Dissatisfaction with Medical Practice

Abstract

The profession of medicine has taken its members on a wild ride during the past century: a slow, glorious climb in well-being followed by a steep, stomach-churning fall. In the decades after World War II, sociologists portrayed American doctors as the lucky heirs to a golden age of medicine. They were surrounded by admiring assistants, loyal patients, and respectful colleagues and had full autonomy in their work, job security, and a luxurious income. This era was short-lived. By the 1980s, newspaper headlines proclaimed that many of the nation's "dispirited doctors" were considering bailing out of medicine, and subsequent observers have continued to describe a profession in retreat, plagued by bureaucracy, loss of autonomy, diminished prestige, and deep personal dissatisfaction.The commentary from within the medical profession has been equally bleak. Anecdotes and an expanding body of empirical data suggest a widespread professional malaise. One disturbing metaphor has likened the prevailing emotional climate in medicine to the atmosphere surrounding a deathbed, arguing that doctors are mourning the passing of a beloved professional identity with the full cascade of denial, anger, bargaining, depression, and acceptance.1 Physicians' dissatisfaction with the practice of medicine may have public health implications over and above the obvious problems of recruiting new members into a troubled profession. Data suggest that dissatisfaction on the part of physicians breeds poor clinical management, as well as dissatisfaction and noncompliance among patients, and that the rapid turnover of unhappy doctors in offices and hospitals may lead to discontinuous, substandard medical care.2,3,4 This article reviews subjective and objective indicators of present-day dissatisfaction among physicians, attempts to place the phenomenon of dissatisfaction in a cultural and historical context, and summarizes some of the solutions that have been proposed for relieving dissatisfaction.Subjective Indicators