More Canadian doctors and medical professionals reported burnout and considered suicide over the past year as compared to pre-COVID times, a new national survey shows.
The survey conducted by the Canadian Medical Association (CMA) from Oct. 13 to Dec. 13, 2021, involving 4,121 physicians and medical learners, states that in the past 12 months, over half of the respondents reported experiencing symptoms of burnout — 1.7 times higher compared to four years ago.
Other psychological factors, apart from burnout, where there have been “alarming increases” include rates of positive screening for depression and recent suicidal ‘ideation’, according to the report published Thursday.
Why is this happening?
“There are much more people who are coming in need of more urgent and acute care…. (There are) longer wait-lists and the longer patients have to wait to receive care,” Dr. Alika Lafontaine, president of the CMA, says.
This is leading to “a lack of” relationship between physicians and their providers, says Lafontaine. “Because we really don’t have time to stop and see each other. All of these things kind of work together to create worsening environments for burnout.”
The survey shows that half of the 4,121 respondents screened positive for depression, an increase of 1.4 times or 13 percentage points compared with 2017. And recent suicidal ideation, in the past 12 months, was reported by 14 per cent of respondents, an increase of 1.5 times or five percentage points since 2017.
“I work as an anesthesiologist… there are much more people who are coming in need of more urgent and acute care…(there’s) longer waitlists and the longer patients have to wait to receive care,” said Dr. Alika Lafontaine, president of CMA.
“The lack of creating that relationship between physicians and their providers, because we really don’t have time to stop and see each other. All of these things kind of work together to create worsening environments for burnout,” he added.
According to the report, “heavy workloads, demanding standards of training and practice, and complex practice environments are just some of the factors that can put any physician at higher risk of personal and professional dissatisfaction, burnout and depression.”
Lafontaine says everyone wants to get the best out of their physicians, but the reality is if medical health providers continue to come into working conditions that aren’t the best and in some cases getting worse, then it will definitely start impacting patients and the quality of the country’s health-care system.
The key findings from the study reveal that many subgroups in the medical field are experiencing significantly higher burnout, including medical residents, those under 35 years of age, those identifying as women, those practicing six to 10 years, caregivers of a child and/or parent or family member in the home, those living with disabilities, and those working in small town/rural or isolated/remote areas.
According to the report, women are 59 per cent more likely to experience burnout compared to 43 per cent of men. The increase in burnout since 2017 is much higher among women, with 26 percentage points higher from 2017 versus 14 percentage points among men.
Respondents under the age of 54 (61 per cent) are also significantly more likely to be experiencing burnout than those 55 and older (38 per cent), the report added.
When it comes to respondents practicing in small towns (58 per cent) or isolated/remote areas (60 per cent), reports of burnout were higher than those in urban/suburban areas (51 per cent).
“It increased by 25 percentage points among respondents in small town/rural areas and doubled, increasing by 30 percentage points, among respondents in isolated/remote areas,” the report stated.
Social isolation, uncertainty
According to the report, “while medical residents are more likely to experience burnout, screen positive for depression, and report recent suicidal ideation in the pre-pandemic… practicing physicians have seen larger percentage increases (of burnout, depression and suicidal ideation) compared with pre-pandemic (2017) levels.”
Also contributing to the burnout for some physicians was the social isolation, uncertainty about the future, and increased family obligations brought on by the COVID-19 pandemic.
READ MORE: Health workers call for radical changes to health care to treat pandemic burnout
“I was trained to experience high-stress environments and interactions with patients. But the level of stress that I experienced during the pandemic and the level of stress that I experience after the pandemic is both a lot more than I think any of us expected,” said Lafontaine.
Because of that high level of stress, he said what worries him the most is that at some point physicians and health care workers are going to stop wanting to come to work.
“I really hope that we can do interventions from the federal and provincial level to ensure that that doesn’t happen,” said Lafontaine.
The report shows that the likelihood of physicians reducing clinical work hours in the coming years is higher among those who have reported having depression, anxiety, and low professional fulfillment. Half of the respondents are thinking of reducing or modifying their clinical work hours in the next 24 months, the report said.
“While a growing shortage of physicians was certainly an issue pre-pandemic, the cost of increased burnout in the form of early retirements and reduced clinical hours due to the pandemic may be substantial in the coming years,” the report said.
Prioritizing wellness
The report states that there is a “silver lining to the findings,” with COVID-19 prompting a “culture shift” towards prioritizing wellness.
This is seen among younger physicians, like medical residents and those under age 25, who report prioritizing their personal wellness and seeking help to support their well-being, “possibly an indication of the fading stigma associated with seeking mental health support,” the report said.
Some of those who are at a higher risk of psychological distress, such as women, are also accessing them. Nevertheless, the report says that there are still significant barriers to overcome in terms of increasing access, overcoming stigma, and emphasizing the need to seek out wellness supports.
“For some physicians, stigma and shame (among men and older people), or a belief that things aren’t serious enough to necessitate seeking help (among women), may be preventing them from seeking out help,” the report said.
The survey also shows that confidentiality is often cited as a reason why many physicians don’t access supports. This is particularly the case among younger doctors and those practising in small towns, rural areas and isolated, remote sectors. They worry about potential harm to their career.
“Their geographic location and the size of the community in which they practice may mean that even in the best of circumstances they lack some of the social connections and wellness supports that physicians practising in urban areas may tap into more easily,” the report said.
“With limited staff in these areas, it may also be difficult to take any time off to prioritize their wellness.”
Lafontaine, too, worries that at some point physicians and health-care workers are going to stop wanting to come to work.
“I was trained to experience high-stress environments and interactions with patients. But the level of stress that I experienced during the pandemic and the level of stress that I experience after the pandemic is both a lot more than I think any of us expected,” said Lafontaine.
“I really hope that we can do interventions from the federal and provincial level to ensure that that doesn’t happen.”
What next?
Lafontaine says urgent action is needed to deal with burnout and that governments need to acknowledge that there is a broad, widespread problem involving mental health across the health-care system.
“Physician and health-care worker burnout is always a late sign of system stress,” Lafontaine said.
He also believes that people need to be incentivized to work in these working environments. Space needs to be created for physician-patient relationships to flourish, he said.
“The best treatment for physician burnout and health-care worker burnout is the connection we have with patients,” said Lafontaine.