Why are doctors so unhappy? Calibre of people recruited to medicine may be too high for the job.

Editor—As an economist who has spent the past 30 years looking at health care all round the world, may I suggest that frustration and perhaps boredom play a part in the anger of doctors and contribute to their unhappiness, as described by Smith in his editorial?1 This is aside from what I accept are genuine conflicts between levels of public funding and clinical aspirations to help patients. Looking at other professions, I note that people advance through their careers, their work changes, and they build teams and grow their businesses. Some stay in single practice, but many move into management, with changes periodically in their working life. Similarly, economists like me have a wide range of research and travel as part of our work, and we manage teams on a diversity of projects. I have no idea what I will be doing in September this year, but I am confident that it will be interesting. Contrast these professional lives with those of doctors. General practitioners may have opportunities to develop their management skills but in an environment where the management structures and self employed status of colleagues make this far from easy. And someone has to see the patients each week. Consultants have more of the variety and team building mentioned, but, again, their work plans look very much the same—year in, year out—to the outsider. This leads me to my conclusion. Might the calibre of people recruited to medicine be too high for the job, not necessarily for the technical elements but for the pattern of work once general practitioner or consultant status is reached? Is a degree of frustration inevitable given doctors' abilities and the relative consistency of the job beyond the age of 30 or 35? Are many years of clinical practice consistent with the job enrichment that able people may want as their career develops?