Burnout, resilience and culture change

There seems little doubt that ‘burnout’ is currently afflicting many clinicians, who feel undervalued by a government that has restricted pay increases to 1% for the past 5 years, and overstretched as they struggle to cover rota gaps and deal with ever-increasing patient demand. The manner in which the junior doctors’ contract was imposed was also harmful. The GMC has recommended ‘resilience training’ as a remedy for some of these issues; however, it is hard to be resilient if you are already demoralised. It could be argued that a significant pay rise this autumn might provide a more positive boost to morale.

A radical culture change in the way the NHS deals with its younger clinicians may be even more beneficial. Isn’t the term ‘junior doctor’ in itself somewhat demeaning? Perhaps the traditional ‘firm’ structures, which encouraged teamwork and mutual support, should be restored to replace the current transient and peripatetic rotations that do so little to foster loyalty. Increased support for trainers, training and enhanced study leave, as well as reintroducing the doctors’ mess, might also have an uplifting effect on doctors’ morale.

Read the editorial here. 

What are your views? How can we prevent burnout which seems to be resulting in more older doctors taking early retirement, and many younger ones leaving the profession for good?

Comments (8) Add yours ↓
  1. Jaydeep Sarma Consultant Interventional Cardiologist

    Your comments are pertinent and highlight the altered position that healthcare occupies in today’s society. There is clearly burnout and disaffection in ‘junior’ colleagues. I work as a Consultant Interventional Cardiologist in a high-pressure regional centre delivering out of hours emergency care. I have found little recognition and less support for sustaining my continued activity. All day lists followed by all night emergencies can take 48 hours to recover from. The lack of recognition of the risks, emotional toll and medicolegal aspects of such work are factors that will contribute to deteriorating physical as well as mental health. Ironically one of the key groups that appear obstructive to revising working practices is cardiologists themselves. I would welcome comments from other specialties as to how we can continue to deliver emergency specialty care without risking our own health.

    September 28, 2017 Reply
  2. Peter McDonald Mr

    When I had an episode of acute severe burnout over a complication suffered by a patient it was only the kind supportive assistance given to me by close colleagues that prevented my distress from escalating to dangerous levels. Pay may be important for morale but is nothing compared with the importance of camaraderie. Anything that sustains that, whether it be firm structures or medical societies, is vital to preserve.

    October 3, 2017 Reply
  3. Rowland Rees Mr

    Agree with all of that. Bring back the firm structure which fosters bonds, closer relationships and support network for all colleagues, junior and senior. More numbers and slack in the system also required to meet rising demand

    October 4, 2017 Reply
  4. Mark J Speakman Consultant Urological Surgeon

    This is a very relevant and timely article. Burn-out and other problems does not only affect ‘other’ doctors it affects urologists just as much. A survey amongst Irish and British urologists published in BJUI last year showed significant problems with emotional exhaustion and depersonalization amongst consultants (O’Kelly et al BJU Int 2016; 117: 363–372). This was mainly brought on by administrative factors or lack of institutional resources and not the surgery itself. I completely agree with Peter McDonald’s comment that the most important factor in reducing these risks is having good colleagues who meet and socialize regularly.
    My big gripe is that there is no proper planning for appropriate changes in a urologist working programme over a 25-30-year time scale. The skills of a younger urologist are different from (and sometimes better than) those of a more senior urologist and we should therefore expect our roles to evolve and change over time. We are expected however to provide the same service year in year out, until something goes wrong.
    My best advice is to always keep looking for new challenges throughout your career; set yourself new goals. A few years in medical management will at the very least make the ‘day-job’ a lot more enjoyable when you return to simple clinical work and who knows you might even enjoy it. Look for opportunities through specialty associations such as BAUS and the RSM because the more we are stimulated the better we perform.
    We also have to accept that we are training inadequate numbers of medical students for the future and that we have far too few places available in specialty training within urology in the UK.

    October 4, 2017 Reply
  5. Helen Gordon CEO

    A personal view, not RSM view.

    Burnout, and pressure at work generally, is a real issue and we must build in more support and skill development for doctors, and all health professionals, at all stages in their training and career, to help them thrive, not merely survive, in the ever challenging and changing NHS. Building resilience and really great inter-personal skills for times of stress and pressure are essential. These are not soft skills, but essential skills, and yet still not prioritised as such.

    In my experience, some firms worked better than others IMHO, yet there was continuity, and I think that current training arrangements bring challenges to team working.

    But how do we prepare those who are teaching and supporting others? And how do we foster great team work in evolving networks and models of care? More to be done there I think and is feedback we get at RSM about need for development.

    October 9, 2017 Reply
  6. Roger Kirby Professor of Urology

    The label “junior doctor” faces banishment from the NHS after the country’s head medic backed a campaign to change job titles that have been condemned as confusing and demeaning.

    Ministers and NHS training chiefs are considering an end to the use of terms such as “trainee” and “junior” to describe qualified doctors who often have a decade of experience.

    Dame Sally Davies, the chief medical officer, said that doctors needed job titles that give them “the respect they deserve”.

    She is supporting a campaign to rename doctors below consultant level in conjunction with Oxford University.

    October 10, 2017 Reply
  7. Krishna Consultant Urologist

    It is unrealistic to expect that government or somebody else will help us to reduce the burnout. It is our own responsibility as colleagues, our medical societies and organisations like Royal colleges to help its members to reduce the burden on individuals.At individual level we should learn to respect each other, support each other and fight the issues on the united front.Counselling services for affected people in timely manner may help.

    October 13, 2017 Reply
  8. Roger Kirby Professor Roger Kirby

    Registry data are showing a rise in the number of UK trained doctors who are registered to work in Australia and New Zealand. A total of 699 more doctors from the UK were registered to practise in Australia in 2016 than in 2014, a 17% rise (from 4182 to 4881), show data from the Australian Health Practitioner Regulation Agency

    October 20, 2017 Reply

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