Almost 1 in 3 UK Doctors 'Burnt Out'

Peter Russell

January 28, 2020

Almost a third of UK doctors were found to be 'burned out' and just over a quarter experiencing secondary traumatic stress, a study found.

Health professionals from emergency medicine and general practice appeared to be most at risk of exhaustion, stress, and 'compassion fatigue', researchers from Queen's University Belfast said.

The British Medical Association (BMA) called the findings "alarming".

The NHS said it was committed to a strategy of mental health support for doctors.

Underfunding and Pressure at Work 

Doctors are known to be at higher risk of anxiety, depression, substance misuse, and suicide than the general public.

Long hours in pressurised working environments, and coping with stretched budgets, take their toll on mental health.

The latest study used data from October and November 2018. It was therefore not unsurprising that the results chimed with a 2018 survey conducted by Medscape News UK , which found that 32% of doctors who responded reported feeling burned out at some stage.

Researchers wanted to find out how resilient doctors across the UK were and how well they coped with the pressures they faced.

They also wanted to quantify prevailing levels of stress and burnout in the profession.

The cross-sectional study, published in BMJ Open, drew on responses from 1651 doctors from a wide range of specialities and grades across the UK. Health professionals were invited to complete an online survey made up of validated psychological instruments.

In total, 1518 answered questions on resilience, 1423 responded to questions about professional quality of life, and 1382 answered questions on coping mechanisms.

The mean resilience score was 65.01, lower than in the general population.

Of those who responded:

  • 31.5% had high burnout

  • 26.2% had high secondary traumatic stress

  • 30.7% had low compassion satisfaction

Resilience in the Workplace

The researchers said there was particular concern that 8% of responding doctors scored high for burnout, high for secondary traumatic stress, and low for compassion satisfaction. Their score, placing them in the 'at risk' category, could mean they were experiencing clinical depression "and would benefit from treatment, time off work or even changing their job", they said.

The scores for the individual psychological tests were broadly consistent across all four nations in the UK.

However, some differences emerged among grades, specialties, and geography.

For instance, hospital doctors scored higher for resilience than GPs, while doctors in surgical specialties scored higher than their non-surgical colleagues.

Recently qualified doctors and specialty and associate specialist grade doctors scored lower than specialist trainee doctors and consultants.

Doctors working in Northern Ireland scored higher for resilience than their colleagues elsewhere in the UK.

The most frequently cited coping mechanisms were distraction from a problem or stressor, or self-blame, rather than thinking about or planning how to deal with a situation. That indicated that doctors were not adjusting well to pressures, the authors said.

There were some limitations to the study. Doctors self-selected to participate, while the cross-sectional nature of the study meant it could only imply association, not cause and effect.

The authors concluded that "if the NHS is to continue to remain among the highest-rated healthcare systems globally, ensuring the psychological well-being of its doctors should be seen as a matter of national importance".

However, they said it was unclear whether an evidence-based psychological intervention or improvements in the workplace would be best for addressing the well-being of health professionals.

Medscape UK's  2018 Doctors' Burnout & Lifestyle Survey found that reduced patient loads, more manageable hours, better pay to reduce money worries, and gaining more respect from managers, staff, and colleagues, were cited as the top ways to reduce the risk of burnout.

Doctors Face 'Incredible Adversity'

Commenting on the latest study, Dr Chaand Nagpaul, chair of the BMA, said: "These findings are alarming and strongly reinforce precisely what the BMA has been saying for a long time.

"Years of systemic underfunding and serious workforce shortages mean NHS doctors are working longer hours in highly pressured, understaffed environments, and their wellbeing is suffering as a result."

The BMA said its own survey in 2019 found that 8 in 10 doctors were at high or very high risk of burnout, while 27% had previously been diagnosed with a mental health condition.

The Royal College of Emergency Medicine said its members were overworked and under intense pressure in under-resourced hospitals. Dr Ian Higginson, the College's vice president, commented: "Our staff are doing brilliantly well in the face of incredible adversity, but it is undoubtedly unsustainable.

"Offering resilience training to already resilient staff can only do so much: it doesn't fix the underlying problem.

"NHS Leaders need to find ways to get more staff into the specialty, and to offer reasonable working conditions to help retain the staff we do have."

Prof Martin Marshall, chair of the Royal College of GPs, said: "Workload in general practice is rapidly increasing in terms of volume and complexity, yet the resources we have to deal with this are inadequate and the numbers of fully-qualified, full-time equivalent GPs working in the NHS is falling.

"This situation is leading to many GPs burning out and leaving the profession earlier than planned."

The RCGP called for policies to keep GPs in the profession longer, and to reduce what had become an "undoable" workload.

An NHS England spokesperson said: "Staff are the lifeblood of the NHS, which is why we are now for the first time offering the most comprehensive national mental health support offer to doctors of any health system in the world and are committed to doing similarly with other staff groups, as part of our NHS Long Term Plan."

The BMA offers wellbeing support here.

McKinley N, McCain RS, Convie L, et alResilience, burnout and coping mechanisms in UK doctors: a cross-sectional study BMJ Open 2020;10:e031765. doi:10.1136/bmjopen-2019-031765

Editor's Note, 29th January 2020: This article was updated to include a link to BMA wellbeing advice.

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