According to the OECD, Poland had 23,000 educated medics who had left their homeland to work in Western countries by May 2020. In contrast, an EUK report shows that as many as 15% of doctors intended to leave the Polish labor market after the pandemic [1]. In the first quarter of this year, nearly 200 applications were submitted to medical chambers for the issuance of the certificate needed to obtain employment abroad. Against the backdrop of media reports regarding alarming data on the emigration of medical staff to other countries, it is worth looking at the quality of life for young medics in Poland. It is in the interest of the whole nation to have as many satisfied doctors as possible in Poland, since it is difficult to deny the fact that the effectiveness of treatment also depends on the psychophysical state of the person treating them.

An attempt to assess quality of life

Quality of life is an interdisciplinary issue of social sciences, health sciences and medical sciences (health-related quality of life). The World Health Organization (WHO), in its multicenter study, defines quality of life as “an individual’s perception of his or her position in life, in the context of the culture and value system in which the individual lives and in relation to his or her goals, expectations, standards and concerns” [2]. Although the WHO has defined what quality of life is, it has not established a minimum level of quality of life, taking into account age, gender, occupation and culture. Despite the fact that measuring quality of life is difficult, as its assessment is individual, subjective and temporary, researchers are increasingly trying to collect enough objective data to make comparisons of quality of life between different risk groups.

Several years ago, the Ministry of Labor and Social Policy commissioned a report on the conditions and quality of life of Poles [3]. The authors of the study identified eight dimensions of quality of life and compared 39 occupational groups. The project took into account in a single survey all important aspects of the lives of individual households and their members – both economic (e.g., income, material wealth, savings, credit) and non-economic (e.g., education, medical treatment, ways of coping, stress, mental well-being, lifestyle, pathological behavior, participation in culture, use of modern communication technologies and many others). The complexity of the study shows how difficult it is to define the essence of what quality of life is.

Some of the studies deal with the quality of life of doctors themselves. One interesting item involved a group of resident physicians, graduates of the Medical Faculty of the Medical University of Gdansk [4]. A proprietary questionnaire was developed that addressed two areas related to positive and negative aspects of quality of life assessment. The positive areas of quality of life assessment included general psychological well-being (measured by assessing feelings of happiness, and satisfaction with specific areas of life such as social, material, environmental and health dimensions). The negative area of quality of life assessment was examined in terms of life stress – health, financial and work-related, coping strategies and difficulties, self-destructive behavior, including drinking alcohol and smoking. The majority of respondents, in assessing their lives in the past two weeks, declared that they were “very happy” or “fairly happy.” Resident physicians most often cited family, education, ability to meet food needs and future prospects as reasons for happiness. A detailed analysis of life stress showed that the doctors surveyed presented lower levels of health stress than Poles in general, and higher levels of work-related stress than all comparison groups. It is believed that occupational stress may increase the risk of coronary heart disease, hypertension, as well as obesity and depression. It has been observed to be associated with adverse health outcomes such as chronic fatigue syndrome and occupational burnout. In addition to increased occupational stress, doctors in hospitals are exposed to a number of other risk factors, including biological, chemical and psychosocial factors that can have a significant impact on their quality of life. The nature of the work, long shifts and night duty also have potential adverse effects on employees’ health. Of the coping strategies, physicians most often used task-based strategies and less often used emotional strategies. 16% of the doctors surveyed said they smoked cigarettes systematically, and 7% admitted to reaching for alcohol in a difficult situation. A detailed analysis of the differences showed that the doctors surveyed smoked fewer cigarettes than the comparison groups, and reached for alcohol in trouble as often as others [3].

