Service gives meaning. (Guest Editorial).

Maintaining physician commitment is one of the most urgent issues facing hospital administrators and medical educators today. Unprecedented numbers of doctors are abandoning practice for administration or taking early retirement.

In a recent study by the Sacramento Medical Society of 464 California doctors, 40% of those interviewed were clinically depressed. The majority said that they would not choose the profession again or want their children to be physicians. Another recent study found that one out of three physicians interviewed was making plans to leave medicine sometime in the next 3 years.

This is not only a California problem. Doctors nationwide are saying that the work has lost meaning for them. This is a kind of unprecedented crisis in the history of medicine.

There's a growing interest among policy makers, educators, and the medical community in finding ways to remotivate physicians. And because meaning is the antecedent of commitment, there's a growing interest in enabling physicians to reclaim the meaning of their work.

Our training makes us particularly vulnerable to the loss of meaning. The meaning of our work is found in its human relationships, in the quality of its human dimension. Our training actively encourages a sort of disconnection from the human dimension of ourselves and of others.

We may need to learn to pursue meaning in the same way that we now pursue expertise and knowledge, to recognize it for the resource that it is, and protect it against the erosion of time.

Each of us may need to reconnect personally to the core purpose and underlying framework of values that have motivated physicians since the beginning. The meaning of medicine is not science but service.