Working in healthcare may be one of the most difficult jobs in the world. Caring for people’s well being requires knowledge, compassion, patience, selflessness, humility, and professionalism. Even small decisions are made with care and caution. But things aren’t getting any easier. Why do we do it? For the love of it? For the money? Both? Let’s talk about medicine as a calling or just another job.
The answer to this question is complicated. Doctors, like men and women in general, are motivated by a mix of factors. They may be drawn to the challenge or sense of responsibility that comes with practicing medicine. Or perhaps it’s the potential for helping others. Money can also be an important factor. Very few professions out-earn doctors.
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I’m not sure healthcare is my calling.
I can’t speak for everyone but perhaps some of my thoughts will ring true for you. I think the answer to the “calling vs job” debate has a lot to do with identity. How many different roles do you play in your life?
Some people instinctively know the answer to this question. For others, myself included, it’s not so simple. I started on this career path 15 years ago. I was young and inexperienced. A lot of things have changed.
Is healthcare your calling?
What drives you? Why do you get up in the morning? For me, it’s largely a matter of routine. I’ve been doing this for so long, it’s just what I do. I can’t really see myself doing anything else than practicing medicine.
But why? Is this what I was made for or do I just lack imagination? Perhaps I’m bound by the golden handcuffs of comfort and familiarity.
Why I Get Up in the Morning
I think a lot about my family. Does being married or having a family lead you to different attitudes about your personal mission or purpose in life? It does for me.
Family is my highest priority. I define myself first as a husband and father. I would say that being a PA comes next, but I’m not sure I want that to define me.
When someone asks what I do for a living, I reply by saying that I work in healthcare. I’m careful not to say: “I’m a PA”. I work as a PA but that’s not who I am. It’s a subtle but significant difference.
To me, work is a means to an end. I don’t live to work but I do have to work to live. A career as a PA has allowed me to provide for my family’s needs and many of their wants. For this, I am extremely grateful.
It’s Okay to Be Different
Is there anything wrong with medicine being “just a job”? PA David Hiram doesn’t think so. “People deserve to be happy. Medicine not being a calling doesn’t mean that one does not take pride in their work.”
For PA Hiram, putting the patient first is what brings him happiness. “That’s why it’s a calling for me. That’s also probably why a lot of us are burned out–because we put patients before ourselves but the system puts profits before clinicians.”
PA Hiram, soon to be Dr. Hiram after completing Butler’s DMS program, has put others first his entire career. He’s the sole emergency medicine provider in a rural area. Before that, he served in the US Navy.
I’m also passionate about the work I do. I care deeply about providing quality, evidence-based therapies and performing at the highest possible level. But that doesn’t mean that my work defines me.
PA Doctors Overwhelming Say “Calling”
I polled a group of my colleagues as I was writing this article. Of the 60+ who responded, 75% said they viewed medicine as a calling. About 15% said “job” and the rest were undecided which is where I cast my own vote.
What Do You Get Out of Your Job?
For those that feel that practicing medicine is indeed a calling–what is it about the job that fulfills you? Is it the praise? The position of authority? The opportunity to serve? Whether you believe that healthcare is a right or not might influence your position. For a time, I felt that it was all about the money. Now I’m not so sure.
I don’t think doctors and PAs are the only ones who struggle with this question. All of us, at one time or another, have asked ourselves “What am I doing with my life?” If you’re lucky enough to be able to work in a vocation that you love–that fulfills you on some level–then congratulations, you’ve got it all figured out.
If your job isn’t fulfilling or you’re struggling with balance in your life, it may be time to take a look at what’s driving these feelings. Maybe there’s something else out there that would be a better fit for you. Maybe the money isn’t worth it anymore.
Sometimes It’s Not What You’re Doing, but Where You’re Doing It
You could also conder the type of medicine you practice. If you’re a PA, it’s easier to move into a different specialty than if you’re a physician. And that might be all it takes.
I’m seeing more and more physicians leaving their chosen specialties to practice in “functional” or “concierge” medicine. A little piece of me dies every time I see a new medispa or IV nutrition business go up.
Let’s consider some arguments for medicine being a calling:
- It’s a selective profession. Many more start the journey than actually finish it.
- It’s an investment. Better yet, a sacrifice; both in terms of time and money.
- It’s a near-sacred responsibility to receive someone’s trust in their time of weakness.
- Birth and death are regularly part of the deal.
Now to be fair, let’s consider opposing arguments that suggest that medicine is just another job, no more unique than any other:
- We are all motivated by money. We make employment decisions based on income.
- Few would do the job for free–for the love of it.
- What do you think about when you don’t have to think about anything? Probably not work!
- Clinicians are leaving medicine at an alarming rate.
The Cryptic Nature of Work-Life Balance
Everyone’s talking about “work-life” balance these days. What does that mean exactly? For employers, it means checking your home life at the door. But for the employee, it’s just the opposite.
I for one don’t want to take my work home with me! I’m lucky enough to only rarely take call, and for me, it only involves answering the phone and providing some triage services. Now before anyone gets too fired up, you should know that we just don’t get a lot of calls after hours. Why? Because of the patient portal, that’s why.
Work Finds a Way…
I have a love/hate relationship with the patient portal.
It functions like a secure email system that saves all communications into the chart. Our patients know that we review portal messages throughout the day. It’s actually the first thing I do when I get to the clinic and the last thing I do before I go home. There’s nothing like starting your day with 10+ patient messages in your inbox on top of the people you’ll be seeing in clinic!
