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Seven survival tips for doctors in training


You’ve completed your studies, done your internship and are finally qualified to practise. You might think the worst is behind you, but research is increasingly showing that junior doctors in training are one of the most vulnerable groups in medicine.

According to a 2008 AMA survey, junior doctors routinely work up to 60 hours a week, with most sleeping less than seven hours and only a quarter finding the time to exercise regularly.

But it’s not just the long hours that can be deleterious, it’s also the lack of autonomy that goes with the job, with junior doctors having little say over how and where they spend those long hours.

The hours, coupled with uncertainty over placements, can take a heavy toll on personal relationships and family life. Days off are few and far between, and the temptation can be to use any spare time to do work-related activities rather than enjoy proper down time.

The workplace itself can add to a junior doctor’s stress. Doctors may be uncertain about their future, suffer inflexible work conditions and may be exposed to abuse from patients as well as bullying from senior colleagues. It can be a bewildering minefield for a doctor fresh out of internship to navigate.

Here are some tips for staying healthy and keeping your sanity during the training years:

  • Research as much as possible the demands of each specialty, including hours and placements. That way you’ll have a clearer idea of whether it fits in with your idea of an appropriate and healthy lifestyle.
  • Adopt a mentor: many hospitals have mentorship programs, and having a senior consultant with whom you can discuss clinical, professional and career-related issues on a one-on-one basis can be an enormous help.
  • Keep close relations with your peers. It’s good to find colleagues with whom you can socialise outside shift hours: that way, you’ll be able to debrief each other and also lean on each other through the tough times.
  • Make your own health your priority: you can’t manage other people’s health if you can’t manage your own. Find a GP before you need one, particularly if you’re moving to a new area. And resist the pressure to turn up for work when you’re sick: it’s not good for you, your patients or your colleagues.
  • Find time for physical exercise: it’s not only good for your health, it’s essential for combating inevitable work fatigue and potential burnout.
  • Work at maintaining family relationships and friendships: they are your outside support network, giving you perspective and helping you manage day-to-day stress.
  • Maintain or develop outside interests. Whether it’s sport, playing music or going to the movies, non-medical interests will help you find some work-life balance and can be an important de-stressor.

Source: Avant

The Australian Medical Association has a wide range of online resources for doctors in training on their website.

For more information about health issues for doctors, access a range of online resources from Doctors’ Health Services Pty Ltd.

Study quantifies junior doctor distress


Australian junior medical officers (JMOs) suffer from dangerously high levels of psychological stress that are considerably greater than in the general population, according to new research published in the Internal Medicine Journal.

The study of over 1,000 JMOs surveyed between 2014 and 2016 assessed distress according to the commonly used Kessler Psychological Distress Scale (K10). The average score was 18.1, compared with 13 in the general Australian population shown in previous studies.

Unsurprisingly, increasing hours of work correlated with higher distress, with every extra hour worked per week increasing the odds of a high K10 score by 3%.

Smoking and drinking alcohol as ways of relieving stress were correlated with higher levels of distress, as was taking illicit drugs, which 7.7% of those surveyed admitted to doing.

Feeling ill-equipped during internship and workplace bullying were also associated with higher distress levels.

On the other hand, spending time with friends or family correlated to lower levels of distress.

Only 17% of those surveyed had resorted to professional help for their psychological distress. GPs were most commonly the first port of call, followed by private psychologists or psychiatrists.

Worryingly, nearly 20% of JMOs said that if they had their time over again, they wouldn’t choose to do medicine.

The researchers from Sydney’s Nepean Hospital said that theirs was the first study to measure psychological distress in Australian JMOs over a three-year period. The bulk of existing literature relies on data from overseas, they noted, and even that literature was skewed towards senior clinicians rather than junior doctors.

They wrote that although long hours correlated with increased distress, one of the issues was the difficulty of accurately monitoring how many hours JMOs worked, due to a culture of unpaid overtime.

They said their work demonstrated the need for a more focused approach to JMO support and education, encompassing increased administrative support, education on coping strategies and action around bullying behaviour.

You can read the study here.

The Australian Medical Association has a wide range of online resources for junior medical officers on its website.

For more information about health issues for doctors, access online resources from Doctors’ Health Services Pty Ltd.

Doctors’ health: the wrap


All this month at doctorportal we’ve been highlighting the critical issue of doctors’ health and wellbeing.

The doctorportal website hosts the online resources of Doctors’ Health Services Pty Ltd, an organisation funded by the Medical Board of Australia and coordinated by the Australian Medical Association. Its aim is to ensure doctors and medical students, no matter where they live in Australia, have access to consistent and readily available services, including advice, referral and health-related triage.

Here’s a roundup of doctors’ health stories we’ve covered at doctorportal this June:

For more information about health issues for doctors, access a range of online resources from Doctors’ Health Services Pty Ltd.

Or phone:

NSW and ACT … 02 9437 6552

NT and SA … 08 8366 0250

Queensland … 07 3833 4352

Tasmania and Victoria … 03 9495 6011

WA … 08 9321 3098

New Zealand … 0800 471 2654

Lifeline on 13 11 14

beyondblue on 1300 224 636

What needs to happen to build resilience and improve mental health among junior doctors

Doctors experience higher levels of suicide and mental distress than their non-medical peers. A review of studies in the area found male doctors had a 26% higher risk of suicide, while female doctors had a 146% higher risk (more than double) than the general population.

