The only job harder than being a doctor—so the data tells us—is being an emergency-room nurse, which comes with higher levels of burnout and depression and (at 19 percent) almost twice the level of PTSD seen in combat veterans.

Those who reported that they spent at least 20 percent of their time doing things they loved had dramatically lower risk of burnout. Each percentage point reduction below this 20 percent level resulted in a commensurate and almost linear increase in burnout risk. Remove the love from a physician’s work, and the work grates, and grates some more, until it hurts.

In Britain, the Health and Safety Executive reported in 2018 that close to 15 million work days were lost as a result of workplace-related stress, depression, and anxiety, and that among a total workforce of 26.5 million, nearly 600,000 individuals self-reported suffering from work-related mental health issues that year.

2. WHERE DID THE LOVE GO?

“At work, according to the most recent data, less than 16 percent of us are fully engaged, with the rest of us just selling our time and our talent and getting compensated for our trouble. In the worst extremes of always-on, high-stress jobs, such as distribution centers, emergency room nursing, and teaching, incidences of PTSD are higher than they are for veterans returning from war zones. Imagine that. We’ve created work conditions that are so blind to the needs of each human being that they wind up experiencing more soul-destroying distress than soldiers who’ve witnessed the killing and harming of other human beings.

Almost as common is the plausible but erroneous definition of the fundamental problem. Here is one example.

‘Since the end of World War II the American military services have been plagued by their inability to keep highly trained medical people in uniform. There have been dozens of studies and dozens of proposed remedies. However, all of the studies start out with the plausible hypothesis that pay is the problem—whereas the real problem lies in the traditional structure of military medicine. With its emphasis on the general practitioner, it is out of alignment with today’s medical profession, which stresses the specialist. The career ladder in military medicine leads from specialization to medical and hospital administration and away from research and specialized practice. Today’s young, well-trained physicians, therefore, feel that they waste their time and skill in the military service where they either have to work as general practitioners or become chairbound administrators. They want the opportunity to develop the skills and apply the practice of today’s highly scientific, specialized doctor.

So far the military has not faced up to the basic decision. Are the armed services willing to settle for a second-rate medical organization staffed with people who cannot make the grade in the highly scientific, research-oriented, and highly specialized civilian profession of medicine? Or are they willing and able to organize the practice of medicine within the services in ways that differ fundamentally from the organization and structure of a military service? Until the military accepts this as the real decision, its young doctors will keep on leaving as soon as they can.

Or the definition of the problem may be incomplete.