Unhappy doctors: what are the causes and what can be done?

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Abstract
As the response to a recent BMJ editorial showed, unhappy doctors are a worldwide phenomenon. In this article, based on workshops with doctors in the United States and United Kingdom, Nigel Edwards and colleagues suggest that the cause is a breakdown in the implicit compact between doctors and society: the individual orientation that doctors were trained for does not fit with the demands of current healthcare systems. They outline what a new compact might look like Richard Smith's editorial in the BMJ about unhappiness in the medical profession provoked a huge response and confirmed that this is an international and widespread problem.1–4 We describe here the views of doctors themselves, gleaned from workshops in the United States and the United Kingdom, on the problem and what might be done about it. #### Summary points Several reports from around the world describe declining morale among doctors, but little is known about the reasons Workload and pay, though important, do not fully explain the problem A key factor seems to be a change in the psychological compact between the profession, employers, patients, and society so that the job is now different from what doctors expected Developing a new compact that is more acceptable to the profession is important Clinical leaders have a potentially crucial role in developing a new compact There is limited evidence to inform the debate, and therefore this article and our longer report5 are based on literature on the subject and seminars held in Massachusetts last August and in London in October. As with Smith's original article the ideas should be treated as tentative. In the US seminar the participants were managers and medical executives from various healthcare systems including Kaiser Permanente. The UK participants were mostly senior members of the medical profession, educators, officers of the BMA, …