Physicians in crisis: the impact of burnout

Physician burnout has been recognised as a public health crisis in many countries because it not only affects physicians’ personal lives and work satisfaction, but also creates severe pressure on the whole health-care system -particularly threatening patients’ care and safety.

The nature of the work means exposure to high levels of stress, combined with a heavy workload, including administration, and long working hours in a poor working environment. As a result, a third of doctors were suffering from burnout with frontline hospital doctors, followed by general practitioners most affected. (Mckinley et al 2018).

The GMC’s annual training survey showed that burnout amongst both trainers and trainees is at an all time high, with two-thirds of trainee doctors worn out at the end of the working day.

Burnout has reached critical levels in the UK and US, and this study shows for the first time that it directly affects patients’ outcomes negatively.

A new meta-analysis by the BMJ of 170 studies of 24,000 staff has shown that physicians with burnout are twice as likely to be involved in patient safety incidents, and show lower levels of professionalism. They are over two times more likely to receive low satisfaction ratings from patients, compared with satisfied patient ratings. This is most likely to occur in younger physicians working in emergency medicine and intensive care.

Burnout is characterised by feelings of emotional exhaustion, detachment from the job, feelings of cynicism and a sense of ineffectiveness and personal achievement. In turn, many staff respond to the stresses of the job with anxiety, depression and substance abuse. What’s more, the emotional exhaustion of burnout makes doctors three times more likely to consider quitting altogether.

The Royal College of Nursing’s head of health, safety and wellbeing, Leona Cameron, agreed that the link between burnout and patient safety risk reported in the new study was also applicable to nurses.

“Although this study is about doctors not nursing staff, it appears to back up what we already know – which is that when there aren’t enough nurses on hand, it’s patient care that suffers,” she said.

Nicki Credland, chair of the British Association of Critical Care Nurses (BACCN) said the same problems were found in ICU nursing.

“We are continuing to see increased mental health and wellbeing issues which translate into increased staff sickness, decreased job satisfaction, intention to leave, poor staff retention,” she said.

What’s to be done? We’re in the middle of a burnout crisis caused by backlogs, under-funding and under-staffing. And yet the 2018 NHS staff survey found that only 28% of staff felt that their organisations took the matter seriously.

The McKinley study noted that staff could be helped to be more resilient to stress by acknowledging and changing workplace factors such as improving the work environment and offering social support. Other studies have found that simple factors such as access to PPE, the ability to rest and recover during breaks, and having an input to working patterns would make a difference.

HWF’s own 2021 survey reported that the working environment was the second most important factor in staff deciding to stay with the NHS or not. One in three staff had no rest room at all. And only one in three staff felt that their organisation paid enough attention to their well-being. Staff don’t always have the opportunity to take breaks, many have no access to drinking water on the ward, hot food during breaks, or a place to rest while on call or before driving home. Staff need access to one-to-one personal support and counselling to help them cope with workplace stress.

At HWF, we have a programme of staff room refurbishments which provide staff with a comfortable place to rest and have a hot meal. You can apply online for help with a rest room refurbishment. We also support the mental health of healthcare workers thorough free access to counselling with qualified and experienced therapists.

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