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February 24, 2016

Secrets of the happiest specialties

Orthopedic surgeon Chad Krueger, M.D., loves the technical challenge of fixing broken bones. Restoring someone’s function and motion is very hands-on and concrete.

His greatest satisfaction, though, comes from his patient population at the Fort Bragg (North Carolina) Womack Army Medical Center - men and women who’ve suffered mangled extremities and other devastating injuries from military conflict. Even though they require extensive services to optimize their potential and rebuild their lives, Krueger revels in their progress. He sees inspiration in every soldier who once only hoped to walk his daughter down the aisle but can now share picture proof that he finally did. Ditto for the patient who’s strolling with her spouse or holding her child for the first time in a long a time.

"Knowing that you’ve impacted someone’s life so positively is pretty powerful," says Krueger. "It’s hard to put into words the happiness you experience when someone tells you, ’I was able to do this because of everything you did for me - thank you!’"

Chad Krueger MD
"…You’re working with many other people to get the best outcomes for these patients. When things align, I feel very good," says orthopedic surgeon Chad Krueger, M.D.
 

In the pecking order of professions, you can’t get much better than medicine for feel-good moments. In fact, even if you’re fairly new to your job, you’ve likely had a few gratified patients make your day. But are ringing endorsements enough to ensure happiness as a physician? Chances are no, as other factors can toy with your emotions and impact your work and lifestyles.

What are the happiest specialities?

Even your specialty can make a difference, at least according to one survey. When Medscape asked users about happiness in Physician Lifestyle Report 2014: Do Physicians Lead Healthy Lives? certain specialties rose to the top five.

In terms of work, dermatologists, allergists/immunologists, ophthalmologists, pathologists and psychiatrists scored the highest happiness responses. The deck was shuffled a bit for home life with ophthalmologists and dermatologists still rising on the contentment scale, but accompanied closely by urologists, orthopedic surgeons and emergency medicine physicians.

What’s the secret to their happiness?

So what are the secrets to these so-called happiest specialties? A PracticeLink follow-up with physicians in several of the disciplines reveals a spate of common denominators enriching their experience: a sense of fulfillment, great workplace dynamics, good opportunities for growth and room for an active life outside the office. As a job-seeking physician, you may be targeting the perfect match for your skills and ambitions. Yet focusing on factors that have impacted others - whether or not they share your specialty - could be significant to your long-term success. Chief among them is a seemingly basic key in keeping spirits aloft in any field: "I think happiness really boils down to the core matters of being optimistic and doing what you love," says Maryann Mercer, Ph.D., co-author of the book Spontaneous Optimism: Proven Strategies for Health, Prosperity and Happiness. "It’s not so much about the profession you’re in as it is about the choices you make. If you’re following your heart or the vision you have for your life, you’re likely going to be happy."

The idea that following one’s heart leads to happiness is more than a philosophical ideal. Scientists have produced a bevy of studies quantifying why some people are working and living fulfilled while others don’t have the same internal GPS. They’re bringing into focus a once-fuzzy picture as to how individuals internalize and respond to the world.

Experts like Mercer, for instance, look to optimism as the force that drives an upbeat attitude. Because perennially cheerful individuals tend to have more positive thoughts and emotions than those unhappy blokes who like wallowing in the negative attitudes that make them persistently pessimistic, they’re also able to form a meaningful vision for their lives along with a can-do attitude about meeting its challenges.

Mercer is not alone in noting the role of purpose. Scientists exploring positive psychology, a branch of the mental health field that’s shining a rigorous research light on well-being or the virtues and strengths of living more fulfilling lives, say the roots of happiness are indeed multidimensional. They include three basic components: meaning or serving a cause bigger than yourself; engagement or being so absorbed by the daily activities that you enjoy that you lose track of time and yourself; and pleasure or relishing the everyday plusses of life.

Although people with high levels of all three seem to be most satisfied, according to positive psychology’s leading gurus, some components have more staying power than others. For instance, good times can definitely add balance to an otherwise hectic life, but the afterglow is typically short-lived. That leaves meaning and engagement working in tandem to provide the linchpin for an abundantly gratifying life. Whether you identify strongest with faith, family or your professional mission, you’re bringing to bear your highest potential and best self. Whether you’re performing a challenging procedure or playing a riveting musical piece, you’re so fixated that you get lost in the "flow" of the experience. A life woven with many "flow" activities is a life of great satisfaction.

In terms of his own happiness, Landon Trost, M.D., a urology subspecialist in male infertility and andrology at Rochester, Minnesota-based Mayo Clinic, puts stock in the deep pillars of his life. He ranks religious beliefs and family as the top two items that give his days meaning, with job satisfaction a not-too-distant third and an active lifestyle a distant fourth. As someone who experienced his own medical scare several years ago and chronicled the journey, Trost says his enthusiasm for life never diminished. That’s in large part because he views happiness as reaching for and achieving the aspirations and guiding principles one sets for oneself. "Happiness is living your life in a manner consistent with your ideal expectations and goals," he says. "If you fall short of them, you’re going to be unhappy. But if you achieve them, you’ll have a renewed sense of choice and control about your life."

