Quick — what are the major signs of depression? Fatigue. Hopelessness. A long-lasting sad or empty mood. Agitation. Irritability.

Sound like any physicians you know?

It sounds like lots of physicians I know. The profession is depressed.

"There is nothing we can do," one physician wrote to me. "The paperwork, poor reimbursement ... the hassles have gotten worse every year and will continue to get worse. All our efforts have failed."

Others say they are "unhappy and feel trapped," and "bloody fatigued, beaten down."

And this is just the anecdotal evidence. The empirical data are just as convincing. The studies describing dismal physician job satisfaction have been cited in this and many other publications.

Last month in this space, I mentioned that physicians aren't the only ones straining under unprecedented workloads and stress levels. Most of us with professional careers and families —  certainly everyone I know —  are struggling to keep up.

As with clinical depression, it is inappropriate to suggest that physicians should or can just snap out of it. At the same time, I fear the profession is too accepting of a culture of despair. The more we talk about how bad everything is, the more likely we are to assume it is going to stay bad. We take it for granted that nothing can be done, when, in fact, given a little ingenuity and effort, physicians can improve medicine —  at least within their own offices.

For example, you can get paid more if you persist in claim follow-up, spend less time on the phone and more time seeing patients in the office, or even just make sure you code the proper level of office visits. You can even decide to pursue business in self-paid, executive exams or add more ancillary services.

In this month's cover story, Joanne Tetrault describes steps that some physicians have taken to reduce stress and restore balance between their professional and personal lives —  and how you can do the same.

You don't have to change the entire healthcare system to find more satisfaction in your day-to-day life. The physicians featured in the September issue have managed to shape a medical life they can live with by building practices consistent with their visions —  by going solo, or cash only, or taking more drastic action. They were able to do it partly because they felt like they could; they refused to accept that the only choices are to suffer through another chaotic clinical day or quit being a physician. Imagine having the chutzpah to start your own cadaver lab. You'll meet a doctor who did.

As with depression, the tendency to give in to the bad news isn't a personality flaw; it's a reasonable reaction to the negative forces hammering physicians. But it's also not the healthiest long-term response.

From a business and emotional perspective, it is better to face the challenge head on and drive for new opportunities.

Do you buy it? Let me know by writing to me at pmoore@physicianspractice.com or chat with colleagues about stress and modern life at http://groups.msn.com/
PhysiciansPracticeRabbleRousers.