how doctors can handle rising stress and demands to avoid burnout
burnout is driving some doctors to consider leaving their profession, raising more concerns about access to care
8 minute read
exhaustion is a common theme rooted in medical school, with a “power through” expectation instilled in students early on.
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burnout is driving some doctors to consider leaving their profession, raising more concerns about access to care. there are as many as 6.5 million canadians who don’t have a family physician at a time when the population is aging and growing.
stress, to some degree, is part of life and work, but how do physicians manage stress in a system that is already pinched and demands are high?
dr. joss reimer is asked this question often and speaks from experience. she’s past president of the canadian medical association (cma), chief medical officer for the winnipeg regional health authority and a hospitalist physician at women’s hospital in winnipeg, working alongside obstetricians to help deliver babies, see people in early labour and offer her expertise in the operating room.
is there room for work-life balance?
“when people ask me, ‘how do you do work-life balance?’ i don’t strive for work-life balance because work is part of my life and i want to have a job that gives me energy, not just takes it away,” she says, noting that everybody is going to be different as far as what gives them energy and satisfaction in their day-to-day.
for some medical doctors and those going through their medical residency, overall satisfaction may be more work and longer hours. for others, it means family, sports, reading or gardening—“whatever it is that gives you that feeling of a fulfilled life, that you’re energized by what you do each day more than you’re exhausted by it.”
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exhaustion, however, is a common theme rooted in medical school, with a “power through” expectation instilled in students early on in the program, reimer says. they must rise to the challenge in order to graduate, so people tend to take that mantra forward into their careers. there’s also the fact that students have little control over their time and are matched with a career direction or specialty that may not be their first choice.
find fulfillment in work and consider options
“one of the pieces of advice i give to medical learners all the time is to be open to change, be open to creating the career that works for you. because we in medical school get forced to pick a specialty and you go into this computer matching system and you put in your preferences, but then it just spits out where you’re going and what you’re doing,” she says. the process narrows the thinking of medical students into figuring out their whole life immediately and doing everything they can to get that top spot.
“my advice to them is to change your mind. there is a career out there that’s going to be the right fit and it’s going to help you thrive, but it might not be the thing you think it is, and that’s okay.”
she switched programs and went into public health, which blended her passion for science with her desire to impact the population. her advice resonates with medical residents who are struggling with feelings of not being good enough or feelings of failure. wanting a change in career direction or environment is not failure, she points out: “the failure would be to keep doing something that’s not fulfilling you.”
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she has the same message for new graduates starting their respective jobs. while they need to learn and adapt, they can still be open to change. some people will start working in a hospital and find that the clinic is a much better space for them, for example.
it’s important to recognize that a medical degree has a lot of options for new practitioners and experienced ones.
“you can be what we think of as the typical doctor in the clinic who’s seeing the patients one after another. or you can work in a hospital, or you can work in an emergency room. you can be a consultant to government. you can teach in a university. there’s so many options and ways to tailor your practice that i do believe that almost everyone can find something that is fulfilling and helps them thrive in a blend of clinical academic research.”
another antidote to burnout on the job is taking on a project that matters to you or working toward a goal. this approach makes you feel as though you’re contributing and that what you do matters. “burnout is not just about the hours that you work; it’s about feeling valued in your work, feeling like your work has meaning. if you can bring in some of that work that makes you feel like you’re part of the solution, that can help burn out, not hurt it.”
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reimer says that she ended up in leadership because she found problems and took the initiative to solve them. even as a medical resident, she became an expert in managing human remains because there was a need. immigrant communities who wanted to ship their loved ones to their home country had to navigate a complex, difficult process at a time when they were grieving. reimer stepped in to create a better, clearer process for them that still followed safe public health principles.
“knowing i was helping somebody, knowing i was creating a better outcome, was energizing to me,” she says, despite the pressures of her workload.
‘rise to the challenge’ should be tempered by self-care
also important is seeking help before you reach exhaustion and hit burnout. she’d like to see students speak up if they need support and develop that self-awareness and self-care to guide them in the profession later on.
reimer went through a high-stress period in her residency where she had to step away.
“i hit the point where i just couldn’t do it. i couldn’t go in anymore,” she recalls. “it caught me by surprise because i was always a very high-functioning student, always achieving, being involved in extracurriculars, doing all the checkbox things. so, i was quite used to functioning at that level. and in medical school, very early on, i had to accept not being top of the class.”
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it’s clear that she doesn’t want people to just keep going when they’re feeling burned out, because that doesn’t help them. “the culture is ‘get in there, be the best, power through,” she says of the approach she was taught to champion. instead, she’d like to see people step back, reflect and make time for self-care.
“burnout seems to be at levels higher than we’ve ever seen. and that is largely because we have an aging population with higher needs, but we also have an aging healthcare workforce that is retiring and shifting how they work. the demands are higher, the patients are more complex and there’s fewer of us to manage them,” she explains, adding many healthcare providers experience a lot of guilt because when they do need to pull back, the work will fall on someone else.
across the country, medical associations have mental health support services to recognize and meet the growing need, like cma, with a website page dedicated to helping guide people through what might be available to them.
“there’s never been more recognition of burnout, not as a personal flaw, but instead as a systemic flaw. so reaching out and getting help is less stigmatized than ever.”
a big part of burnout prevention is to seek help and support, and to feel supported in the work environment.
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“what i want now as a medical leader is to work to create workplaces that help people thrive and don’t depend on their resiliency to get through.” healthcare providers need to be healthy in order to help other people be healthy, even if that means pulling back so that others carry a bit more weight.
“i’d rather have somebody contribute and be an excellent doctor half of the time than be there and be stressed out. that’s not good for the team dynamic. that’s not good for the patients.”
adopt new technology tools to help avoid burnout
she also recognizes the fact that doctors have long been stretched thin by demands that go beyond patient care. there’s an administrative burden to solve. a study released by a medical billing platform in october revealed that canadian physicians are devoting nearly a full day each week to overlooked non-clinical administration, with 72 per cent of physicians noting that non-clinical administrative work contributes significantly to burnout and workplace exhaustion. as well, 78 per cent reported reduced job satisfaction and 77 per cent said administrative workload reduces the time they can spend with patients.
new ai tools can help relieve some of that unfulfilling work, reimer says, pointing to ai scribe as one example, which summarizes key points of each patient visit. ontario has a program to provide physicians with this tool.
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“when you have to sit and take notes during the visit, it causes that barrier between patient and physician,” she says, “or sitting in the evening after you put the kids to bed, writing notes.”
her advice is to use technology as it becomes available to help both healthcare providers and patients, such as adopting virtual care for patients based on their needs at any given time.
“the virtual care that’s for unattached or episodic things is a helpful thing to fill in the gaps, but it’s not the end goal. we’d much rather have those physicians attached to patients so that when they come in with their fifth bladder infection that year, they don’t just get prescribed the same antibiotics that they got the other four times because we don’t know.”
she’s also a strong advocate for sharing patient medical records across the country to improve care. the concept is fraught with provincial barriers and data privacy concerns.
“that is something we hope to see in the future because that also would decrease administrative burden. when someone comes in, i can see what medications they’ve taken. i can see what they’ve been treated for in the past. i can see what happened when they were in the hospital, what got tried and what worked or didn’t work,” she notes.
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“the whole country of spain shares electronic records, so it can be done, but does require political will to make it happen because there’s no incentive for any individual (it solutions) company to start.”
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