Physicians who’ve managed to forge such a life are indeed finding meaning and engagement in the roles they’ve pursued. They love what they do because they’re well matched to the interactions and tasks making up their day. Whether that means taking care of patients over the long term or intervening for an acute health event, it’s how they envisioned practicing medicine. What’s more, they’re still jazzed about making a difference.

Jonathan Jones M.D., for instance, loves the fact that as program director and associate professor of emergency medicine at The University of Mississippi Medical Center in Jackson, he sees patients in their time of need. Whatever the outcome, he delights in the hands-on part of his job - relying on his stethoscope, a patient’s history and physical exam to discover what’s really going on, particularly in someone whose chief complaint is "I just don’t feel good."

"People often make fun of our specialty, saying that we don’t actually fix a lot, we just diagnose someone and then call in a specialist." Jones says. "Sometimes that’s absolutely true. But diagnosing is what medicine is all about. Whether I eventually fix the patient or refer to a colleague, solving the enigma is what really gets my brain going."

By splitting time between Columbus-based The Ohio State University’s James Cancer Hospital and Solove Research Institute, where she’s director of the Pigmented Lesion Clinic, and her nearby general dermatology practice, Shannon C. Trotter, D.O., says she has the best of both professional worlds. By merging academic medicine and patient care, she’s able to tap many aspects of her personality, including her ability to roll with the punches or lead the charge. In either case, Trotter relishes the direct, sometimes dramatic, impact she can have on patients. "I think patients truly appreciate what we do for them because the skin has such an impact on one’s outward appearance and self-esteem," she says. "I often kid my primary care friends that if they lower someone’s blood pressure, that patient doesn’t necessarily care. If I clear up someone’s acne or psoriasis, I’m their new best friend."

And even though she doesn’t always work directly with them, Heather Signorelli, D.O., clinical pathologist for UniPath in Denver, gets the same joy from helping her patients. Whether it’s through a consultation or multidisciplinary conference, she’s helping colleagues make effective choices for people she’s never even met. "One of my favorite things about pathology is that we’re heavily involved in how clinicians work up and treat patients," she says. "We have a great opportunity to help them select and interpret the right tests so that we deliver the best patient care as early as possible."

A workplace culture that mirrors your philosophy of medicine and arms you with the tools to do what you want to do can be critical in putting a purpose-driven life into action. True happiness may have little to do with the ebbs and flows of the workplace or workday - and more to do with one’s general state of mind - but joining a supportive, collegial organization certainly can make a perceptible difference.

That’s not to say that health care’s growing bureaucracy doesn’t ever intrude on one’s ability to make prudent choices, call the right shots or even relate like they want to relate. But physicians content with their situations don’t allow such changes to spoil their excitement for medicine or their specialty. In fact, they’ve learned that the key to being happily successful is not to internalize every obstacle they encounter. Instead, they stay focused on the needs of their patients, even as they navigate interferences. More importantly, they work with administrators who have lessened the barriers to delivering quality care and encouraged them to be decision-makers.

"One of the critical things for physicians is to find that spot, whether it’s in private practice, a hospital or another setting, where their voices will be heard and their input sought in making decisions for the community they serve," says Christopher R. Scott, FASPR, assistant administrator-orthopedics for Durango, Colorado-based Mercy Orthopedic Associates.

Jones is able to do what he’s trained to do because other factors make it relatively easy. He has the wherewithal to make an accurate diagnosis, order a treatment or even call in additional help because of the complement of specialists and technological bells and whistles available throughout his institution. He also doesn’t worry about insurance or other administrative tasks tying his hands because other people take that on. "I’m not naïve," he says. "I know that people have to pay their bills and hospitals have to collect money. But it doesn’t matter if someone is rich or poor. I’m there to take care of them in their time of need. I’m there to ask, ’Where do you hurt?’"

Krueger has learned not to focus on what he can’t control and instead prioritize those things that he can. Because his patients often have multiple health issues, that means finding meaningful ways to collaborate with other departments. "It’s very easy to become myopic in the sense that you only focus on what would be perfect for you," he says. "But you have to understand that you’re working with many other people to get the best outcomes for these patients. When things align, I feel very good."

Growing in the job

Although there are many ways to be fulfilled as a physician, advancing your training and other passions not only can round out your career, but also contribute to a great workplace experience. Opportunities to grow in the job are especially relevant in medicine, given studies repeatedly demonstrating that highly skilled individuals who are highly challenged are much happier and energized in their jobs than highly skilled individuals who aren’t performing at maximum capacity.

Whether you pursue research, write journal articles, train residents and fellows, participate in specialty societies or advance your training, you’re doing what researchers believe is important for staying upbeat: performing at peak potential.

