When I was preparing for a panel on burnout and wellness for the Triological Society Combined Sections meeting held in January 2018, I came across a large national survey on job satisfaction in the workplace by Tom W. Smith, director of the General Social Survey at the National Opinion Research Center at the University of Chicago (“Job Satisfaction in the United States.” Published April 17, 2007.). In this study, Smith reports the most satisfying jobs in the United States. While most might agree that the changes in healthcare over the decades have not led to improved physician satisfaction at work, I was still shocked to find that we aren’t even among the top 10. Here’s who topped the list:
Explore this issue:
July 2018- Clergy;
- Physical therapists;
- Firefighters;
- Education administrators;
- Painter, sculptors, related;
- Teachers;
- Authors;
- Psychologists;
- Special education teachers; and
- Operating engineers.
Smith pointed out a common theme among these different jobs: “The most satisfying jobs are mostly professions, especially those involving caring for, teaching, and protecting others and creative pursuits.”
But wait a minute … we are a profession too and, arguably, the prototypical profession. We espouse all the elements that he cites, and I argue that we remain one of the most highly respected and important professions in our community. So, why aren’t we listed here among the top most satisfying jobs? Many reasons may come to mind. At the end of the day, however, we do and should have very high expectations of having satisfying work despite the various stressors that are intrinsic to our occupation.
So where does our expectation come from for satisfaction and reward in work? What makes us think that our work should be joyful and satisfying? Is this somehow intrinsic to work?
With just a little bit of thought, one can see that joy and the expectation of satisfaction in work is not intrinsic to work at all. When you look at the dictionary definition of “work,” there is nothing at all about intrinsic joy or satisfaction. Work for many, perhaps most, is simply what one does to earn a living that then enables them and their family to enjoy other aspects of life. So how is it that we physicians (though not certainly physicians alone) expect our work to be joyful and satisfying?
Tying this into Smith’s perspective, this is primarily because physicians have created a profession dedicated to health and healing and have, over time, built a highly developed guild-like solidarity and established systems of rigorous training and practice in that service. And as it turns out, it’s primarily the occupations that people generally understand to be professions—such as medicine, law, and teaching—in which the expectation of satisfaction is built into the work. Also, in most Western societies, a tradition has evolved in which the laws of the nation enabled professions to emerge and become relatively autonomous and self-regulating entities, so long as they maintain an implicit social contract to hold themselves and one another to the highest standards and continue to put service—understood popularly as “professionalism”—above collective or personal gain.
How much is the huge upsurge in burnout and other forms of distress and dissatisfaction that we have been experiencing over the last two or three decades been the result of the chipping away of our professional roles and responsibilities?
As Canadian physician William Osler, MD, put it, “Medical Professionalism is characterized by four great features: Its noble ancestry, which includes the critical sense and skeptical attitude of the Hippocratic School that laid the foundation for a modern medicine; medicine’s remarkable solidarity; its progressive, scientifically-based and forward looking character; and its singular beneficence and basis in charity.”