What needs to happen to build resilience and improve mental health among junior doctors

May 25, 2017 by Richard Murray And Brendan Crotty, The Conversation
Are our medical students and junior doctors overworking? Credit: shutterstock.com

Doctors experience higher levels of suicide and mental distress than their non-medical peers. A review of studies in the area found male doctors had a 26% higher risk of suicide, while female doctors had a 146% higher risk (more than double) than the general population.

And a recent survey, conducted by the mental health foundation beyondblue, confirmed there were higher rates of suicidal thoughts and among and than in the general community.

But beyond the numbers are tragic stories of young individuals who lost their lives to suicide. In recent months, the suicide of four junior doctors in New South Wales has prompted the state government to investigate the issue. News reports have suggested at least 20 doctors took their own lives between 2007 and 2016 in NSW.

Family members have pointed to stress, "brutal expectations" and working hours as having had an impact on the doctors' decisions to end their lives.

Are our medical students and junior doctors overworking? Can we identify underlying causes of and suicidal thoughts, as well as the warning signs? Can medical schools, hospital employers, supervisors, professional organisations and peers do more to prevent further tragedies?

A host of factors

Various inquiries and reviews have considered the above questions, in Australia and overseas. The conclusion is that it's complex. Behind the phenomenon are a number of interacting factors.

There's a legacy professional culture that can still view any admission of psychological distress as weakness or incompetence.

Doctors face long work hours in a pressured work environment. They experience anxiety about making mistakes that can have serious consequences.

Workplace bullying and harassment can also contribute. While this has most recently been highlighted among trainee surgeons, it probably extends well beyond surgical .

And of course doctors have technical knowledge and access to the means to end life.

A lot has already been done to try to improve doctors' . For instance, progress has been made to reduce working hours. Prolonged shifts and continuous on-call rosters have been discontinued in most, if not all, health service rosters. This was at least in part in response to pressure from the Australian Medical Association (AMA) Safe Hours campaign, which outlined the risks to patients and practitioners of excessive hours worked and the need for breaks between shifts.

These recommendations have been incorporated into industrial agreements for hospital medical staff. These stipulate maximum working hours and mandatory periods of time off. However, 14-hour shifts and rosters that include one in three or four weekends without any reduction in weekday hours are not uncommon. There is considerable anecdotal evidence that some junior doctors are working more hours than they are rostered for.

Progress has been made in other areas too. Polices for better orientation of in hospitals to explain supervision and avenues for support have been implemented. Other measures adopted include: education and mentoring programs in hospitals; supervisor training; blame-free reporting; assessment by external accreditors of health services' and specialty colleges' reporting and support arrangements; mental health first aid training for students; medical student guides; and confidential doctors' health services.

But introduction of these initiatives has been patchy. The levels of support available in different hospitals are variable, and too often dependent on a few enthusiastic individuals. A systematic national approach would have much greater impact.

Medical graduates

One source of increasing stress for recent graduates, anecdotally, is the intense competition to get a job that will be their pathway to a specialist qualification. This pressure has its genesis in the dramatic boost to medical graduate numbers over the past 15 years.

Training beyond is an intense period of four to nine years of work, on-the-job learning, study and examinations. By doubling the number of medical schools and almost tripling the number of medical graduates, Australia has severely increased competition in capital-city teaching hospitals (where, unfortunately, most of the training jobs for remain based).

Ironically, the main reason for the boost in graduate numbers was the shortage of doctors in regional areas. An increasing number of young doctors (including those who trained in rural clinical schools or regional medical schools) feel that they have little choice but to apply for accredited metropolitan training posts.

They would be better off working and training from a home base in regional Australia, if only the specialist training pathways existed. Australia desperately needs to re-align this phase of medical training to better serve both regional communities and graduates.

Building resilience

There are core professional capabilities that should be taught and modelled throughout medical training. These include managing one's own health needs, dealing with stress and fatigue, recognising and assisting distressed colleagues, and reporting bullying and harassment.

Medical schools and hospital employers could do better in finding ways to communicate with one other to protect more vulnerable graduates as they transition into the workforce.

We should also critically review our approaches to selecting students into medical school. Selection policies that promote greater diversity, place more emphasis on humanistic qualities (qualities that define who we are as human beings such as honesty, integrity, courage, self-awareness and wholeheartedness) rather than examination marks, and that include people with a positive orientation to risk and innovation may help to take the steam out of the pressure cooker. These approaches could also improve workforce outcomes in rural and under-served communities.

Beyond "resilience building", there are important system challenges in how the nature of healthcare needs to be transformed into something that is more integrated, person-centred and community-based. This has particular implications for our larger institutions.

It turns out that finding "joy and meaning" in healthcare work is not only good for doctor well-being, it's also safer for our patients. Teamwork, fun and personal fulfilment in caring for others are the essence of the joy of medicine.

Explore further: First national study comparing rural and city medical specialists

Related Stories

First national study comparing rural and city medical specialists

May 1, 2017
The first comprehensive national study about medical specialists working in rural and regional areas will be presented today at a national rural health conference in Cairns.

New study describes standardized assessment for students graduating from UK medical schools

May 22, 2017
A new study describes a standardised assessment that ensures that students who graduate from UK medical schools have achieved a minimum standard of knowledge and skill related to prescribing medications. Following the introduction ...

9 out of 10 doctors like their jobs

March 30, 2017
(HealthDay)—The next time you sit down with your doctor, it may help to know that they most likely love what they do. Nine out of 10 American doctors are happy with their choice of profession, even though they have some ...

Career advancement a strong incentive for medical practitioners to 'go rural'

May 27, 2015
The shortage of medical practitioners in regional rural and remote areas of Australia continues despite government initiatives.

More hands-on training for doctors required if policy changes

February 23, 2016
Research into views on whether doctors should be fully registered to practise on graduation has highlighted scope for improvements in the medical education training system. Students would benefit from more hands-on training ...

Doctors trained rurally stay rural

January 12, 2015
Medical students with a rural background who train in a rural setting are more likely to practise in regional and remote areas, a University of Queensland study shows.

Recommended for you

Moderate exercise before conception resulted in lower body weight, increased insulin sensitivity of offspring

October 22, 2018
Men who want to have children in the near future should consider hitting the gym.

Juul e-cigarettes pose addiction risk for young users, study finds

October 19, 2018
Teens and young adults who use Juul brand e-cigarettes are failing to recognize the product's addictive potential, despite using it more often than their peers who smoke conventional cigarettes, according to a new study by ...

Self-lubricating latex could boost condom use: study

October 17, 2018
A perpetually unctuous, self-lubricating latex developed by a team of scientists in Boston could boost the use of condoms, they reported Wednesday in the journal Royal Society Open Science.

Engineered enzyme eliminates nicotine addiction in preclinical tests

October 17, 2018
Scientists at Scripps Research have successfully tested a potential new smoking-cessation treatment in rodents.

Nutrition has a greater impact on bone strength than exercise

October 17, 2018
One question that scientists and fitness experts alike would love to answer is whether exercise or nutrition has a bigger positive impact on bone strength.

How healthy will we be in 2040?

October 17, 2018
A new scientific study of forecasts and alternative scenarios for life expectancy and major causes of death in 2040 shows all countries are likely to experience at least a slight increase in lifespans. In contrast, one scenario ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.