As a physician who helps administer and analyze our medical staff’s wellness data, I have been puzzled by one consistent finding from our semi-annual physician wellness survey – the group of physicians with the highest level of distress are the mid-career physicians, those who, like me, graduated from medical school 15 to 24 years ago.

Our hospital, a community-based, semi-academic hospital, utilizes a nine-question survey to track physician’s well-being.  Some of the data confirm what we know already;  female physician’s distress scores are twice as high as their male counterparts, and specialties like primary care and OB-GYN also fare worse.

But, why high levels of distress for the mid-career physician?

It seemed to me the mid-career physician was in medicine’s “sweet spot.”  We should be the happiest of the bunch.

For one, most mid-career MDs are comfortable financially. We have been making real money for over a decade.  Our student loans may be paid off. Those working in private practice are likely full partners, lending even more financial security.

Clinically, the mid-career physician is sought-after. The combination of experience and relative youth makes the mid-career physician desirable to patients and referring physicians.

Socially, mid-career MDs are established in their communities – finally rooted after a decade of transience dictated by medical school and post-graduate training.

Comfort + certainty ≠ happiness

Reflecting on my own career,  I was happiest during internal medicine residency when I worked twice as much and made 10 percent of my current salary.

In residency, I woke up every day with purpose: to learn how to put in an A-line, to (finally) be the one guess the mystery diagnosis at morning report (and win free movie tickets!),  and to generally enjoy the company of my fellow residents.

Now, my day is spent largely working in isolation, thinking about RVUs, the number of inpatient consults, answering phone messages, and completing the torrent of EMR tasks as they roll in. Before I know it, the day is over.  There is little time for idle conversation with colleagues, if I even see them, and the feeling of being part of a team seems quite distant.

The Japanese use the term, ikigai, to describe purposeful living. Loosely translated as “the reason for being,” ikigai, is strongly correlated with happiness (and, incidentally, longevity).

Maybe ikigai is what we mid-career MDs have been missing.  We sacrificed for years to build a practice, create a nest egg, support our families. But, now what?

What takes the place of the excitement of putting in your first central line, seeing that flash of dark blood in the finder needle as you advance into the subclavian vein? What brings the same stimulation as sitting around the table discussing cases with colleagues?

Mid-career colleagues: it’s time to go back to the future.

Time to learn again. Time to build professional and social networks at work. Take a lunch break. Bring home a few fewer RVUs.

I recently started a monthly journal club for our small section of gastroenterologists as a way to recreate some of what I loved about residency.   A case conference to discuss difficult cases is next.

While the rewards of these diversions are not quantifiable, they are still valuable.

I hope my colleagues feel the same way.  Maybe I’ll throw in some free movie tickets, as well.

Anish Sheth is a gastroenterologist.

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