Hospital leaders hold the key to fixing our burnout crisis | AMA (WA)


Burnout_Dr Anna Wilshire

Hospital leaders hold the key to fixing our burnout crisis

Monday October 24, 2022

Dr Anna Wilshire, Medical Registrar

I am on a leave of absence from my job as a trainee medical registrar. I informed my hospital I needed leave because of my overwhelming commitments outside of work, which is not untrue.

I have a mother who is palliative with chronic pulmonary graft-versus-host disease, and two teenagers who need me. I had managed to keep on top of these other things in my life and work before, so what changed? And why couldn’t I tell my employer the truth?

It wasn’t due to lack in resilience. I have resilience in spades. But resilience didn’t help when I realised I was suffering from burnout. It crept up on me. I tried to decrease my workload, put in personal boundaries, learnt to be mindful, and practised yoga daily. But none of that was enough. It was time to take leave. Doctors who are burned out are more likely to make a medical error, and also more likely to leave the medical profession altogether.

Firstly, let’s be clear – burnout for Western Australian doctors was an established crisis well before the COVID-19 pandemic. We entered the pandemic with a depleted workforce, both physically and emotionally. COVID-19 was just the straw that broke the camel’s back.

Secondly, this is not an individual doctor issue, and the solution to ‘fix’ burnout does not lie with the doctor. Burnout is an organisational issue, and the solutions start at the top. The leadership and administrators of the hospital hold the key to solving this crisis.

Burnout presents as emotional exhaustion, depersonalisation, being less effective at work, and feeling as if you will never be good enough. Burnout is not anxiety or depression, but those with burnout are more susceptible to mental health issues. In the AMA
Doctors in Training Survey in 2021, approximately 30 per cent were burned out. I can’t imagine what the rate is now with WA being short of 349 junior doctors. This number will continue to grow if issues such as burnout are not addressed, with the ramifications on our population overwhelming.

When I review my first year as a physician trainee, I can now clearly see the factors that contributed to my burnout. For example, my personal mobile phone would ring seven days a week with calls from wards, junior doctors and nurses asking for plans for patient care, even when I wasn’t rostered on. I couldn’t divert these phone calls or ignore them, as I was invested in my patients’ care.

Why did this occur? Because the hospital switchboard was not able to access our rosters despite several requests for this to happen. Secondly, our roster meant we worked nine days straight and then two days off – which meant my team was left without a registrar for those two days, which was subpar for a general medicine job. This could easily be fixed with sufficient rostering of the medical teams, and a software upgrade to enable the switchboard to see who’s working and when.

As a medical registrar, I received frequent calls from medical admin to cover extra shifts. This was on top of the already rostered on-call. The on-call roster meant you were often rostered for your ‘day job’ to end at 5pm and on-call job to start at 4pm, meaning you were doing two jobs at once. I lost the sense of control over my working life at this point.

And those that lack control over their work suffer from burnout. On-call is part of our lives as medical registrars, and often that’s where the learning happens. But on-call should be attached to the job you’re doing so that learning can be optimised and prioritised, rather than putting registrars in different departments.

On top of that, I didn’t feel rewarded or recognised financially as a public medicine trainee. This sentiment has changed since I was an intern. And while it’s getting better with the advocacy of junior doctor committees, it’s discouraged to put in overtime claim forms. Or it might be that I feel a sense of obligation to achieve what the doctor before me did, and therefore not claim the hours
worked. This results in unpaid hours and not being rewarded for your time. This could easily be fixed, with a hospital policy that states you must claim the hours you work and that you will be paid, within reason, without question.

As trainees, we move jobs every three to six months. You come into a team, needing to be a leader as the medical registrar, but we are the newbies to the group. You’re often placed into teams that are well established where you are the ‘trainee’ with no knowledge. This would be fine, if you were treated as the trainee that needs training – but it’s the dichotomy
of being a leader whilst also a learner.

We spend the first few weeks, potentially in a hospital we’ve never worked at before – getting lost, trying to learn computer logins, while trying to teach our juniors and build rapport with nursing staff. This could be structured differently, having trainees spend longer in one position so they can reap the benefits of being in a long-term collaborative team, learning and functioning in a group. This protects people from burnout.

I’ve realised I didn’t admit to being burned out because I felt ashamed that I wasn’t able to cope with the demands of clinical medicine. But this isn’t my shame to be felt. It’s the leaders of our health department that need to feel shame. It’s time some simple changes were made, so we can protect our future juniors from suffering burnout. We aren’t asking for more money – just to be paid for our time and treated fairly, as one would expect from any other career.