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May 5, 2014

The importance of autonomy, mastery and purpose in the practice of medicine

Jesse Irwin headshot

There’s a Daily Beast story that’s been going around about how much being a physician sucks. If you’re a doctor or work with doctors, there’s a good chance someone has emailed you the link or posted it on social media.

The story is called "How Being a Doctor Became the Most Miserable Profession," and it brings together a number of recent trends to paint a pretty sad picture: an increasing number of doctor suicides, rising unhappiness and job dissatisfaction, rising numbers of physicians who choose to be employees rather than have their own practice, more joint MBA programs which allow physicians to move up to management, and more physicians who choose specialties that pay more and allow them to retire and get out of the profession earlier.

Survey: 9 of 10 doctors unwilling to recommend health care as a profession

Perhaps most stunning is the findings of a survey from The Doctors Company, which showed that 9 out of 10 doctors were unwilling to recommend health care as a profession. This "would you recommend" question is a sort of Gold Standard in the world of marketing, asked by tens of thousands of businesses to measure positive affinity to their business or brand.

As the news release from The Doctors Company points out, this negative affinity is likely to exacerbate the physician shortage: "Physician Survey Respondents Indicate They Are Actively Discouraging Individuals from Entering the Medical Profession," reads the headline.

And yet, another recent survey from Medscape of more than 24,000 physicians from Medscape doesn’t paint nearly so drastic a picture. In one telling slide, 58% of physicians said that if they could do it all over again, they would still choose medicine as their profession. Meanwhile, 47% would choose the same specialty, but only 26% would choose the same practice setting.

Slide via Medscape.com

 Slide via Medscape.com

Those results speak both to the intrinsic qualities that make medicine a satisfying career - and the industry-shaking upheavals that are making the actual practice of medicine increasingly frustrating.

The 26% number also suggests something else that should give residents of every stripe and color pause: three out of four of you will later regret the decision you make about where to practice medicine.

So how to explain these findings for a profession that most would agree offers above-average pay, job security, societal prestige, and both meaningful and intellectually stimulating work?

Why autonomy, mastery, and purpose matter to physicians

In a 2009 TED Talk, author Dan Pink makes the case that what we know about the science behind individual motivation is vastly out of step with how businesses motivate people. The gist is that most companies expect that financial incentives will motivate employees to achieve results, while in fact this only holds true for the most rudimentary of job functions, or those that require nothing in the way of creative or independent thinking.

What does in fact motivate people, according to Pink, are three things: autonomy (the urge to direct our own lives), mastery (the desire to get better and better at something that matters), and purpose (the yearning to do what we do in the service of something larger than ourselves).

What the Daily Beast story describes is really a failure on point number one: autonomy. The unintended consequences of electronic health records, complicated billing and reimbursement processes, increasing rules about how we conduct ourselves, which are designed to influence patient satisfaction scores, more and more regulatory requirements, and legal liability concerns all impact a physician’s autonomy on the job.

As the author Malcolm Gladwell recently said: "You don’t train someone for all of those years of medical school and residency, particularly people who want to help others optimize their physical and psychological health, and then have them run a claims-processing operation for insurance companies."

How to make physicians happier

The silver lining in all of this negativity is that we can actually get pretty close to pinpointing what’s wrong. It’s not medicine itself that’s making physicians unhappy; it’s the way we’re practicing it. And while it may be true that finding job satisfaction as a solo primary care physician with a small-town practice may be an increasingly unreasonable proposition, it is also true that physician groups have it in their control to give their physicians the things that can really make them happy on the job: autonomy over their work, schedules, and career trajectories; mastery of their profession through continual training and education; and purpose, both through practicing medicine and making people better, and by being a part of a company with serious ambitions for the greater good.

Originally posted on the MEP Health blog on April 24, 2014.

By Jesse Irwin, M.D.



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