Side effects of medical education

Studies have shown that medical education is dangerous to students’ health [5] and creates an environment of psychological toxicity. Getting into medical school affects a student’s health and quality of life, as it requires adaptation and lifestyle changes. A foreign study of medical students found that first-year medical student participants have a deficit in hours of sleep, physical activity and social interaction. The stress of studying medicine is associated with high competition, lack of leisure time and psychological tension caused by indirectly experiencing human suffering, co-experiencing with patients their diseases and feeling loss [6]. Medical students are exposed to higher levels of stress compared to other young people of the same age in other fields of study. They also have a higher daytime sleepiness score. A 2016 meta-analysis [7] found that depression affects nearly a third of medical students worldwide. Even more disturbing is the fact that treatment rates for depression are relatively low, demonstrating a kind of stigmatization of the disease and a lack of developed appropriate mechanisms for overcoming it. Current findings suggest that medical universities and public health institutions should offer early detection and prevention programs for depression, as well as interventions for the onset of depression among medical students before graduation.

In the study “What do medical students think about their quality of life? A qualitative study” [8] medical students shared their observations about their medical studies. When asked about subjective factors that increase their quality of life, they mentioned support from teachers and participation in community projects and research, among others. They declared that the aforementioned factors increased their self-esteem and usefulness in fulfilling their social role. Among the negative factors they mentioned: unqualified teachers and coordinators, classes taught by people with inappropriate attitudes towards students, being pressured or morally abused by classmates. Participants also described various strategies for coping with stress and seeking balance during student life. These included playing sports and recreational activities such as going to the movies, watching TV, listening to music, reading or learning other languages, studying philosophy, seeking meaning in life through religion, and meeting with friends to spend time together. Participants sought support in conversations and discussions with family, friends and teachers.

Unfortunately, there are also less desirable ways to cope with stress. Excessive alcohol consumption remains one of the most difficult problems in the student community. The results of a study entitled “Alcohol drinking as a way of coping with stress in medical students” [9], conducted by the staff of the Karol Marcinkowski University of Medical Sciences in Poznan, showed that students tend to engage in risky and harmful drinking. The most common motivation for medical students to drink turned out to be “coping with stress” (52% of medical students, 58% of dental students, 52% of dietetics students). Some of the theories of problem behavior proclaim that such behavior is part of the normal development of a young person and is an integral part of the transition to adulthood. Nevertheless, it seems that turning a blind eye to some student antics should go hand in hand with education on adaptive ways of coping with stress. Adequate techniques for dealing with emotions and taking care of one’s own health are necessary to enjoy a satisfying work environment. Knowing the factors that affect students’ quality of life during medical training facilitates health promotion and psychopedagogical support. It is also important in curriculum design.

It may be promising to note that a new field of medicine – lifestyle medicine – has recently become increasingly popular. Lifestyle medicine is nothing more than conscious attention to daily habits in order to reduce the risk of developing chronic diseases in the future, eliminate most premature deaths and reduce health care costs. Behaviors that are extremely important for health include physical activity, a healthy diet, sleep hygiene, smoking cessation, not consuming excessive amounts of alcohol, forming and maintaining relationships, managing stress and being able to get support from one’s environment. Familiarizing patients with behavior change strategies in these sensitive areas can help them develop lasting healthy habits. In some universities, including the UK and Lithuania, lifestyle medicine has already become part of the training of future doctors. A 2017 report [10] from the Medical University of Jerusalem describes the development and dissemination process of a 58-hour lifestyle medicine curriculum at Hebrew University between 2010 and 2014. The report’s summary states that students viewed the new subject as an important part of a doctor’s professional role and were willing to explore the subject for both professional and personal reasons. The report’s authors recommend that medical school deans consider developing similar initiatives as a key component of preventive health policy strategies.

In conclusion, the quality of life for young medics leaves much to be desired around the world. An education system that requires young people to expend a great deal of energy and time is taking a toll on students’ health. Researchers from many backgrounds recommend introducing a subject into the curriculum that would make young medical students aware of how to care not only for the health of patients, but also for their own health. Lifestyle medicine is a very promising field of medicine that seems to have its heyday yet to come. Health promotion among medical students should result in an increased level of their quality of life in the future.