January 13th, 2019

Are We ID Doctors Really So Unhappy Outside of Work?

Must be a rheumatologist or otolaryngologist. (Source: National Library of Congress.)

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:

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:

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?

So, what do you think? Is the Medscape survey valid?

20 Responses to “Are We ID Doctors Really So Unhappy Outside of Work?”

  1. Wendy Armstrong says:

    In 2014 Becker’s Hospital Review published a survey placing ID physicians in the top 10 “happiest specialties.” You can see the data here: https://www.beckershospitalreview.com/hospital-physician-relationships/which-specialty-has-the-happiest-physicians.html
    TO me, this either supports the fact that there are major methodologic flaws probably in all these surveys and/or the Donald J Trump effect. Certainly salaries haven’t gone down since 2014!

  2. Raj Karnatak says:

    Happiness outside the work? Is it related to work? I am not sure if this the right question to ask. As we know our happiness mostly depends on our personal or family life. Difficult to understand how practicing a specialty would make you unhappy outside the work. Happiness at work may be directly related to specialty, but outside work happiness may not be directly related to specialty practice.
    Definitely I was suprised to see the lowest self esteem. Definitely seems some serious issue with sampling. Results could be upside down with different group of ID docs. Just my views

  3. Libby Hohmann says:

    Reading this post brought a laugh! I’m sure the Nobel Committee is happy to get the update. There should be a “Mark Twain Prize” for medical humor — needs a new eponym of course, maybe the Paul Sax Prize!

  4. Albert Morgan says:

    I am an Anesthesiologist that leans sharply left so maybe I’m anomalous to begin with. My advice on self-esteem is to ignore it completely. It is a worthless metric. Think about it, who would you rather have as your doc, a nebbish futzing around making sure everything is just so, or some commando barging in with his Ferrari keys jingling in his hand? My opinion, and business studies back this up, is that confidence is inversely proportional to competence.
    This focus on self esteem comes from that part of the world that conflates it with material success. Your response should be that all mass murderers have amazingly high self-esteem. Shuts it down for a little while at least.

  5. Tim Lahey says:

    I bet two separate concepts are conflated in these data. Love to see them disentangled: (1) Enjoyment of work – I bet very high; and (2) Sense that one’s work is properly valued – low. Much as I wish #2 would improve, including monetarily, I have no regrets, baby, because, hey, #1.

  6. Stephen Shafran says:

    This adds insult to injury after the recent BMJ paper stating that ID was the specialty with lowest percent of golfers.


    The obvious conclusion is this: we golf more, we will be happier

  7. Tara Vijayan says:

    I am going to venture another reason (apart from methodologic flaws)- we say YES to far too much. It is harder to set boundaries. Maybe it is in part because we have to convince people that we really do earn our keep by meeting those RVUs (ha) but also I think as folks who are more “left leaning” we perhaps tend towards more altruism (social determinants of health is our jam), and are perhaps a little overly empathic/sensitive in nature. (See this interesting “survey” : https://www.upworthy.com/these-27-non-political-questions-can-predict-whether-you-re-a-republican-or-democrat?). Lastly, agree with Libby Hohman’s comment about the Mark Twain/Paul Sax prize for medical humor. 🙂

  8. Tony says:

    It went from blame Bush to blame Trump.Maybe part of it is arrested development.One of my sons is a clinical psychologist at a major university and he was amazed at how many students( usually undergrads) had to see him after Trump’s victory.I’m a retired internist( politically conservative)and also became an HIV/AIDS expert as in addition to a private practice I had a job at a max security prison- guess I should be really depressed etc. I’m not. I do miss the Hopkins HIV conferences and I really miss the humor of Dr. Sax-great moderator and speaker. I think doctors think to much about money.What do Internists and ID specialists have in common- no procedures. As I was told years ago you don’t get paid much to think. My advise- stay in the moment. Personally I tend to doubt the validity of articles like this one . Dr. Sax- enjoy your new degree!!

    • Dee says:

      Hmm…I’m not sure its arrested development as much as lack of curiosity about why those undergrads were upset. Not to wind off too much into political debate. Certainly being an immigrant woman lately has been distressing, directly and indirectly, even in an increase in the casual racist experiences with my patients; 2 years of reading news about sexual assault is–a conflicting experience. And friends who are LGBTQ worry a lot about the legal protection of their families. Also probably federal workers are a bit stressed currently. During the Obama years, my conservative in-laws were constantly distressed about terrorists and protecting their guns. Politics impacts daily life. Maybe not for everyone, in different ways for different people, but for many, it does. I also think the survey results are strange, but many people are unhappy for different reasons, it is also not methodologically sound to dismiss it without knowing the relevant facts of their lives.

      • Tony says:

        A clinical psychologist obviously has curiosity about why patients are feeling a need to be seen. That’s a given.”arrested development” was a joke-apparently not a good one. Hope you’re happy with your career.

  9. Metaphysical!
    Life is infectious.
    Let me fight it?
    (putting myself on the line)

  10. Ted Gedebou says:

    How is self esteem measured? Or satisfaction? If self assessment based survey is the method, then the results of the article will have to be flipped upside down. As a plastic surgeon, i do not recall running across a single happy surgeon, and only a few exhibited healthy self esteem. Egotism is merely an expression of compensation for low self esteem. Dont worry ID people, you may yet prove to be the happiest of us

  11. David K says:

    The daily murder of trillions of bacteria takes a psychological toll, apparently.

  12. Rick Watkins says:

    A day without pus is a day without sunshine!

  13. Atiq Rahman. says:

    I D speciality is unhappy speciality. So much brain work/ cognitive work— taking more time being cognitive and comprehensive — but being less paid compared to those who do the procedure type work , less comprehensive and less time- consume work.

  14. Mobolaji Ogunsakin says:

    Wow, this describes me to a “t”!! Now I feel happier that I am not alone and my ID colleagues worry about the same things I do!!

  15. Linda says:

    I definitely love reading all that is posted on your blog.

  16. Erin says:

    I am not sure they are measuring what they think they are measuring. Since so much of our work ties into our outside life I am not sure you can separate the two. I believe ID was also fairly burnt-out as a specialty in one of these polls (along with some of these other low happiness rankers) and I believe this impacts all spheres of life. Burnout + long hours + being told you as a unit have relatively little value= generally not happy which means not happy outside of work either. But then if you look on the whole, most ID docs like their specialty and it is just the system around them that makes them batty. I think a measure trying to encompass how happy or content you are with your whole life would be more telling as well as the follow-up question of ‘do you think you would be more or less happy if you were no longer practicing medicine?’

  17. Jaan Naktin says:

    I suspect this is because ID physicians do tend to be the types of people who have a “calling” rather than a “career” or a “job” – you won’t find too many of us who are not accessible to our family, friends, neighbors or associates inside or outside of work. Years ago our group was awarded the “Doctor’s Doctor” award from the Network for our selfless devotion to our patients and our careers – it was my wife (also a physician) who pointed out the “booby prize” nature of this award – we are stuck in the hospital rounding late, charting, making phone calls while the rheumatologists and ENT folk are about leave, left or already home. I would see this “dissatisfaction” score as a badge of honor – there are not too many of us left who care about our work to this degree.

  18. Happiness is about balancing your time and your personal life. To determines what is happiness is all about the Patients we served. If they are happy with our service, it means we are effective and doing our job. Rheumatologists knows how to smile. Let’s learned from them shall we?

HIV Information: Author Paul Sax, M.D.

Paul E. Sax, MD

Contributing Editor

NEJM Journal Watch
Infectious Diseases

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