NOWHERE is the cliché “practise what you preach” more pertinent than in the medical profession. Despite doctors being professional empathisers, we seem to experience difficulty extending this empathy to ourselves or our colleagues. More often than not, experiencing hardship in medicine is seen as being soft, undependable or “acopic”. Taking sick leave is often regarded as “letting the team down” rather than time for an individual to recover.
Australian doctors’ health and wellbeing is influenced not only by medical practice being a difficult and demanding profession, but also by the increasing competition for training places and jobs due to a more than doubling of medical graduate numbers. Levels of stress and suicide rates among doctors are above those in the general population and other professions (beyondblue 2013). Perhaps influencing these rates are laws that require the mandatory reporting of doctors’ “impairments”. According to Australian Medical Association (AMA) President Dr Michael Gannon, “mandatory reporting laws deter health practitioners from seeking early treatment for health conditions that could impair their performance”. The AMA is lobbying the government to try to have these laws repealed, as it is paramount that doctors feel safe to seek advice and treatment.
Is there any evidence that doctors’ health has actually worsened over time, or are we hearing more about it due to a rise in awareness from social media, mainstream media and other public forums following the Royal Australasian College of Surgeons’ report and response with respect to bullying? Certainly, problems such as violence, aggression, bullying, gender discrimination, burnout, unsafe hours, mental health and suicide rates have featured prominently in the media.
The Medicine in Australia: Balancing Employment and Life (MABEL) study is a unique longitudinal study that has surveyed a large cohort of Australian doctors — on average 9325 respondents per annum — with the 10th annual wave out in the field. Descriptive data from the 2008–2015 surveys offer some evidence about changes in doctors’ perceived health over time.
Each year, MABEL asks doctors to rate their own general health from “excellent” through to “poor”. In 2015, 34% of respondents reported “excellent” and 39% reported “very good” health, whereas 6% reported “fair” and less than 1% reported “poor” health. These results fit the stereotype that doctors are healthy people.
Of concern are the 0.76% of doctors (63/8245) who reported “poor” health. If this fraction is applied to the 83 731 Australian medical practitioners in clinical practice (Australian Institute of Health and Welfare 2015), it translates to 636 doctors who reported “poor” health. That is 636 doctors in this country who possibly had health issues that could be perceived as “impairments”.
Have the numbers changed over time? According to MABEL, they fluctuate; the highest percentage reporting “poor” health was in 2008, the inaugural survey year, constituting 1.1% (110/9972) of surveyed doctors. Low numbers meant that this small percentage varied between 0.6 to 1.1% over the years surveyed (Figure, A). Looking at those doctors reporting “fair or poor” health, the percentage was highest in 2008 at 9.5% (946/9972), falling to 6.0% (527/8851) in 2013, but climbing again to 7.1% (588/8245) in 2015 (Figure, B).
Figure. Percentage of doctors reporting “poor” (A) or “fair or poor” (B) general health by year of MABEL survey (2008–15)
Of course, self-assessed health status is a simple and crude measure of overall health. The upturn since 2013 could be the result of increased likelihood of reporting due to recent publicity. It would be useful to add more questions to MABEL that capture mental health, as was done in the 2013 beyondblue survey. Despite the fact that physical illness contributes to impaired psychological wellbeing and suicide risk, doctors are guilty of neglecting their own health. Australian data are limited, but reports suggest that only 55% (Davidson 2003) to 66% (Markwell 2009) of doctors have their own regular GP.
A recent paper by Milner and colleagues using MABEL data went further in analysing the psychosocial stressors affecting doctors’ health and wellbeing. They found that higher exposure to excessive job demands, low social support at work and long working hours result in poorer self-reported health and wellbeing among doctors. There were apparent gender differences in factors contributing to poor health, with women more adversely affected by part-time work arrangements, low reward for work and work–life imbalance. Men were also affected by work–life imbalance, but more soby high job demands and reduced job control.
Although doctors have higher rates of mental health problems and suicide than the general population, they take very few days off work. In MABEL, doctors reported an average of 2.7 sick days per annum. Whether this number accurately reflects doctors’ health, stoicism or a perceived inability to take sick leave, remains unknown.
We need to obtain more systematic evidence of changes in doctors’ health over time, and the factors that drive poor health, in order to support them. MABEL is in the perfect position to achieve this objective, being a national longitudinal survey with a vast database. Perhaps subsequent surveys could analyse doctors’ health questions in more depth. For example, their physical versus mental health, access and barriers to health care, and who may be at highest risk of mental illness and suicide.
We need more effective ways to support doctors, rather than dismissing their most difficult days as “character building”, and telling them to “toughen up”, or be “more resilient”. To date, while some initiatives, such as Doctors’ Health Advisory Service and Sydney-based BPTOK (a pilot program at Royal Prince Alfred Hospital for Basic Physician Trainees), are offering health and wellbeing programs to doctors, there has been little evaluation of their impact. Is the onus on the individual doctor to access these types of services? Are these services adequately reaching out to doctors at risk? Are doctors being referred because of some adverse event and in what numbers? Questions such as these could potentially be addressed by MABEL, enabling targeted services to benefit doctors in the future.
Venita Munir is a non-practising emergency physician, writer and editor, writing for MABEL (Medicine in Australia: Balancing Employment and Life), Melbourne Institute of Applied Economic and Social Research, University of Melbourne.
This article used data from the MABEL longitudinal survey of doctors conducted by the University of Melbourne and Monash University (the MABEL research team). Funding for MABEL comes from the National Health and Medical Research Council (Health Services Research Grant: 2008–2011; and Centre for Research Excellence in Medical Workforce Dynamics: 2012–2017) with additional support from the Department of Health (in 2008) and Health Workforce Australia (in 2013). The MABEL research team bears no responsibility for how the data have been analysed, used or summarised in this article.
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