And a recent survey, conducted by the mental health foundation beyondblue, confirmed there were higher rates of suicidal thoughts and psychological distress among doctors and medical students than in the general community.

But beyond the numbers are tragic stories of young individuals who lost their lives to suicide. In recent months, the suicide of four junior doctors in New South Wales has prompted the state government to investigate the issue. News reports have suggested at least 20 doctors took their own lives between 2007 and 2016 in NSW.

Family members have pointed to stress, “brutal expectations” and working hours as having had an impact on the doctors’ decisions to end their lives.

Are our medical students and junior doctors overworking? Can we identify underlying causes of mental distress and suicidal thoughts, as well as the warning signs? Can medical schools, hospital employers, supervisors, professional organisations and peers do more to prevent further tragedies?

A host of factors

Various inquiries and reviews have considered the above questions, in Australia and overseas. The conclusion is that it’s complex. Behind the phenomenon are a number of interacting factors.

There’s a legacy professional culture that can still view any admission of psychological distress as weakness or incompetence.

Doctors face long work hours in a pressured work environment. They experience anxiety about making mistakes that can have serious consequences.

Workplace bullying and harassment can also contribute. While this has most recently been highlighted among trainee surgeons, it probably extends well beyond surgical training.

And of course doctors have technical knowledge and access to the means to end life.

A lot has already been done to try to improve doctors’ mental health. For instance, progress has been made to reduce working hours. Prolonged shifts and continuous on-call rosters have been discontinued in most, if not all, health service rosters. This was at least in part in response to pressure from the Australian Medical Association (AMA) Safe Hours campaign, which outlined the risks to patients and practitioners of excessive hours worked and the need for breaks between shifts.

These recommendations have been incorporated into industrial agreements for hospital medical staff. These stipulate maximum working hours and mandatory periods of time off. However, 14-hour shifts and rosters that include one in three or four weekends without any reduction in weekday hours are not uncommon. There is considerable anecdotal evidence that some junior doctors are working more hours than they are rostered for.

Progress has been made in other areas too. Polices for better orientation of junior doctors in hospitals to explain supervision and avenues for support have been implemented. Other measures adopted include: education and mentoring programs in hospitals; supervisor training; blame-free reporting; assessment by external accreditors of health services’ and specialty colleges’ reporting and support arrangements; mental health first aid training for students; medical student guides; and confidential doctors’ health services.

But introduction of these initiatives has been patchy. The levels of support available in different hospitals are variable, and too often dependent on a few enthusiastic individuals. A systematic national approach would have much greater impact.

Medical graduates

One source of increasing stress for recent graduates, anecdotally, is the intense competition to get a job that will be their pathway to a specialist qualification. This pressure has its genesis in the dramatic boost to medical graduate numbers over the past 15 years.

Training beyond medical school is an intense period of four to nine years of work, on-the-job learning, study and examinations. By doubling the number of medical schools and almost tripling the number of medical graduates, Australia has severely increased competition in capital-city teaching hospitals (where, unfortunately, most of the training jobs for medical graduates remain based).

Ironically, the main reason for the boost in graduate numbers was the shortage of doctors in regional areas. An increasing number of young doctors (including those who trained in rural clinical schools or regional medical schools) feel that they have little choice but to apply for accredited metropolitan training posts.

They would be better off working and training from a home base in regional Australia, if only the specialist training pathways existed. Australia desperately needs to re-align this phase of medical training to better serve both regional communities and graduates.

Building resilience

There are core professional capabilities that should be taught and modelled throughout medical training. These include managing one’s own health needs, dealing with stress and fatigue, recognising and assisting distressed colleagues, and reporting bullying and harassment.

Medical schools and hospital employers could do better in finding ways to communicate with one other to protect more vulnerable graduates as they transition into the workforce.

We should also critically review our approaches to selecting students into medical school. Selection policies that promote greater diversity, place more emphasis on humanistic qualities (qualities that define who we are as human beings such as honesty, integrity, courage, self-awareness and wholeheartedness) rather than examination marks, and that include people with a positive orientation to risk and innovation may help to take the steam out of the pressure cooker. These approaches could also improve workforce outcomes in rural and under-served communities.

Beyond “resilience building”, there are important system challenges in how the nature of healthcare needs to be transformed into something that is more integrated, person-centred and community-based. This has particular implications for our larger institutions.

It turns out that finding “joy and meaning” in healthcare work is not only good for doctor well-being, it’s also safer for our patients. Teamwork, fun and personal fulfilment in caring for others are the essence of the joy of medicine.

The ConversationIf this article has raised issues for you or if you’re concerned about someone you know, call Lifeline on 13 11 44.

Doctorportal hosts a dedicated doctors’ health service providing support in the medical community.

Richard Murray, Dean of Medicine & Dentistry, James Cook University and Brendan Crotty, Professor & Executive Dean, Faculty of Health, Deakin University

This article was originally published on The Conversation. Read the original article.