What Happens When Disillusion Sets In?

Monday, December 20, 2010 |

A number of career milestones occurred in 2010. Events which, by all accounts, should've encouraged me to strive for greater achievements.

So it was unexpected - and strange - to come to the realization that I dislike my job. ( On really bad days, 'dislike' turns to 'hate'. )

Not so unexpected: other colleagues sharing the same sentiment. Some blame 'the system' ( i.e. public sector bureaucrats ). Others cite 'early mid-life crisis'. A number of them have already left, or plan to leave, for private practice. Me - not a viable option, for complex reasons.

Funny thing is, I rather enjoyed being a doctor for a whole decade before these negative feelings set in. There isn't a specific tipping point, but more of a slow build-up of unpleasant experiences.

Life was much easier when I was a junior physician. Yes, I was a slave to my seniors, but that also meant I was shielded from office politics, administrative chores and bureaucratic bullies.

With increasing seniority came budget proposals, power struggles and endless public relations debacles. Requests for essential equipment got rejected if you didn't know the right people, not based on the merits of the proposal itself. You started noticing major flaws in fellow colleagues' characters. Patients and relatives rarely show any form of appreciation for your hard work, writing complaint letters to the media whenever it strikes their fancy.

But the thing that really gets to me are the yearly performance appraisals.

It's divided into different categories, e.g. administrative, teaching, research etc. You earn points for each section based on your level of involvement, and it's become quite clear to me over the years that it benefits a very select group of people, often those in the upper echelons of the department / hospital.

How many of us junior physicians get assigned to perform medical cover for VIPs ( something that commands a ridiculous points weightage, considering the fact that the person performing this medical cover is effectively absent from the department, and others have to cover his / her duties )?

How many of us become prolific medical researchers, or get invited to speak at international conferences?

While a small number of doctors may be able to attain such recognition, what then becomes of the rest of us mere mortals? Aren't the powers that be sending a message that drones aren't considered valuable? That if you spend more time doing ward rounds and running clinics, but aren't very interested in research, it's only right that you end up with a lower appraisal grade, and thus, smaller bonus payments.

Perhaps that's one of the motivating factors for those who leave for the private sector. No grading system that penalizes the lack of research or administrative duties. Much higher financial returns for doing ward rounds and running clinics. That, and the ability to have fulfilling personal lives.

If remaining in the medical profession isn't tolerable, a number of my friends have gone on to succeed in non-medical fields, from F&B businesses to piloting commercial jets.

But if switching jobs isn't viable ( yes, dear reader, not all of us can uproot ourselves at the drop of a hat ), then the next best thing is to pursue an activity or activities you love, and not let medicine define your existence.

Last but not least, a suggestion with regards to possible modifications of the appraisal forms - include the number of clinical hours worked per week ( ward rounds, clinics and shifts ), with sensible allocation of points. I guarantee it will level the playing field and make us drones feel a lot more appreciated.


gigamole said...

It's tough when our school and working lives continually condition us to define ourselves only in terms of the parameters set by others. It is particularly difficult in the hospital/university environments when many of these parameters are "dishonest" in the sense that they pretend to set very broad based KPIs when in fact the organization really only evaluates a very narrow set of performance indicators.

Yes, if you can go into private practice it can be quite 'liberating' ....but not all can do so.

I think it is critical for everyone of us to continually take stock of what is important to ourselves, and come to terms with how we want to define ourselves. It's horribly cliché I know, but in the end we do need to be true to ourselves. And if it means stepping out of medicine,...go ahead.

Anonymous said...

Kudos to the poster for airing the plight of us long-suffering public sector docs!

Anonymous said...

I heard your plight and I understand. No point staying when not appreciated, when the first opportunity came to leave, jump ship!

On an interesting noted, polyclinic has started terminiting its resident physicians in preparation to hire cheaper source of "doctors" in form of nurse practisioners (where can they find so many of them??) and overseas non tradional source doctors. Maybe the admin can write about this and be distracted for a while ^_^

Anonymous said...

I totally agree with being underappreciated by patients and relatives. We stay in the public sector to serve Singaporeans, and do the work because we would rather help fellow Singaporeans than do charity work overseas.

But the appreciation that public docs get from Singaporean patients is totally different from the appreciation we get overseas, even though we're doing the same functions.

