It’s an age-old adage that we can’t have well patients without healthy doctors (writes Richard Hull and Nigel Trudgill). As the first stage of the COVID-19 public health crisis comes to an end, it’s vital that we understand what it takes to keep doctors physically and mentally healthy, and do everything we can to ensure that medical staff within the health service are prepared for the hard work to come in the months and years ahead.
In February this year, just before the pandemic began, our College joined with the Royal College of Physicians of London and the Royal College of Physicians of Edinburgh to commission a survey of UK consultant physicians. The work, which built on two previous annual surveys and was carried out on our behalf by workforce experts at the RCP London’s Medical Workforce Unit (MWU) asked this group a range of questions about their wellbeing during the previous year. 2,644 consultants responded.
What we found was disappointing, if unsurprising.
Just under half – 49% – said morale was worse than a year ago and only 12% reported that it had improved. Linked to this, respondents continued to report that they faced pressure from high workloads:
- 43% are never or only sometimes in control of their workload.
- 49% describe their workload as excessive always or most of the time.
- 47% work excessive hours always or most of the time.
The survey also examined the rates of burnout faced by respondents. Based on the Maslach Burnout Inventory, female consultants and consultants of white ethnicity appeared at higher burnout risk than men and consultants from black, Asian and minority ethnic backgrounds. Working less than full time carried a lower burnout risk. Consultants who are disabled or have a long-term health condition had a higher burnout risk.
The specialty at highest burnout risk was gastroenterology – 8% of all respondents but 12% of those at highest burnout risk.
Over two thirds (69%) of those at highest burnout risk said work had affected their relationship with their partner and 71% their relationship with their children.
Consultants at highest burnout risk were the least likely to have taken their full leave allocation for the last year (only 54%).
Mental wellbeing scores using the Warwick-Edinburgh Mental Well-being Scale (WEMWBS) [© NHS Health Scotland, University of Warwick and University of Edinburgh, 2006, all rights reserved] revealed a similar picture. Consultant physicians had lower (worse) mean scores (men 47.5, women 46.2) than the background UK population (men 50.1, women 49.6). Lower mean scores were particularly found among full time consultants and specialties such as gastroenterology, haematology, infectious diseases and medical oncology.
Areas of work affecting wellbeing
So what are the main factors which adversely impact on wellbeing? Our survey identified the following issues as those that had the most common adverse impact: Answering complaints 17%
- Patient administration 17%
- Meeting the organisation’s management team 15%
- Service development 10%
- Clinical management 7.1%
The same number of consultants at high and low burnout risk had received a complaint in the past year. However, those at high burnout risk were more likely to have been the subject of a serious incident investigation and four times more likely to have undergone a disciplinary investigation.
73% felt supported by colleagues during their complaint or investigation and but only 47% by their organisation.
16% of respondents had become a consultant in the past five years. 39% reported that this had adversely affected their wellbeing.
53% of consultants had undertaken a medical leadership role in the past five years. 54% reported that this had adversely affected their wellbeing.
Meeting with colleagues
Medicine has always relied on mutually supportive teams. Discussing work-related issues with colleagues, eating together and meeting outside work develops and reinforces such bonds. Trends in Hospitals have worked against this. Examples are disappearance of doctors dining rooms, loss of mess facilities and reduction in postgraduate meetings.
74% of consultants meet colleagues weekly or monthly to discuss work-related issues and only 3% said this never happened. However, 40% never eat meals at work with colleagues and 17% never meet socially outside work. Consultants at highest burnout risk met colleagues less either at work or socially and they reported feeling isolated at work.
What can we do to improve wellbeing among consultant physicians?
Our Colleges have been united in their view that we need to recruit more doctors from outside the UK in addition to developing a robust future workforce plan to reduce pressures on consultants. The plan must include a significant increase of medical school places and focus on effective job planning and facilitating flexible working, including keeping consultants working later in their careers. We set out our key proposals when we published the latest edition of the Physicians Census last year.
Other things employers can learn from this survey include:
- The importance of developing a just culture – in which systemic problems are identified and rectified, and mistakes learned from – as opposed to a blame culture in which burnt out doctors are held solely accountable for errors.
- Ensuring new consultants and those undertaking management roles feel supported, for example through induction and mentoring, is likely to improve wellbeing.
- Supporting consultants dealing with complaints, large patient administration burdens and disciplinary issues will help wellbeing.
- Encouraging socialising, both at work (through communal places to eat) and outside it, should have a positive effect on the risk of burnout and wellbeing.
- Formal opportunities to reflect on difficult clinical situations should be encouraged. These include Schwartz rounds and Balint meetings.
Richard Hull FRCP (Glasg) FRCP (London) is a Consultant Rheumatologist in Portsmouth, and is the Honorary Secretary of the Royal College of Physicians and Surgeons of Glasgow.
Dr Nigel Trudgill FRCP is the Medical Workforce Unit director and consultant gastroenterologist at Sandwell & West Birmingham Hospitals NHS Trust.