Because patients know they can access their healthcare provider in a timely fashion, most don’t bother with phone calls. I acknowledge that my feelings on this issue might be significantly different if I had to constantly remain in clinical mode and be prepared to rush to the hospital to see a consult.
Because I can leave work at the office, I do. I don’t even like to talk about my day really. My spouse knows not even to bother asking the question. It’s not that I’m having some kind of ongoing traumatic experience, I’m just done with that part of my day. There are other things I want to do.
Practicing Medicine is a Bit Like Training for the Olympics
In my early career, I spent most of my waking hours reading and studying. I didn’t have time for hobbies and barely had time for family. I hadn’t quite figured out how to document efficiently. While my wife was in labor with our first child I was sitting in the hospital room working on patient charts. That’s nuts.
Now I didn’t go to medical school or complete a residency. But I did spend 3.5 years as a PA and Doctor of Medical Science student, so I feel I can relate to medical students. I also think that, as a PA, I’ve had to work harder to keep up with my physician colleagues. It’s hard work.
Balance Requires Moderation
There is no shortage of dissatisfaction in the medical field. Just because we work in health care doesn’t mean that we know anything about self-care. Whether you’re an MD or a PA, I think we could all afford to be more balanced.
Primary care is all about balance. On one hand, we are responsible for everything. Literally everything. There are plenty of tropes about being a “jack of all trades”, but the reality is we can’t get away with knowing “a little about a lot”. We have to know a lot about a lot.
What Science Says About Medicine as a Calling
There was an interesting article published in the Annals of Family Medicine in 2018. The authors surveyed almost 600 fourth-year medical students. While just over 200 did strongly identify with medicine as a calling, the majority did not.
The question was presented to students on a 5-point Likert agree-disagree response scale. So it can be difficult to make assumptions given that most students could at least weakly identify with the idea that medicine was a calling.
But it’s interesting that about 350 medical students, almost 60%, did not strongly believe that it was their calling to practice medicine. Students entering anesthesia residencies were the least likely to feel strongly about their call to medicine.
As noted above, those that did see medicine as a calling were more likely to enter primary care fields such as family medicine, internal medicine, or pediatrics. 58% of future family medicine residents felt that medicine was a calling compared to only 20% of anesthesia trainees. What does that say about future anesthesiologists?
Your Happiness is at Stake
The doctor-patient relationship is another factor to consider. Practitioners of western medicine are accused of looking at patients as a set of symptoms rather than considering the patient as a whole. Give me a break.
JAMA Internal Medicine, formerly known as the Archives of Internal Medicine, looked at how primary care physicians’ sense of duty affected the satisfaction they receive when treating conditions that are often seen as a failure of willpower. The hypothesis was that the more you see your job as a calling, the more satisfaction you’ll derive from working with challenging patients.
Addictions are notoriously hard to treat, especially if we forget that addiction is a disease. In this 2012 study, the researchers again polled a group of primary care physicians and asked them about their feelings towards patients with alcoholism, obesity, and nicotine dependence.
Multivariable analyses showed that physicians who felt that medicine was a calling were significantly more likely to find satisfaction in treating these vexatious conditions.
If You Could Go Back, Would You Choose Medicine Again?
Another notable feature of this particular study was the following question that was also presented to respondent physicians: If I had it to do over again, I would not choose medicine as a career. Almost half would not choose medicine again.
You have to see your patients as real people with hopes, dreams, and flaws. When you start to lose empathy and see patients are objects, complaints, or just a set of symptoms, you’re well on the road to burnout. But having to come up with an intelligent plan for any and all imaginable complaints sometimes leaves me feeling burned out–or at least inadequate.
Education and Expectation
How does medical education affect our views on being “called” to practice medicine? PA, nursing, and medical students all have courses in cultural competence and effective communication. Patient autonomy is the new buzzword while paternalism is a relic of the past. Can these classes change minds or is it a feeling you grow up with?
We’re constantly being evaluated. The government, insurance companies, patients, and even peers are watching us to see how we measure up. Even if we want to take a break or loosen up a bit, there’s always the worry that somebody will notice and call us back into compliance. Online reviews can create significant tension for an employed doc or PA.
In the end, however, I think patients want us to listen and understand them, not just lecture or prescribe. If we want to build rapport, I think we need to show some measure of personal vulnerability. Professional boundaries should be established but we could afford to show our humanity once in a while.
The Happiness Advantage
Author Shawn Anchor believes there’s a third option when weighing whether or not your profession is your calling or just a job–it just may be your career. In his book, The Happiness Advantage, he says: “People who think of what they do as only a job, end up wanting only a paycheck and are less intrinsically satisfied with what they do. Those who view it as a career are more invested in their work and enjoy the process a little more. Those who view what they do as a calling view themselves as contributing to a greater good and find meaning and purpose in their work. People with a calling end up working harder and longer and more enjoyably than those in the other categories.”
So, what’s the verdict? Calling, job, or career?
It takes considerable thought and self-examination to figure out what makes you tick. If you’re struggling with these questions, talk to a colleague. See how they feel about their own practice as a calling or just a job. Share your thoughts below and let’s talk about it.
Ultimately, it’s up to you to decide if practicing medicine is your calling or just a job. No one can decide if it’s the right thing for you or not. It takes dedication and hard work to be a good doctor or PA but so does anything worthwhile in life. So don’t let anything stand in your way–if the job isn’t giving you everything that you want and need, then it might be time to find something else that will.