American College of Physicians: Internal Medicine — Doctors for Adults ®

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President's Column

The secret of happiness for internists

From the July 2001 ACP-ASIM Observer, copyright © 2001 by the American College of Physicians-American Society of Internal Medicine.

When I meet members at regional meetings and elsewhere, the topic of professional satisfaction frequently comes up. Sadly, I hear numerous stories from sincerely unhappy internists.

At times, these voices seem to predominate conversations at meetings and in physician satisfaction surveys. It’s no wonder that morale is declining among our ranks.

When I was recently discussing this problem with a colleague, he offered a suggestion. Instead of focusing surveys on identifying what’s wrong with the practice of internal medicine, he said, we should identify happy doctors and delve into their secrets.

Perhaps a “silent majority” among our membership still looks forward to each day as an opportunity to do good and become more skilled physicians. We should ask them “How do you do it?” and seek to learn from their successes.

The happy internist

With this goal in mind, let me share the story of a College Fellow I’ve gotten to know. This Yonkers-born and -bred physician graduated cum laude from Harvard Medical School, completed residency and headed for Wyoming with his nurse wife, never once looking back.

He established a solo practice in a small mining town where he was the only internist, taking call every night and weekend. During the decade that followed, he helped run the local hospital’s ICU, directed the town’s only nursing home and served as a public health officer.

When his daughters reached high school and needed better educational opportunities, he and his family moved to a more urban community in the same state. There he joined a medical practice that grew to become the area’s premier internal medicine group. He has served in nearly every position of responsibility at the local hospital, in addition to working as the county health officer.

He also actively volunteers. While serving on the local cancer society’s board, he initiated a task force to enhance breast and cervical cancer detection among women in the state who have little or no health insurance. He lectures for numerous community groups around the state.

Somewhere along the way, he taught himself Spanish. He has been involved with ACP-ASIM regionally, and he served a term on the College's Board of Governors. Perhaps it is not surprising that he has been honored in his state as both volunteer of the year and physician of the year.

I must confess that I’m a bit jealous of this College Fellow, primarily because of the less tangible accomplishments of his life. Simply put, he is the most satisfied internist I have ever met. He finds his career rewarding despite professional isolation, lack of financial security and a relentless workload, as well as the profession’s common problems with fee schedules and administrative hassles.

In my conversations with him, two personal characteristics stand out. First, his approach to medicine seems to be that of a prototypical “reflective practitioner,” as described by Donald Schön in his book of the same name. This internist derives as much intellectual satisfaction from honing his ability to prioritize problems as he does from actually solving patients’ problems, a skill that goes beyond the conventional boundaries of medical diagnosis and therapy. Simultaneously, he constantly reflects on his own decisions, uncertainties and mixed values, always seeking, analyzing and improving his performance.

Second, as his extracurricular activities amply demonstrate, he makes frequent deposits into his community’s repository of “social capital.” He is eminently connected with his family, friends and neighbors. These social bonds no doubt contribute to his satisfaction.

Lessons for the rest of us

What can we learn from this happy internist?
First, happiness can flow from viewing contact with patients as a major source of personal sustenance. Second, enjoyment can be found in not only solving clinical problems, but also prioritizing which problems to solve by taking a highly individualized approach to each patient. Finally, professional satisfaction does not come from acquiring money, but instead from gaining “social capital” through community ties.

In his sociological study, “Bowling Alone,” Robert Putnam observed that regularly attending an enjoyable club meeting is equivalent to doubling your income in terms of life satisfaction. Wouldn’t it be wonderful if we could demonstrate that active involvement in ACP-ASIM produced a comparably positive rate of return?

If you are a satisfied internist who enjoys your chosen profession, consider how you could help colleagues whose morale is sinking. Please share your secrets by contacting me at william_hall@urmc.rochester.edu. Later in the year I will gather and disseminate your comments for the benefit of the membership and the profession.

In the meantime, if you happen to be near Laramie, Wyo., stop by to see Dan Klein, FACP, and talk with him about how much fun it is to practice medicine.

—William J. Hall, FACP

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