Thursday Review: “The Association Between a Sense of Calling and Physician Well-Being”

Healthcare As More Than a 9-To-5

Looking at work satisfaction studies among primary care physicians and psychiatrists, John D. Yoon, Brendan M. Daley, and Farr A. Curlin noticed that they primarily addressed the issue as if providing health care were any other job.

[C]ontemporary proposals [to improve physician well-being] tend to treat medical practice as a job in which physicians are motivated more by extrinsic rewards (i.e., salary, financial bonuses, and optimal working conditions) than by the intrinsic meaning derived from such work (altruism, self-expression, intellectual challenge, and calling).^{1, 2}

The authors note that there is increasing empirical interest in the idea of calling. There have been studies which tie healthcare providers’ sense of calling together with different markers of positive work satisfaction, but this is the first study that specifically looks at whether calling was associated with markers of well-being, clinical commitment, and burnout among these physicians.

A sample of over 1,000 physicians and psychiatrists was drawn from the AMA’s database and were asked to rate

• their own sense of calling,
• whether they were happy with their chosen area of practice or a career in medicine in general,
• whether they intended to reduce or eliminate the amount of time they spent with patients in the next several years, and
• their level of burnout.

Yoon et al. found that fewer than half (42 %) felt a strong sense of calling in their work. Not surprisingly, though, they found that a self-identified sense of calling correlates positively with career satisfaction, “clinical commitment”, and resiliency:

… physicians with a high sense of calling were more likely than those with a low sense of calling to report being very satisfied with their overall career (49 vs. 29 % low calling …). Similarly, physicians with a high sense of calling were less likely to report that they would not choose medicine as a career if they had to do it over again (18 vs. 38 % low calling …) …

… physicians with a high sense of calling were less likely to report intentions to leave the practice of medicine in the next few years (14 vs. 25 % low calling …) …

… physicians with a high sense of calling were less likely to report burnout (17 vs. 31 % low calling …) …

The authors discuss that they didn’t specifically define “calling” in the survey, although they do point to research which indicates that a “sense of calling” has a broadly well-understood meaning in medical professions.³

When Yoon et al. discuss their findings, they cite a paper by David Loxterkamp ominously named “Doctors’ work: eulogy for my vocation”, whose abstract reads:

I, like so many of those who filled the first ranks of family practice, often described my career choice as a calling, a vocation, something more than a meal ticket. It was a source not only of pride and conviction but also resentment and resistance to change. By mid career I was largely out of step with new movements in family medicine that veered from the generalist approach toward focused fellowships, added qualifications, and office practices that opted out of obstetrics and hospital work. As often happens, it was a patient of mine who brought the issue into focus and showed me the potential that lay in each encounter. We long for connection — doctor and patient alike — and for the skill and compassion to express it without judgment or self-denial. There is no higher calling.⁴

The authors demonstrate that it’s worth continuing research about health care providers’ sense of calling. They discuss the growing consensus in the last decade that work in healthcare has lost its intrinsic value, and the fact that burnout can be understood as both a cause and a symptom of this separation from intrinsic value. Burnout may be a symptom of this loss, as burned-out workers find their work unrewarding, experience a sense of alienation and injustice, and are confronted with conflicting values. Conversely, burnout may prevent physicians from responding to the intrinsic motivations they have.

This is slightly confusing, although it’s not the researcher’s purpose to draw conclusions about causality. They do give a succinct definition of “calling”, though: drawing from other resources, either internal or external to the profession, that help restore meaning and intrinsic reward.

Stories of Calling

In my early narrative work with healthcare providers, I was asked to help a group of residents tell a story about some aspect of their life in a room full of their peers. There weren’t many restrictions on what the story would be about. Many of the residents chose to tell stories that either illuminated why they got into medicine in the first place, or were about a patient that touched them in some way. I provided a very simple framework for structuring a story, and then helped residents who wanted to shape the story aloud with the group.

It’s not surprising, given the context, that residents chose to tell these kinds of stories. I think everyone in the room was surprised, though, how deeply even the simplest of story exercises touched us. There were some tears as residents described the death of a loved one, or their attachment to a particularly difficult pediatric case.

These kinds of stories stay with us. Even people who don’t work in healthcare have stories of illness that we carry with us. We construct meaning and context for events in our lives through storytelling.

When we talk about resiliency in healthcare, one of the simplest tools to fight burnout is the conscious effort to tell a story. When the stress of caring for patients increases, or as Yoon et al. say, there is a growing disconnect between what one is doing and what one is expected to do, one of the simplest tools we have is to tell the story of why we went into healthcare in the first place.

That story of calling is powerful.

There are all different kinds of stories around the calling to be a healer. Stories exist in networks and layers, and most care providers will probably have more than one. Some providers, though, might never have considered what that story is, beyond the simple recollection of an event in their personal history.

When it’s difficult to find intrinsic meaning in their work, it’s worth bringing up one of the stories of calling. Telling it to a colleague, a patient, or even to oneself when the going gets rough is a reminder that of all jobs in the world, like Loxterkamp said, There is no higher calling.

Sources

The article reviewed: Yoon, John D., Brendan M. Daley, and Farr A. Curlin. “The Association between a Sense of Calling and Physician Well-Being: A National Study of Primary Care Physicians and Psychiatrists. Academic Psychiatry 41, no. 2 (2017): 167–73. https://doi.org/10.1007/s40596-016-0487-1.

¹ Hutchins, M. “Medicine As A Job, Not A Calling?” Health Affairs 28, no. 3 (May 1, 2009): 927–28. https://doi.org/10.1377/hlthaff.28.3.927-a. ↑

² Ratanawongsa, Neda, Eric E Howell, and Scott M Wright. “What Motivates Physicians throughout Their Careers in Medicine?” Comprehensive Therapy 32, no. 4 (2006): 210–17. http://www.ncbi.nlm.nih.gov/pubmed/17918306. ↑

³ Curlin, Farr A., Karen D. Serrano, Matthew G. Baker, Sarah L. Carricaburu, Douglas R. Smucker, and Marshall H. Chin. “Following the Call: How Providers Make Sense of Their Decisions to Work In Faith-Based and Secular Urban Community Health Centers.” Journal of Health Care for the Poor and Underserved 17, no. 4 (November 2006): 944–57. https://doi.org/10.1353/hpu.2006.0120. ↑

⁴ Loxterkamp, D. “Doctors’ Work: Eulogy for My Vocation.” The Annals of Family Medicine 7, no. 3 (May 1, 2009): 267–68. https://doi.org/10.1370/afm.986. ↑