The Happiness Paradox of the Health Care Professional

KovtunArt_AdobeStock

IT’S A WILD WORLD: HOW TO WORK WELL IN AN UNJUST SOCIETY

“But then a lot of nice things turn bad out there.” – Wild World, Cat Stevens

I have always felt being a clinician offers me an opportunity to make a tangible and important difference in the lives of the people I serve. Clinical work is filled to the brim with meaning, and not only is it important work but also intellectually interesting work.

On good days, being a clinician is life-enhancing. The profession allows me to maintain a valuable perspective on what really matters in life, and work often does not feel like work in the traditional sense of the word. On a good day, I feel blessed.

Yet, health care professionals seem to be at continual risk for the occupational hazard of burnout.¹ This risk was further exacerbated by the unique demands the COVID-19 pandemic placed on health care organizations and their employees.

Many clinicians are spending more and more days at work feeling overwhelmed despite the fact they are practicing in their chosen profession, a role they have spent years, even decades intentionally striving for. The result? They are simply too stressed to feel blessed.

The way I see it, a confluence of 4 factors contribute to this dire situation.

First, medical training overwhelmingly places emphasis on the primacy of patient welfare while simultaneously pushing ourselves to continually be better. Patient welfare becomes our north star, an ideal that, by the time we are done with our arduous training commitments, has become ingrained within us. In addition, to successfully complete training requires us to work harder, be better, and show up day after day. Training requires us to delay gratification, and self-negate and be self-reliant. In short, the path to our hard-earned qualifications requires a mindset that favors an internal locus of control, ie, our actions matter, and we are the authors of our own destiny.

Second, training may leave us ill-prepared for the real-world challenges in medicine. When we finally become independent practitioners, we face stressors (eg, time and tediousness associated with data entry for medical records and the haggling and negotiating with insurance companies), that our training has not fully prepared us for. In essence, we run into a problem when our ideals, values, and professionalism do not fully align with the organizations and institutions that we are required to interface with on a daily basis. Usually this is because they are not solely accountable to patients and have other goals or stakeholders to consider. This misalignment causes daily friction.

Third, and here's where the situation becomes highly problematic: As frontline clinicians we remain responsible (clinically, legally, ethically, and professionally) for patient welfare. Thus, we are vulnerable to ending up in situations in which we have all the responsibility yet no authority.

In my opinion, this scenario is an underacknowledged source of toxic stress for practicing clinicians and is not compatible with happiness at work. Moreover, my 25 years as a frontline clinician has shown me that women and minority clinicians are particularly vulnerable to this predicament, as we live in a world that does not easily grant such groups authority, no matter their qualifications and competencies. My anecdotal experience has been echoed in recent publications discussing the reasons that so many female doctors—including women of color—are quitting medicine,² despite patient success,³ and the reasons black doctors are leaving medical academia.⁴

Fourth, to add insult to injury, the internal locus of control that defined us in the early stages of our career is now working against us. “Trying harder” or “pushing yourself to do better” when operating in the structural limitations of an organization or institution leaves us feeling disempowered and vulnerable to poor mental health.

These 4 factors combined result in a happiness paradox: As clinicians, in our daily work with patients we should feel blessed, because we are exactly where we have chosen to be. Yet, we are too stressed to tap into the gratitude that should be part and parcel of our everyday life.

Toward Solving the Paradox

“The most important skill in the 21st century is the ability to live happily with uncertainty.”— Warren Buffet

The following suggestions are not a solution but a start to addressing the problem. They represent small steps on a path toward ensuring career longevity and prosperity in our wild world.

Align professional goals and ideals as much as possible with the organization in which you work. For instance, you may be passionate about serving a particular patient population that your organization is likewise committed; the clinic in which you are based specializes in treating a condition you are likewise fascinated by; the organization prioritizes teaching medical trainees and you aspire to become an educator.

Because 100% alignment may be unrealistic, the 80:20 rule comes in handy. At the end of any given week or month, take a few minutes to look back on your schedule and calculate where you are spending your time. If 80% or more of your time is spent on activities that align with what matters to you as a health care professional and are likewise in keeping with organizational priorities, then that is likely sufficient. More alignment equates to less friction, and this helps one’s career longevity.

Avoid situations where you have all the responsibility and no authority. This occurs when you are asked to be the clinical supervisor of a clinician who does not report to you on the organizational chart, or you are required to maintain clinical operations in settings that are dangerously under-resourced.

If managers and leaders are unable to see the dire nature of your predicament or are unwilling to empower you to extricate yourself from such untenable situations, you need an exit strategy (eg, a change in position, a change of service or institution).

Transition from having an internal locus of control (rewarded in your trainee years) to an external locus of control (more apt for your practicing years). The way 21st medicine is practiced, cultivating an external locus of control may be adaptive. Pay attention to the structural and systemic factors that are responsible for the quality of care you can offer a patient. When appropriate, accept these situations and the resultant limitations for what they are. That said, this is not an excuse to become passive, or complicit with structural limitations that are subpar; rather, it is advice to readjust your expectations when faced with factors beyond your control. Accepting what cannot be changed in some circumstances and saving your energy for more worthy battles is a healthier strategy than feeling hyper-responsible for rigid structural factors.

Dr Jain is a board-certified general psychiatrist, with specialty expertise in PTSD, primary and mental health integrated care, and women’s health psychiatry. From 2012-2020, she served as Medical Director for Integrated Care at the VA Palo Alto Healthcare System and is also a former health services researcher, affiliated with the National Center for PTSD. She is an adjunct clinical professor of Psychiatry and Behavioral Sciences at the Stanford University School of Medicine and a distinguished fellow of the American Psychiatric Association and the author of The Unspeakable Mind: Stories of Trauma and Healing from the Frontlines of PTSD Science (Harper, 2019).

The views expressed are those of the author and do not necessarily reflect the official policy or position of the organizations with which she is affiliated.

References

1. De Hert S.Burnout in Healthcare Workers: Prevalence, Impact and Preventative Strategies. Local Reg Anesth. 2020; 13:171-183.

2. Dudley J, McLaughlin S, Lee TH. Why So Many Women Physicians Are Quitting. Harvard Business Review. Jan 19, 2022.

3. Anderson C. Why Are California’s Female Physicians of Color Leaving Medicine Despite Patient Success? Sacramento Bee. May 1, 2024.

4. Blackstock U. Why Black Doctors Like Me Are Leaving Faculty Positions in Academic Medical Centers. STAT. Jan 16, 2020.