This week, the Canadian Medical Association (CMA) held its annual meeting. Representing Canada's 80,000-plus physicians, the role of the CMA is to advocate for them on national health and medical matters.
This year, the CMA was presented with alarming data that suggests 54 per cent of Canadian physicians have symptoms of burnout. Let that sink in for a minute. If you require health care, you have a greater than one in two chance of being treated by someone who has symptoms of burnout.
Alas, this is hardly a Canadian phenomenon. Statistics on this subject are hard to come by (many physicians still try to pretend they are super human and immune to banal things like burnout) but the level of burnout in physicians is rising across the globe.
At first glance, this doesn't make any sense. Physicians continue to have an enormous amount of respect from the public, with 89 per cent having a positive view of them. Additionally, despite various disputes, physicians continue to be paid higher than the average Canadian.
So, why are physicians burning out? Multiple theories abound on the internet. It's the electronic medical records! It's the type "A" personality required to be a physician! It's the bureaucrats taking over health care! It's because of Google!
The reality of course, is that burnout occurs in physicians for much the same reason it can occur in any other person. An excellent article in Psychology Today magazine lists the six most common causes of burnout, and most apply to physicians.
Politicians simply assume that doctors will always be there to do the work, no matter the working conditions.
Lack of control
Physicians are trained to be the experts on health-care matters. Yet, more and more, physicians are being governed and limited in their ability to provide health care. Hospital administrators cut back operating room times to save money this year, even though the long-term effects of delayed surgery cost the system more. Government bureaucrats are often given power to distribute resources in ways that front-line physicians know won't help the population. In places like Ontario, you have health ministers like, "Unilateral" Eric Hoskins, who make decisions about health care without proper consultation.
To be clear, I am not talking about money. This refers to being taken for granted and not appreciated. Many physicians feel completely underappreciated by politicians. Politicians simply assume that doctors will always be there to do the work, no matter the working conditions. Because we took a solemn oath to protect patients, we generally wind up working in extreme circumstances. But instead of being appreciated, you get situations like this one, where the governing Liberal Party of Ontario heckles Opposition Health Critic Francois Gelinas for suggesting that physicians are human beings. Or you have federal health ministers like Jane Phillipot, who left physicians feeling like they were talked down to at the CMA meeting.
There are simply not enough physicians in Canada. As a result, those that are here are working harder and harder. Patient care continues to increase in complexity, and patients need more and more time to help them with issues, as the population ages. Not their fault, of course, but it means that physicians are being stretched thin. Physicians work an average of 50 hours a week, and in addition to that, spend 20 to 30 hours "on call."
This one seems almost ridiculous. How could it be unfair to be a physician? Well, it turns out that no provincial government has recognized that physicians have the right to freedom of association under the Charter of Rights and Freedoms (every other essential service worker has this right). In Ontario, the Ontario Medical Association is actually suing the provincial government to force them to acknowledge this basic right. Additionally, the Labour Relations Act, ensuring minimum working standards, do NOT apply to physicians.
Breakdown of community
This is the saving grace so far. To my mind, this hasn't quite happened yet. Yes, physicians disagree with others at times and often have spirited debates, but for the most part, when we need help I've found my colleagues very supportive.
Physician burnout has many consequences for patients. Burnt-out doctors are more likely to make medical mistakes. Burnt-out physicians are less likely to engage in health policy and planning. Burnt-out physicians don't advocate effectively for patient needs. Burnt-out physicians are more likely to consider medicine a "job" rather than their passion. (Believe me, you want a doctor who is passionate about medicine.)
Tragically, burnt-out physicians get into trouble with severe mental-health issues like addiction and depression. The suicide rate for physicians is three times higher than the general population. Approximately 40 physicians take their lives each year in Canada.
I ask that you eat right, exercise regularly and take time off for yourself. You know, the stuff you tell your patients to do.
What can be done? First and foremost, governments (especially in Ontario) need to stop attacking physicians. Belittling them like "Unilateral" Eric has done regularly will not lead to solutions for patients. Disagreements between physicians and governments have happened before, and will happen again. But there is no reason to escalate things with one-sided actions.
Governments also need to start to allow the representative organizations of physicians to have a say in who gets chosen to be a "clinical lead" for various health-care organizations (HCOs). Currently, HCOs have a reputation for hiring "yes men" as clinical leads, because bureaucrats don't want people to challenge their authority. We need independent thinkers in these positions, and allowing physician representative organizations to have a say will help to ensure that. (I should add that I know a lot of clinical leads that are NOT "yes men," but even they will admit that this perception certainly is out there.)
Finally, to my colleagues, I ask that you eat right, exercise regularly and take time off for yourself. You know, the stuff you tell your patients to do. If you feel burnt out, get the help you need from your provincial association. Our profession is in crisis. Let's not lose another physician to it.Are you in a crisis? If you need help, contact your local crisis centre. If you know someone who may be having thoughts of suicide, visit suicideprevention.ca to learn how to talk about suicide with the person you're worried about.
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