A Word of Thanks

Comment From the Editors A Word of Thanks often encourage my pre-teen daughters to count their blessings. I learned this from my parents and hope my girls will pass this along to the next generation in due course. I would like to think that a grateful attitude will help my girls by promoting a sense of optimism, purposefulness, and connectedness. Gratitude also may help them bring out the best in others. In this spirit, I view a grateful attitude as a healthy personal habit and lifestyle choice—much like learned optimism (Seligman ME, “Learned Optimism,” Pocket Books, 292 pp, 1998). Are the benefits of a grateful attitude also applicable in our professional lives? Could this concept have specific implications for American gastroenterology? Let’s jump to a quick imagination exercise: Suppose that you are invited to join a club organized mainly to promote job satisfaction. Club members are also offered a coupon designed to boost their income after a 3-year delay and you accept the coupon as a gift. Perhaps, you tell yourself that you might make some contribution to the club at a later date if the coupon eventually helps you. Three years later, you find that the coupon is producing a surprisingly large increase in your income. Let’s assume that this extra income depends on the coupon and that it will apparently continue for years. How grateful would you feel? How would you act on this feeling? When I tried to imagine how I would feel living through this sequence of events, I realized that my reaction would probably depend on the nature of my relationship with the club at the time I am receiving the financial benefit. If I have an ongoing relationship with the club and if I believe in its mission, then I

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would probably feel indebted and grateful. And my guess is that these feelings would lead me to send a substantial voluntary contribution to the club. The purpose of this exercise is to introduce an analogy related to our discipline. Even though this analogy is simplistic and a stretch, it will be pertinent for most American readers of this journal. Before getting to the analogy, let’s consider how internists become qualified and credentialed as subspecialists in a field like ours in the U.S. The qualification and credentialing process depends on several components. It requires an extended period of specialized training in a recognized clinical/academic program. It requires a prepared, conscientious, and effective trainee who generally must accept reduced compensation and autonomy during the training period. And, it requires a trustworthy credentialing process and documented acceptable performance by the trainee. All these requirements must be met before anyone can enjoy the benefits of practicing as a subspecialist. When internists become subspecialists, they become eligible for a new role. In most fields, this role can lead to improved job satisfaction and autonomy. In our field, an added benefit (at this time in the U.S., at least) is that gastroenterologists also can receive higher compensation when compared with other subspecialists or with internists. This increment in income is large and it depends on many factors including the market value of GI services and the credibility of our subspecialty training and credentialing process. Getting back to the imagination exercise, let’s visualize the “coupon” as our GI subspecialty certification. Continuing with the analogy, we could

define the “club” narrowly as the fellowship program where we trained or we could define it more broadly as American gastroenterology. The broader definition could include all GI fellowship programs plus our field’s national organizations and advocacy groups (AGA, FDHN, etc). The point of the analogy is that all of us who now practice as GI subspecialists in the U.S. are receiving significant financial benefits due, at least partly, to the credibility of our subspecialty training and credentials. If not for our subspecialty training and credentials (our “coupon”), we could not enjoy the full benefits of practicing in a subspecialty that now provides us with unexpectedly high levels of job satisfaction and compensation. It seems only natural for us to feel grateful and indebted. How much gratitude should we feel for our GI training and credentials? How should we channel this feeling into a course of action? These are personal questions for us to consider in the context of our individual experiences and values. For those of us who trained in fellowship programs where we feel an ongoing connection, we might first look for ways to help support the next generation of trainees in that particular program. If our gratitude leads us to think of past mentors or role models, we might contact these people for suggestions. And, for all of us who enjoy benefits related to the credibility of American gastroenterology, we might also look for ways to support our discipline’s national organizations and advocacy groups. JONATHAN A. COHN Associate Editor

doi:10.1053/j.gastro.2005.07.052