The Stress of Being a Doctor

The Stress of Being a Doctor

In the era of an on-going pandemic, I am keenly aware of the stress of being a doctor. I am a practicing pediatric hospitalist who teaches and a physician coach. I was asked by one of my medical students if I would become a doctor again. My answer was “hard pass or no.” Our medical system is broken and we do not take care of our own. In a profession of high risk and high stress, there should be more of an emphasis on taking care of the professional well-being of health care providers.

The pandemic has also uncovered worsening burnout. Physician burnout has been present pre-pandemic and now we are seeing physicians leaving the profession in record numbers.

COVID has brought so much professional trauma. Many health care professionals have seen so many deaths. Freezer trucks filled with body bags and overburdened hospital systems. The body remembers such trauma and can hold on to it for years.

But let’s start from the beginning…
Physicians work hard to get into their profession. The college years are filled with working hard to make sure you have the right GPA, the right research, and right recommendations.

Getting into medical school is tough. There is less than a 10% acceptance rate in many schools and many applicants will apply multiple times before they get into medical school.

The cost of this adventure is high. The average cost of medical school is $55,000 per year.
Unless you are independently wealthy, you will likely end up borrowing money for medical school and end up with quite a bit of debt.

Students graduating medical school will pursue a graduate medical education called a residency. The average debt for residents coming out of medical school is above $300,000. School debt can be crushing. This debt makes it very hard to buy a home, start a family, or save for the future. Although salary levels rise significantly as a resident becomes an attending physician, doctors still feel trapped by debt.
New attendings may buy houses and nice cars because they feel they can finally afford to do so and feel they ”deserve it.” This deferred gratification can be costly. These doctors feel they need to work in a job they may not enjoy so they can pay off school loans.

Becoming an attending has its own challenges and can be a difficult transition.
The transition between being a resident to being an attending can be rough. Although the social support between resident colleagues is strong, when you get into a “real job” as an attending, the social support tends to lessen. As the chapters of your life change, the transitions keep coming.

Another tough transition is going from being a practicing physician without children to being a practicing physician with children. This is particularly true for women who bear the brunt of childcare. Physician mothers face guilt of having to do it all or will be perceived as less than by themselves or others.

The unknown…
The stress of being a practicing physician involves uncertainty. It involves not always knowing what walks in the door of your clinic or hospital. Cases can be easy to manage or very complex. As physicians, we understand the gravity of our decisions. We need to be comfortable in the uncertainty. The demands of a physician’s job include insufficient time to do the work and high expectations
I work in a hospital as a pediatric hospitalist which means I take care of pediatric patients in a hospital setting. I am convinced that time moves faster in a hospital than anywhere else. It seems that there is insufficient time to do all the things that actually need to get done. Since I work at a teaching hospital, there are many competing demands: patient care, documentation, billing, research, teaching, and committee assignments. It seems there are not enough hours in the day to do it all and this can be stressful.

The emotional intensity of the work can be stressful for doctors. Pediatrics has one of the highest emotional intensity factors of all the medical fields. We work with children and lots of worried parents and family members. We need to be reassuring, kind, and caring towards the child and the caregivers. Young children cannot verbalize what is wrong with them. Pediatricians need to use their expertise and do not want to be wrong especially for life-threatening issues. This can lead to medical/legal implications.

The threat of medical malpractice lawsuits is on the mind of many physicians. Patients have a right to sue their doctors if there is negligence on the part of the medical team and if the standard of care has been violated. Many physicians worry about the threat of a lawsuit and will order tests and labs .This can lead to unnecessary worry and increase the cost of medical care. The psychological cost of being sued is enormous. Many doctors leave their practice after a lawsuit due to the enormous amount of pressure and stress they have gone through during the medical malpractice process. Burned out physicians may make mistakes which can lead to harm to patients. Medical malpractice insurance companies should have programs to aid in preventing physician burnout as these programs will save them millions of dollars.

The stress of being a doctor is enormous and most doctors that I know are some of the toughest people that I know. We must find avenues for doctors to deal with their stress and avenues such as physician-to-physician coaching are proven strategies that work.