An ongoing dialogue on HIV/AIDS, infectious diseases,
January 13th, 2019
Are We ID Doctors Really So Unhappy Outside of Work?
Medscape released their 2019 Physician Lifestyle & Happiness Report, and the results aren’t pretty for a certain cognitive specialty, one commonly abbreviated “ID.”
Out of 29 medical and surgical specialties, infectious diseases physicians ranked second to last when responding to a 7-point scale rating on their happiness. Only neurologists were gloomier than we were during their off-hours.
Rheumatologists and otolaryngologists finished first and second, smiling all the way.
The news was even worse for ID docs in “self-esteem,” where we ranked last, right behind oncology and internal medicine. Meanwhile, the plastic surgeons, urologists, and ophthalmologists scored highest on this measure.
Some of my ID colleagues have commented about possible methodologic issues with the survey, as the results don’t correlate with our own happy non-work lives.
For example, Dr. Dan McQuillen weighed in with this critique:
Much like crappy data in major salary surveys, ID docs were only 1% of this sample, roughly 150 of 15,069 docs surveyed. @IDSAInfo salary surveys w/ larger sample size have shown small sample size data to be inaccurate. Hard to take 150 responses and generalize to > 11K ID docs.
— Dan McQuillen (@McQHoya81) January 11, 2019
I have a query into Medscape to get more information about these concerns, and they’ve kindly agreed to get back to me. For example, I don’t understand how the 7-point happiness scale translated into the percentages shown in the linked figure.
More importantly, what were the demographics of these 150 ID respondents, and how do they compare with ID practitioners as a whole?
Methodology notwithstanding, it’s worth postulating at least a few reasons why indeed we might be somewhat less happy outside work than other doctors right now. So here goes:
1. The current political climate. It’s no secret that ID doctors skew strongly to the left when it comes to politics. I can’t be the only ID doctor who, on a certain Wednesday in early November 2016, went to work and encountered several colleagues and trainees literally in tears.
(Or maybe you were in tears yourself. It’s OK to admit that to other ID docs.)
I’ve discussed this issue before, postulating that the “safety net” and inclusive ethos of ID doctors was more in line with one particular party than the other. Some even choose ID as a specialty because of these political leanings. Here again are the facts, which could very well contribute to a lower happiness score during the recent survey period:
— Paul Sax (@PaulSaxMD) October 6, 2016
How about today, two-plus years later? Decent chance that the fraction who have registered red is even smaller.
2. Salaries, debts, and money concerns in general. During a time when certain government workers are sadly not being paid at all (see #1, above), it seems petty to complain about ID doctor salaries — which, in this latest comprehensive salary report, aren’t really that bad:
In general, full-time ID physicians in private practice (n = 366) reported higher incomes, with a median annual salary of $260 000, than respondents employed by hospitals, clinics, or academic medical centers (median salaries of $237 500 and $181 500, respectively).
But context is everything, and here are some important considerations. Students graduate from medical school with on average nearly $200,000 in medical school debt, a hefty sum to pay down with these ID salaries.
Furthermore, ID doctors are often paid less than hospitalists and primary care physicians — doctors who have spent less time training, and frequently work fewer hours, than ID doctors. And all of us cognitive clinicians can only dream of accumulating the RVUs (and hence revenues) of a plastic surgeon, urologist, or ophthalmologist.
Hey! Those are the docs who just happen to lead in the “self-esteem” metric! Hmmm.
3. We’re by nature big-time worriers. Obsessive to a fault, we ID doctors take the most detailed histories, frequently contact the outside labs, march down to the radiologists or ECHO room or microbiology lab to review primary data, write the longest (too long) notes, and still — we live in terror of missing something.
Could it be that this personality trait doesn’t translate into happiness? Maybe the sensation that our work is never done translates into non-work “worry hours” that cloud the responses to a happiness survey.
Imagine the thought bubble of some of us as we head home from work:
How can I be happy at home when that patient with Staph aureus on a urine culture may have bacteremia? Or that other patient with a positive IGRA could develop active tuberculosis when starting etanercept? Or that person being discharged on IV antibiotics won’t have close follow-up? Or that guy who missed his HIV follow-up appointment might have stopped ART? Or that patient getting blasted with immunosuppression for graft-versus-host disease might have an undiagnosed fungal infection? Or that person …
You get the idea.
4. Our work lives are so interesting, rewarding, and wonderful that everything else pales by comparison. This must be the explanation, right? For example, look what I accomplished at work just this last week — how could anything beat that?
— Paul Sax (@PaulSaxMD) January 9, 2019
So, what do you think? Is the Medscape survey valid?