And no matter how much we fight for our patients to get the latest equipment and the best scans, they're always unhappy they have to wait. And when they finally get the early scan or the step down care place, they just decide that they don't want to do it/go there anymore.

Anonymous said...

hi, I'm a non-medical person from across the causeway.. My cousin with leukemia opted for medical treatment & of course paid as a private patient at your GH & gave good reviews about the excellent care, good food, clean environment. My Singaporean aunt also said good things about public hospital doctors service.

I wonder why you feel unappreciated. You don't need tq cards, letters etc to feel good. As long as your patient walks out through the door healthier than when they 1st came in, its job satisfaction.

If there is no passion, you hate waking up to the job or the system or seeing sick people all the time, you too can choose to walk out through the door.

angry doc said...

"... I'm a non-medical person...

You don't need tq cards, letters etc to feel good. As long as your patient walks out through the door healthier than when they 1st came in, its job satisfaction."


If you don't want to say 'thank you', that's fine - but don't tell us what we should consider job satisfaction, and don't tell us we can't feel unhappy about our work conditions.

Anonymous said...

Continue being unhappy then coz you already SET your MIND on being one Unhappy ANGRY DOC whatever the work conditions.

btw I do say TQ all the time, writes TQ cards & sends greeting cards & bakes for them too.. its called Two way communication.

angry doc said...

"... I do say TQ all the time, writes TQ cards & sends greeting cards & bakes for them too.. its called Two way communication."

It's called de Clerambault's syndrome.

Anonymous said...

what are some of the likely reasons why pub sector drs cant leave for private practice?

Ozbloke said...

5 Reasons why pub sector drs cant leave for private practice :

1)Fear of the unknown

2)Fear of losing comfort zone

3)Fear of failure

4)Fear of compromising values

5)Fear of confirming the truth

I can tell you that if a doctor hates his job in the public sector, even if he goes to the private sector he will still hate his job. It's just that maybe with the higher income he will have less time on the job to hate it.

My recommendation to doctors who are unhappy with their jobs and hate it is to look to practising overseas where people do appreciate doctors and RESPECT them. And where it is the doctors who tell their patients

"I don't need tq cards, letters etc to feel good. As long as my patient walks out through the door healthier than when they 1st came in, its job satisfaction"

Not the patient telling the doctor that. Singapore has come to such a state where patients/customers think they are so high and mighty that they want to dictate not just what doctors do, but what doctors should FEEL.

Forget it guys. We did not become doctors to become slaves.

Ozbloke said...

Just curious, who wrote that blog post?

Was it angrydoc or spacefan?

You can reply Former or Latter and delete this comment and I will know privately.

My guess is latter.

Anonymous said...

This is the problem of accepting self centered medical students to become doctors.
The doctors of yesterday are selfless and works for their patients.
Doctors should be selected based on a track record of volunteering. My children tell me their classmates only volunteer to get into medicine and stop immediately after the interview.
These students are results oriented and will not develop into selfless doctors.
This is a real problem in future!

Government Doctor said...

@Anon 11:11
I am afraid that this is a phenomenon of today's society. And it is exacerbated by abusive patients/relatives and merciless management. Most of my classmates and colleagues started out as selfless individuals but after a few unfair complain letters, harsh bosses and horrendous workload, is it any surprise that they become disillusioned?? I am afraid the problem will only get worse.

Ozbloke said...

I posted but it wasn't enabled.

Basically the points are

1) Some occupations are termed vocations due to associations with the Catholic Church namely, Healing (medicine), Education (teaching) and Priesthood

2) People expect services from vocations to be free

3) One wonders why people don't expect bankers and lawyers to be "selfless"? While there will be some lawyers and bankers who do volunteer work and get applause, people expect EVERY SINGLE DOCTOR to be doing volunteer work if not they will be chastised.

Calvin said...

Good post about the thoughts and points that lead to your disillusionment. I don't think any of those are unique to the medical community. You can replace "medical" with many other professions in the article and article would still make sense.

Disillusionment with career is typical of anyone in mid-career, speaking from personal experience. The key here is how do you plan to do about it? It's not about money as you have clearly indicated. It's more about ownership and recognition. That's probably the main reason why people go out on their own.

Anonymous said...

Mind over matter. If you don't mind then it does not matter.