Ophthalmologists should pursue balanced lifestyle in face of professional dissatisfaction
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I find the annual surveys on physician compensation, lifestyle/happiness and burnout/depression, published by Medscape, to be informative. In the following paragraphs, I will share some of these findings and my perspective.
The Medscape findings are reliable, with a 98% validity. The interested reader can review them in detail online. Across all specialties, the four key things that make physicians unhappy are insufficient reimbursement and take-home pay; too heavy a workload; too many rules, regulations and insurance challenges; and the daily pain of electronic health records.
For ophthalmology, in 2023, average annual income decreased for the first time since 2015, with a 7% pay drop to $417,000 per year. Men surveyed outnumbered women 62% to 38% and earned on average 19% more, but this was not adjusted for hours worked per week. The reduction in income for ophthalmologists in 2023 was the largest out of all 30 specialties surveyed. Not surprisingly, ophthalmologists were unhappy about this change and ranked 29 out of 30 in income satisfaction.
There is a glass half full and glass half empty story here. Ophthalmologists take home less pay than most surgeons but significantly more than most medical caregivers. Ophthalmology is a hybrid specialty, with most of us working 4 days a week in the clinic and 1 day a week in the OR. The top surgeon specialties earned just under $620,000 per year in 2023, while the average primary care physician earned only $260,000. Ophthalmology is in the middle for physician compensation. However, ophthalmologists on average work less than most physicians, with a 36-hour workweek and 46 weeks of work per year being typical (with 6 weeks for vacation and meetings). Seventy percent of us work less than 40 hours per week, and many ophthalmologists work 4 days a week.
Despite high dissatisfaction with pay, 80% of ophthalmologists would choose medicine again, and 92% would choose ophthalmology. We ophthalmologists are only 2% of all physicians, so we have a small voice in medicine. In addition, we are an aging group of physicians, with 57% of us being age 50 years or older, and because retirees outnumber trainees, every year there are fewer of us. As I have discussed before, I see the ophthalmologist-led integrated eye care delivery model being the answer to a significant shortage of ophthalmologists in future decades.
While most ophthalmologists would choose medicine and ophthalmology again, 48% report some level of burnout, and 23% suffer from depression, similar to other physician groups. More women than men suffer from burnout and depression. The causes of burnout and depression reported by physicians include too heavy a workload, too little take-home pay, insufficient staff support, hassles with rules, regulations and insurance, the time and pain of using EHR, continuing loss of autonomy/control, and a perception of decreased respect in the workplace and society as a whole.
Of interest to me was the fact that having a scribe reduced physician frustration and burnout significantly. This agrees with my experience at Minnesota Eye Consultants. A scribe also increases patient throughput, enhancing revenues. The challenge is convincing management of this fact and recruiting, training and retaining quality scribes.
The antidotes for burnout and depression include reducing work hours, spending more quality time with family and friends, participating frequently in activities and hobbies outside of medicine, exercising regularly, sleeping 7-plus hours per night, eating heathy and, for 10%, professional therapy.
I have reviewed the Medscape surveys every year, and the evidence supports my impression that physicians in general, including we ophthalmologists, are less satisfied with their professional life every year. I believe this trend is both real and likely to continue. The antidote for most physicians who are unhappy is to grieve the distressing workplace challenges but come to acceptance with realistic expectations regarding the external environment and then pursue a more balanced and healthier lifestyle. When the frustrations of medical practice progress to burnout or depression and happiness remains elusive, it is wise to seek professional help. The prudent practice makes professional help easy to access in a confidential manner.
Overall, while we ophthalmologists are blessed, our profession is demanding, and the external environment challenges will likely increase. I find it helpful to remember that most joy comes from serving others, and the “paradox of giving” affirms the more we give, the more we receive. While at times it is an impossible dream, we must all seek a more balanced life and remember to enjoy the journey hour by hour and day by day. What we ophthalmologists do to enhance our patient’s quality of life by preserving, restoring and enhancing their vision is a modern-day miracle, and we all deserve a happy and joyous life.
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