As reported in several articles, physicians are becoming increasingly dissatisfied with many aspects of their professional life [1-6]. What reasons can be identified for the doctors' discontent and the considerable number of young physicians leaving the medical profession?
Changing role of doctors in a changing society
Although physicians are spending more time with patients than in earlier periods, increased public and patient expectations towards the medical system and administrative and regulatory controls contribute to perceptions of increased time pressures and erosion of autonomy. As is known, these conditions lead to job strain .
Lifestyle and career orientation have changed in the younger generation, and this applies to doctors as well. Both male and female doctors are looking for a better balance between work and personal life. Not as many are willing to prioritize their professional career at the expense of their personal life [7-9].
Several studies report on the residents' dissatisfaction with their postgraduate training, both clinical and scientific [10,11]. Half of these residents complained of unstructured residency programmes – especially in surgical fields -leading to an extension of the time needed for qualifying in their speciality. Furthermore, a sizable number of doctors intending to specialize in surgery change their minds because of insufficient training and unfavourable workplace conditions.
One major reason for young physicians leaving medicine is the drop in income over the past decade . Compared to other academics, return on educational investment over a working lifetime is fairly low . Instead of embracing curative medicine and facing unattractive working conditions, they choose a career in health management, pharmaceutical companies, or medical informatics.
Health care systems have a great impact on the working conditions and the doctors' job satisfaction [1,14-17]. State-administered health care systems seem to provide work environments which contribute to reasonably high job satisfaction as long as the professional autonomy is not eroded [15,17]. In competition-based settings, the job satisfaction declined in the last decades, mainly caused by financial incentives that strain doctors' professional principles, loss of control over their clinical decisions, and consuming administrative work.
Career outside medicine
Some of the mentioned reasons might contribute that a considerable number of doctors prefer to pursue a career outside medicine. Nine years after graduating from medical school, 5% of the BMA cohort doctors had chosen a career outside curative medicine or had already left medicine . In Germany, about one quarter of medical school graduates do not enter the medical profession . Unfortunately, there are no such statistics for Switzerland.
As part of quantitatively assessed data of a prospective Swiss residents' career- development and life-satisfaction study [19,20] participants were asked (1) what arguments there still were in favour of or against a career in medicine, and (2) whether or not they would again choose to become doctors.