Why are doctors so unhappy?

BMJ 2001; 322 doi: https://doi.org/10.1136/bmj.322.7298.1361 (Published 02 June 2001) Cite this as: BMJ 2001;322:1361

Calibre of people recruited to medicine may be too high for the job

  1. P A West, director (paw11@york.ac.uk)
  1. York Health Economics Consortium, IRISS Building, University of York, York YO10 5DD
  2. Liverpool Medical Institution, Liverpool L3 5SR
  3. Bacon Road Medical Centre, Norwich NR2 3QX
  4. Royal Free and University College London Medical School, London NW3 2QG
  5. Doctors' Residences, Bay-of-Islands Hospital, Kawakawa, PO Box 290, New Zealand
  6. Broadwood House, Maghull L31 7BG
  7. Health Centre, Gunnislake PL18 9JZ
  8. Queen's Medical Centre, University of Nottingham, Nottingham NG7 2UH
  9. South Shropshire Community Mental Health Trust, Ludlow SY8 1ET
  10. Welsh Institute for Health and Social Care, University of Glamorgan, Pontypridd CF37 1DL
  11. Mill Lane Medical Centre, London NW6 1NF
  12. London NW2 4DU
  13. Mixenden Stones Surgery, Halifax, West Yorkshire HX2 8RQ
  14. Kazakhstan
  15. 144 Pleasant Street, Laconia, NH 03246-332, USA
  16. Brighton Community Mental Health Centre, Brighton BN1 3RJ
  17. Division of General Internal Medicine, Dalhousie University, Room 406, Bethune Building, 1278 Tower Road, Halifax, Nova Scotia, Canada B3H 2Y9
  18. Group Health Cooperative, Group Health Medical Center—Tacoma, 209 M L King Jr Way, Tacoma, WA 98405, USA
  19. BMJ

    EDITOR—As an economist who has spent the past 30 years looking at health care all round the world, may I suggest that frustration and perhaps boredom play a part in the anger of doctors and contribute to their unhappiness, as described by Smith in his editorial?1 This is aside from what I accept are genuine conflicts between levels of public funding and clinical aspirations to help patients. Looking at other professions, I note that people advance through their careers, their work changes, and they build teams and grow their businesses. Some stay in single practice, but many move into management, with changes periodically in their working life.

    Similarly, economists like me have a wide range of research and travel as part of our work, and we manage teams on a diversity of projects. I have no idea what I will be doing in September this year, but I am confident that it will be interesting. Contrast these professional lives with those of doctors. General practitioners may have opportunities to develop their management skills but in an environment where the management structures and self employed status of colleagues make this far from easy. And someone has to see the patients each week. Consultants have more of the variety and team building mentioned, but, again, their work plans look very much the same—year in, year out—to the outsider. This leads me to my conclusion.

    Might the calibre of people recruited to medicine be too high for the job, not necessarily for the technical elements but for the pattern of work once general practitioner or consultant status is reached? Is a degree of frustration inevitable given doctors' abilities and the relative consistency of the job beyond the age of 30 or 35? Are many years of clinical practice consistent with the job …

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