Young doctors face a high risk of burnout because of excessive and prolonged emotional, physical and mental stressors from their work. Who is responsible for improving their health and wellbeing – government, employers, colleagues, or the young doctors themselves?

by Ye Li, 6th Year Medicine, University of Auckland

Burnout is the development of exhaustion, depersonalisation and low professional efficacy.[1] In New Zealand, the prevalence of burnout in medicine is up to 50%[2]. Burnout creates mental and physical health problems, suboptimal work performance, and compromised patient care.

From my observations, burnout is a multi-faceted issue which is perpetuated by governmental, employer, collegial, and individual influences, through a downstream effect. Recognising and accepting that burnout is a real and detrimental issue amongst doctors is crucial. In order to implement targeted interventions, it is important to understand the influences behind the emotional, physical, and mental factors which cause young doctors to burnout. As burnout is the cumulative result of all the above factors, everyone is responsible for improving the health and wellbeing of young doctors.

Governmental policies and funding influence doctors’ progression to burnout. Affordability of fewer positions in hospitals increases workload and time pressure for those employed. This is exacerbated by insufficient funding for primary and preventative healthcare, which overburdens the hospital inpatient and outpatient system. One example I commonly see is clinics running over time due to insufficient allocated time for each patient, leading to frustration and patient dissatisfaction. At which point, patients are perceived as become objects of burden rather than individuals. Its influence extends to the wellbeing of other healthcare professionals, as suboptimal attitude from doctors can have a domino effect on their interaction with others. Alteration of governmental policies and funding can be instrumental in improving the health and wellbeing of young doctors. Provision of funding for stress management and burnout prevention workshops is also warranted.

Employers have the potential to exert stressors. Although likely a flow-on effect from the insufficient funding, rosters implemented by employers can generate stressors. The long stretch of working days with multiple days of extended working hours without a chance to recuperate no doubt serves as a physical stressor which contributes to burnout. Anecdotally, young doctors are often frustrated by imperfections in the hospital system, creating an emotional stressor that negatively impacts their health and wellbeing and interactions with patients. Tension between employers and young doctors can be resolved by clear communication, through identification of reversible gaps in the system. Effective communication can facilitate the implementation of workplace changes that will benefit employers themselves, young doctors, and patients.

Young doctors spend much of their time at work, and may spend more time with colleagues than family and friends. Colleagues may either perpetuate or halt progression to burnout, tilting the balance in the positive or negative direction. Cynicism amongst colleagues and senior doctors may propagate progression towards burnout. As colleagues are often going through similar stressors, residence in a constantly negative environment can transmit such feelings onto one another. Multiple stressed individuals self-propagate the negative working environment, leading to burnout for all members of the multidisciplinary team. Senior doctors can improve young doctors’ health and wellbeing, through provision of mentorship. I always find that consulting seniors/mentors during times of hardship helps me to cope and acquire skills to prepare for and combat future challenges. 

Young doctors themselves are responsible for improving their own health and wellbeing, as their inherent personality traits may predispose them to burnout. In medicine, perfectionism and neuroticism dominate the lives of many[3]. Perfectionism can be favourable at times, however it can stimulate poor mental health, and I admit to being a victim of this. Perfection may be difficult to obtain in medicine, owing to the endless amount of uncertainty and uncontrollable factors. Loss of external control in young doctors with type A personality traits can lead to a greater perceived level of dysfunction and stress[4], and ultimately to burnout. Young doctors themselves should acknowledge any personality traits that may increase risk of burnout, and seek help when they recognise signs of burnout.

Resilience plays an important role in preventing burnout and maintaining wellbeing. The composition each individual’s resilience toolkit is varied[5], including self-care, cultural, spiritual, sport, and relationship factors. I find that all of the above helps to halt my progression to burnout. Resilience can be built and honed to counteract work stressors. Although resilience can be enhanced through colleagues and employer/governmental initiatives, young doctors themselves are responsible for steering the usage of their resilience. However, no matter how strong the resilience, there will come a point where their coping reserve is depleted. At this point, external intervention is warranted. One example is the creation of workshops to encourage young doctors to develop and sustain their resilience tools. Early intervention during medical school to identify personal predisposition and enhance resilience can aid the prevention of burnout[6].

In summary, burnout in young doctors is a multifactorial phenomenon manifested through physical, emotional and mental stressors. These stem from governmental and employer factors, and are perpetuated by workplace interactions and the inherent personality traits of young doctors themselves. Burnout affects doctors and the patients they treat. It is necessary for the government, employers, and young doctors themselves to work in synchrony to combat burnout. Prevention of burnout and interventions for those affected is necessary to improve the health and wellbeing of young doctors. 

 

[1] Shanafelt T, Balch C, Bechamps GJ, et al. Burnout and career satisfaction among American surgeons. Annals of Surgery. 2009;250(3):463-71.

[2] Chambers NLC, Frampton CMA, Barclay M, McKee M. Burnout prevalence in New Zealand’s public hospital senior medical workforce: a cross-sectional mixed methods study. BMJ Open 2016;6:e013947. doi:10.1136/bmjopen-2016-013947

[3] Hisam A, Mahmood UR, Mashhadi SF, Raza G. Type A and Type B personality among Undergraduate Medical Students: Need for psychosocial rehabilitation. Pak J Med Sci. 2014 Nov-Dec; 30(6): 1304–1307.

[4] Kirkcaldy BD, Shephard RJ, Furnham AF. The influence of type A behaviour and locus of control upon job satisfaction and occupational health. Personality and Individual Differences. 2002; 33(8): 1361-1371

[5] Balme E, Gerada C, Page L. Doctors need to be supported, not trained in resilience. BMJ. 2015; 351

[6] Henning MA, Hawken SJ, Hill AG. The quality of life of New Zealand doctors and medical students: what can be done to avoid burnout? NZMJ 2009; 122(1307): 102-110