At Bennington’s Southwestern Vermont Medical Center, administrators offer an annual medical leadership course to give doctors a jumpstart if they’re interested in being at the helm of a physician-run practice. With health care moving increasingly toward a physician-in-charge model, they want their Dartmouth-Hitchcock Putman Medical Group providers to be ready when the opportunities are ripe. "The preparation not only is making our doctors better leaders," says Nicole Goswami, physician liaison and recruiter, "but I think we’re also helping them realize how they can make a difference within the organization."

As healthcare changes in both exciting and onerous ways, Signorelli sees a great opening for physicians to stretch and grow, no matter their specialty. Whether it’s making sense of regulatory changes or adding administrative tasks, the experience can be gratifying, particularly if the outcome positively impacts an entire health care system. For instance, the information technology explosion has affected all of medicine, but it’s been particularly beneficial in pathology where better algorithms - in addition to other technologies - are enabling more sensitive laboratory tests. Because pathologists can now identify certain tumor mutations, for instance, they’re able to assist clinicians in personalizing therapy. Such advances are not only helping physicians help their patients, but are also stimulating pathologists by the evolution of their field. "One of the most exciting things about pathology," says Signorelli, "is that it’s developing at such a rapid pace. We’re constantly learning. It’s exhilarating."

Making room for life

Integrating your professional and personal time so that the former doesn’t overshadow the latter is indeed a key element in staying emotionally healthy. But it’s no small achievement for physicians, given that no matter where they are or what they’re doing, they’re always physicians, with everything that entails.

Not surprisingly, it can be difficult to separate the physician from the person enough to enjoy the other parts of the day. But establishing a life outside your practice is critical for long-term sustainability.

"Balance is extremely important to one’s happiness," says Whitney Paige Barnett, physician recruiter for Mon Health System in Morgantown, West Virginia. "The job and organization should hold value and a prominent place in a physician’s life, but they shouldn’t be the physician’s life."

So how do you create a comfortable merger? "I think happiness starts by being honest with what you want in both your personal and professional lives," Scott says. "If you want to be the busiest physician you can be, then you need to go somewhere where that can happen. But if it’s about having balance, you need to take that into consideration. You do yourself a great disservice if you don’t have that honest conversation."

Beyond that initial talk, there’s no one-size-fits-all solution for taking care of yourself since what you do is based on preferences and priorities. But physicians who believe they’ve achieved a rich balance are persistent in pursuing the things that give their lives dimension. Faith, family, friends and interests have helped them remain healthy, energized and happily centered.

Moreover, they’ve found ways to deal with the day-to-day reality that a case might not go perfectly for all of their hard work and commitment. They don’t fool themselves into thinking that everything will be right all of the time. Instead, they’re prepared for inevitable ups and downs so those intrusions don’t necessarily interfere with home life.

"You’re going to have good days and bad days," says Jones. "But you can still have a positive experience if you say, ’How can I approach this situation to make something good out of it?’" Jones says it has taken time to fully realize that he can have a very positive impact even in the absence of a good medical outcome. Yet switching gears to help those he can still help also improves his outlook immeasurably. "I think sometimes you have to redefine how you can make a difference," Jones says. "Maybe I can’t save the patient, but that doesn’t mean I can’t make a difference for the patient’s family."

The fact that Signorelli’s husband isn’t in medicine definitely provides a buffer between her professional and personal time. When she comes home, they focus on their children and other compelling non-medical topics. That doesn’t mean that there aren’t intrusions, however. She still gets messages after office hours and sometimes finds it hard to stop thinking about a difficult case or what didn’t go well that day. For the most part, however, Signorelli makes a conscientious effort to block off time for herself, her family and friends. "It’s so easy to get wrapped up in work because it’s never-ending," she says. "But you have to remember that you’re only human. It’s really important to have time when you’re not thinking about your practice, when you’ve shut off that connection. There’s great satisfaction in being able to say, ’I did a great job today. I’m happy with the way things went. Now I can go home and focus on my family."

Heather Signorelli, D.O.
Being able to focus at home or work - wherever you happen to be - is an important part of the quality of life for pathologist Heather Signorelli, D.O. "There’s great satisfaction in being able to say, ’I did a great job today. I’m happy with the way things went. Now I can go home and focus on my family."
 

If there are secrets to the happiest specialists, it’s that the factors keeping them happy aren’t so secret after all. Physicians who navigate the everyday challenges of work and life with a positive spirit are performing meaningful work that engages them both intellectually and emotionally, regardless of their medical niche. They’ve found supportive environments where they can work to their maximum potential and grow. At the same time, they try to have balance in their lives.

That’s not to say that other factors aren’t at play; scientists have made serious inroads concerning the nuances of happiness with more findings likely in the works. Yet for many physicians, feeling good still comes down to knowing at the end of the day that they’ve contributed when someone needed them the most. Krueger, for instance, is excited to get to work because he simply loves performing surgery. But the bigger joy comes in seeing those men and women who’ve transitioned successfully through surgery and months of rehab. "When they come into the clinic and smile," he says, "it’s pretty powerful stuff."



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