not terribly sympathetic to physicians when they complain about their working conditions. What did they think they were getting into?" Another commenter expresses that an older generation of physicians, who sometimes worked ceaselessly for days at a time and "never hesitated to sacrifice anything and everything for the good of their community" were the true and noble face of medicine, and that younger doctors seeking less than complete devotion to their chosen fields were merely "selfish imitations of real physicians." Fascinated and occasionally mortified, I read through every single online response to the article, and though I was occasionally taken aback, no one opinion ever truly surprised me, because I've heard each of them many times before--from other doctors, from patients, and from my own mouth.
First a little background to give some perspective on where I stand and why I stand there. I am a relatively young physician, eight years out of medical school, less than three years out of residency. I started my medical training in a primary care field--specifically, pediatrics--but after two years, switched to the subspecialty field of anesthesiology. I made this switch partly because I learned over time that my interests and strengths leaned more towards acute subspecialty care than long-term outpatient care, and anesthesiology was one of the fields that offered the unique mix of immediacy and hands-on skill that I craved. But also, Anesthesiology is a field that offered more flexibility in balancing the work life I already had with the family life I hoped for in the future. I had my first child early my first year of anesthesia residency, and six months after graduating, I had my second. My sons are now two and five and-a-half years-old (the half is important, he'll have you know), and I am working a full-time job as an anesthesiologist in a private practice.
I tell you all this not to invite judgment of my choices or values (though I am familiar enough with the experience of writing for an audience that some people will take it as just that--an invitation), but to let you know that I know of what I speak. Having gone through the long winding path of medical training, having made the choices I've made, and living the life I do every day, I am intimately aware of the constant struggle between my duties as a physician and my duties to my family. I try to control what factors I can, but all too often the needs of both--each billed to me as the most important thing I will ever do--seems like a tug of war between two immovable objects.
The problem is that, as a society, we haven't yet decided what we want our doctors to be. We've moved away from the notion of the omniscient, God-like doctor, though overall it is still a profession defined by single-minded devotion, martyrdom, and sacrifice. On the other hand, doctors are now viewed as more human and fallible than ever. Television shows about doctors are perennially popular, though the current crop relish in the iconoclastic demolition of the Marcus Welby ideal of yesteryear; politicians and the public accuse us of greed, opportunism and carelessness in the face of skyrocketing healthcare costs; patients regularly challenge my clinical judgment by bringing in random snippets of often suspect information that they pulled off of Google. I don't begrudge any of this, as I believe idolism of any group of professionals is largely unhealthy.
But if doctors are people, why aren't we allowed to act like we are?
The stressors of a life of medicine are well-documented, and such a discussion goes beyond the scope of this piece. I will refer, however, to the fact that studies have consistently shown that medical students experience depression, burnout, and other mental illnesses at higher rates than their peers,(1) and physicians have a higher rate of suicide than the general population-40% higher for male doctors, and an astonishing 130% higher for female physicians.(2) One can discuss (and many have) the reasons for these differences, but having lived through med school and residency myself, I can tell you that while it is an incredible experience, the crushing expectations inherent in the culture of medicine render it an extremely dehumanizing experience as well.
We want our doctors to be perfect. We want them to know all the answers, to never say the wrong thing, and above all, to always, always, be there for us. We want our doctors to be superhuman. But the fact of it is: they're not. Doctors are not perfect, they're not beyond mortal concerns. After working 30 hours straight, they get tired, and that interferes with their ability to work well. After being in the hospital for three weeks without a single day off, they get burned out. When they get sick, sometimes it's hard for them to come to work (though, to be honest, we are terrible hypocrites and most of us come in anyway). They are young adults, and sometimes, they want to have connections outside of work--friends, spouses, children, and a reasonable amount of time to spend with them. These are not ridiculous things to ask for. These are not unthinkable standards to expect.
I've heard endless criticism about the values and work ethic of the current wave of young doctors (a recent catty favorite, in reference to many practitioner's waning desire to work late into the night, was, "I guess doctors' cars don't have headlights anymore"), and while I can't speak for every doctor in my generation, this much is true for my own experience. I love the practice of medicine. I love caring for my patients. It is a vocation, and it is my passion. Given the choice of whether or not to go into medicine, I would without a second's hesitation do it all again.
But I want other things in my life too. And I think that should be allowed.
Becoming a doctor requires hard work and sacrifice, but a system that expects their doctors to be committed to their jobs to the exclusion of all else is flawed. And maybe there's quite simply nothing wrong with young doctors at all, rather something wrong with the historical culture of medicine, such that the idea of doctors as human beings can inspire so much debate.
(1) Thomas L. Schwenk et al. "Depression, Stigma, and Suicidal Ideation in Medical Students" JAMA. 2010;304(11):1181-1190.
(2) Eva Schernhammer, M.D., Dr.P.H., "Taking Their Own Lives - The High Rate of Physician Suicide" N Engl J Med 2005; 352:2473-2476