Recently, we celebrated Crazy Socks for Docs Day, a powerful reminder of the pressing need for greater awareness and support regarding the mental health of junior doctors in Australia. Created by Dr. Geoff Toogood, the day highlights the importance of addressing burnout among healthcare professionals.
But what can be done? In 2022, the Australian Medical Association (1) released a position paper on the issue, calling for a raft of important changes.
Understanding Burnout
Burnout is characterised by a state of extreme fatigue, decreased motivation, lowered performance, and negative attitudes towards oneself and others (1). It is a response to specific environmental or situational factors,and can often mimic symptoms of more serious medical conditions, including mood disorders, although its root causes lie within the work environment and related stressors.
RecogniSing the Features and Prevalence
Key signs of burnout include persistent fatigue, apathy or dissatisfaction with work, tension headaches, and changes in sleep and diet patterns. Burnout is characterised by chronic emotional and physical exhaustion resulting from prolonged or intense stress. It encompasses emotional exhaustion, depersonalisation or cynicism, and reduced personal accomplishment.
The prevalence of burnout among junior doctors in Australia is alarmingly high. Contributing factors such as long working hours, high workload, sleep deprivation, limited support and mentoring, and a culture that stigmatises seeking help for mental health issues have created a challenging environment. A survey conducted by the Australian Medical Association (AMA) revealed that as many as 50% of junior doctors in Australia reported high levels of burnout (2). Additionally, a Beyond Blue survey (3) found that 1 in 3 junior doctors reported high levels of psychological distress, and 1 in 5 experienced suicidal thoughts.
Unpacking the Causes
To address burnout effectively, it is crucial to understand its underlying causes. Junior doctors face numerous challenges that contribute to their high risk of burnout. These challenges include a heavy workload, long working hours, dealing with emotionally charged situations, limited control over their work environment and schedule, inadequate support and resources, and a pervasive "macho" culture that discourages seeking help for mental health concerns.
Factors contributing to poor wellbeing include disruptions to sleep from shift work, career-family conflict, clinical isolation, long unpaid hours, barriers to accessing leave, and fear of making a clinical error. The COVID-19 pandemic has further exacerbated the situation and has placed the health workforce under unprecedented levels of psychological distress (4).
The Consequences of Inaction
If burnout is left unaddressed, the consequences can be devastating (3). On an individual level, burnout can lead to mental and physical health problems, including anxiety, depression and all-too-frequently, suicide. Doctors have substantially higher rates of psychological distress and suicidal thoughts compared to other professionals and the general population (1)
But it isn’t just the individual doctor who suffers. Burnout can impair job performance, increase the likelihood of medical errors, and result in interpersonal conflicts. Many doctors find the demands too much, and leave the industry entirely (4).
Recent surveys conducted by the Australian Medical Association (AMA) in Queensland and New South Wales (NSW) highlight the increasing risks of overworking junior doctors (1). According to the surveys, almost 60% of junior doctors in Queensland are concerned about making clinical errors due to fatigue caused by the hours worked. Similarly, in NSW, 46% of respondents indicated that they had made a fatigue-induced error – an 8-point increase over the previous year.
Collectively, these consequences affect the quality of patient care, posing risks to patient safety and outcomes. Failing to act on burnout jeopardises not only the well-being of junior doctors but also the integrity and effectiveness of the healthcare system as a whole (5,6).
Poor workplace culture leads to bullying, harassment, and a risk to patient safety. Unhealthy workplaces cost up to $17 billion per year in absenteeism and presenteeism (4).
Reducing the Incidence and Impact
To address burnout among junior doctors, the AMA is advocating for increased governance and accountability in hospitals, with a particular focus on the psychosocial safety of the healthcare workforce (1). One of the main mechanisms for achieving this is to increase hospital and health service boards and senior management responsibilities. This will help to ensure that the needs of junior doctors are taken into account when decisions are being made about working conditions and workload.
To mitigate the prevalence and impact of burnout among junior doctors, a multi-faceted approach is necessary. Here are some actionable strategies:
Improve Working Conditions : Addressing excessive work hours, implementing fair workload management strategies, and promoting work-life balance are crucial steps towards reducing burnout.
Education and Training : Providing comprehensive education and training on stress management, resilience-building techniques, and coping strategies equips junior doctors with essential tools to navigate the challenges they face.
Foster Supportive Workplaces : Cultivating a workplace culture that prioritises mental health and encourages open communication is vital for supporting junior doctors. Implementing peer support programs, mentorship initiatives, and creating safe spaces for debriefing can foster a sense of belonging and provide a valuable support network.
Increase Resources and Access to Support : Ensuring junior doctors have access to mental health resources, counseling services, and confidential helplines can encourage early intervention and promote seeking help when needed.
Promote Self-Care and Wellbeing : Encouraging self-care practices and prioritizing personal wellbeing are essential. This can include promoting regular breaks, encouraging physical activity, and providing opportunities for relaxation and rejuvenation.
Pastoral care : Pastoral care is an important aspect of supporting junior doctors, and it involves providing emotional and spiritual support to individuals as they navigate the challenging aspects of their work. Pastoral care can include access to chaplaincy services, debriefing sessions, and counselling services.
Mentorship : Mentorship programs are another way of supporting junior doctors. These programs pair junior doctors with senior colleagues who can provide guidance, support, and advice. Mentors can help junior doctors navigate the demands of their work, manage stress, and develop resilience.
Advocate for Policy Changes : Collaborating with professional organisations, such as the AMA, to advocate for policy changes that prioritise the mental health and wellbeing of junior doctors is crucial. Strengthening occupational health and safety regulations and ensuring adequate protection under the National Safety and Quality Health Service (NSQHS) Standards can help create a safer and healthier work environment.
Raising Awareness and Reducing Stigma : Continuing to raise awareness about burnout and mental health challenges faced by junior doctors is vital. By fostering open conversations, reducing stigma, and normalising help-seeking behaviour, we can create an environment where junior doctors feel supported and empowered to seek assistance when needed.
Conclusion
Burnout among junior doctors in Australia is a pressing issue that demands immediate attention and proactive measures. By acknowledging the signs, understanding its causes, and recognising the potential consequences of inaction, we can work towards creating a healthier work environment for junior doctors. Implementing strategies such as improving working conditions, providing education and support, fostering supportive workplaces, and advocating for policy changes can help reduce the incidence and impact of burnout. Let us stand together to support our junior doctors, ensuring their well-being while they tirelessly provide vital healthcare services to our communities.