Knowing 40% of doctors are burnt out, should worry us all

Sad Female Nurse At Hospital Corridor

In findings just released this week, more than 40% of doctors—and 50% of female doctors—are burned out, according to Medscape’s 2019 research.

Every Australian should be horrified by this. Having a son about to graduate from medical school, I am very angry.

Although this is USA research, as I reveal below – Australian research and anecdotes, suggest a similar crisis.

The 5 engagement factors most tied to burnout

The Medscape research shows five engagement factors that were negatively correlated with burnout. This meant that those who responded affirmatively to the follow statements were significantly less likely to score highly on the Burnout Index. These included:

  • The organization supports my desired work-life balance (correlation of -.56)
  • The organization is open and responsive to my input (correlation of -.42)
  • I have the right amount of autonomy in managing my individual practice (correlation of -.41)
  • The actions of the executive team reflect the goals and priorities of participating clinicians (correlation of -.41)
  • The organization recognizes clinicians for excellent work (correlation of -.40)

While this correlation doesn’t imply causation, these findings indicate that if doctors believe their organization listens to them, communicates effectively with them, and takes actions in line with their priorities—they are happier with their work.

Well surprise, surprise (my comment).

Surely Australia is better than this!

In beyondblue’s 2013 (that was the latest I could find) National Mental Health Survey of Doctors and Medical Students, they found that medical students and young or female doctors are most at risk, and identified that significant levels of stigma towards people with mental health problems.

  • 9% agreed that doctors are less likely to appoint doctors with a history of depression or an anxiety disorder
  • 8% agreed that many doctors believe that experiencing depression or an anxiety disorder is a sign of personal weakness
  • 27% of all doctors have a ‘minor psychiatric disorder’
  • 4% of all doctors are experiencing ‘high psychological distress’, much greater than the wider community.
  • One in five medical students and one in 10 doctors had suicidal thoughts in the past year. More than four in 10 students and a quarter of doctors are highly likely to have a minor psychiatric disorder, like mild depression or mild anxiety
  • Young doctors work longer hours (50 per week on average), are far more psychologically distressed, think about suicide more and are more burnt-out than their older colleagues
So, have things got better in Australia since 2013?

As reported in the ABC online in March 2019, over half of doctors are working rosters that put them at significant or high risk of fatigue, according to a 2016 AMA study.

The average doctor’s work week was 78 hours with the average shift lasting 18 hours. One doctor did a 76-hour shift.

“I have a sneaking suspicion I was the doctor who did the 76-hour shift and recorded 118 hours per week in terms of workload,” Dr Jason Lam told The Drum. Dr Lam was considering suicide but postponed getting help because he feared being caught up in the mandatory reporting process.

“We were working crazy hours, I was on call for an entire year.”

Yet medical graduates say they dare not complain with an oversupply of graduates competing for training positions.

A recent survey of 1351 doctors-in-training found 65 per cent were worried their fatigue could lead to clinical error.

“At one of my jobs where I made the foolish mistake of putting down my [long] hours I got quietly taken aside and the consultants would say to you, ‘I’m not telling you to work these hours but if you don’t, people will suffer’,” said Dr Lam.

At one clinic orientation he said he was told: “You have three chances with me, if you displease me three times, I will call all the relevant people and make sure you never work in this specialty again”.

“We’re reliant on these consultants to give us references,” he said.

“With that over our heads, how can you say that you can’t do something or that you feel that you can’t cope with a workload?”

Sadly, this leads to all too many suicides. And, what about those who can help doctors in distress?

Overburdened psychiatrists abandon ‘broken’ public system

As reported in the Fairfax Media, Australia’s public psychiatric system is in slow and painful decline, with “profoundly disillusioned” psychiatrists leaving for private practice, senior specialists warn.

The “psychiatric breakdown of the public system” is driving away overburdened psychiatrists who were dedicated to treating some of the most vulnerable mentally ill patients, UNSW Scientia Professor Gordon Parker says.

The hospital psychiatrist and founder of the Black Dog Institute is calling for urgent reforms to arrest “the slow death in quality” in public psychiatric care.

“The tipping point has been passed,” Professor Parker said. “The system has been under threat of deterioration in quality and sophistication of care for several years.

The journalist was told that multiple senior psychiatrists have resigned or are planning to resign from a handful of Sydney psychiatric units within the year.

Other specialties have a shortage of training positions for their oversupply of trainee doctors. But psychiatry is struggling to fill positions with their demanding and unrewarding workloads.

NSW has a record 60 vacant training positions for psychiatric trainees, Professor Parker discovered.

“Trainees are rapidly falling away,” he said. “This is a canary in the coal mine signal.”

NSW chief psychiatrist Dr Murray Wright, sadly, doesn’t believe the situation is critical.

How can doctors support distressed patients, if they are distressed themselves

In Australia, the most common first point of contact when seeking help from psychological distress is a GP. What chance have they got of offering holistic, practical steps forward, if as a group they are also struggling.

So, what are the solutions?

First, admit there is a crisis.

Secondly, commission research to identify the root cause of the issues.

Third, do something. Invest in solutions.

Medscape research recommended the following, via the infographic below.

Mitigate Physician Burnout

The recommendations to Mitigate Physician Burnout include:

  • Start with a Physician listening campaign (does this even have to be suggested!!)
  • Aim for balanced feedback and recognition
  • Give Physicians an active role in decision making (does this even have to be suggested!!)
  • Break the silence with emotional support

I don’t want my son, or his peers, working in a culture like this. It has to change.

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