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Why male and female doctors burn out differently



Female doctors show more empathy than male doctors. They ask their patients more questions, including questions about emotions and feelings, and they spend more time talking to patients than their male colleagues do. Some have suggested that this might make women better doctors. It may also take a terrible toll on their mental health.

Studies indicate that female doctors are at greater risk of burnout than male doctors, and that this might be linked to differences to do with empathy. Burnout is bad for doctors and their patients. People with burnout feel exhausted, emotionally depleted, cynical and detached. They are also less satisfied with their work.

Doctors who develop burnout make more errors, are less likely to answer patients’ questions or fully discuss their treatment options. Interestingly, as people develop burnout, they show reduced empathy for others (so-called compassion fatigue). Compassion fatigue has been called the cost of caring because it is more commonly seen in health professionals such as nurses, psychotherapists and doctors.

One theory about why compassion fatigue sets in is that high empathy causes greater levels of emotional arousal and distress, so the reduction of empathy is simply a survival mechanism to cope with experiencing long periods or extreme emotional stress. This theory has been used to explain why medical students and doctors report lower levels of empathy as they progress through medical school and their post-graduate medical training. It might also explain why doctors’ brains show a reduced response to witnessing people experience pain, compared with people who aren’t doctors.

Men and women burn out differently

As well as the differences in risk of burnout, the way female doctors burn out appears to be different to the ways male doctors burn out. Identifying and understanding these differences might be important for recognising when doctors are developing burnout and getting help and support for them in time.

A four-year study of Dutch GPs found that, for female doctors, burnout begins with emotional exhaustion (feeling emotionally depleted), and then progresses to feeling increased depersonalisation (feeling detached or cynical about people and work). Finally, they tend to feel less work-related personal accomplishment and have reduced self-belief in their competence at work. This last component of burnout, reduced personal accomplishment, involves evaluating one’s work negatively and is likely to compound the problem as it increases stress and emotional exhaustion.

Conversely, male GPs report depersonalisation first rather than emotional exhaustion. Also, males did not report a reduced sense of personal accomplishment at work, even though this is one of the three traditional components of burnout. This means that, as they burn out, male doctors feel growing depersonalisation and emotional exhaustion but they often still feel effective, capable and competent at work – which is typically not the case for female doctors.

High suicide rates

In 2005, Eva Schernhammer of Harvard Medical School argued that there are stark differences in the psychological demands on female doctors, compared with males. Her review of 25 studies found that the female doctor suicide rate was about 130% higher than women in the general population.

In contrast, the suicide rate among male doctors is 40% higher than the suicide rate of males in the general population. Schernhammer concluded that the stress and burnout experienced by female doctors combines with other risk factors to contribute to high rates of psychiatric illness and suicide, compared with male doctors.

The additional risks include greater demands and expectations related to their family life, trying to succeed in a historically male-dominated profession, and experiencing sexual harassment at work. The influence of gender expectations on women’s suicide has a long history of being overlooked or ignored.

Gender expectations

When female doctors deliver more empathetic care, it may reflect our social expectations of gender roles rather than something innate. These include the idea that women are better at empathising than men, and that women are nurturing or caring. Studies also show that patients have different expectations of female doctors than they do of male doctors. For example, patients assume female doctors are more compassionate.

The idea that men are less likely to be caring and empathetic has possible benefits for male doctors. When male doctors show empathy, it can be an unexpected bonus for the patient, and so the doctor might seem better than anticipated. For example, male medical students with a good bedside manner are rated as more competent than female medical students who have a similarly good bedside manner. It seems that the females are simply expected to be more patient-centered and empathetic.

The disadvantages of these expectations for female doctors is that they are expected to do more “emotion work” than males. A study of more than 7,000 doctors found that female doctors were more likely to feel emotionally exhausted by work. They also felt that their work negatively affected their personal life, and they felt less valued by patients, colleagues and superiors, compared with male doctors.

Different expectations of doctors’ empathy based on their gender makes the job and workplace conditions unequal for doctors. And this appears to be a global phenomenon. Female doctors in Finland, South Africa and China all report higher levels of emotional exhaustion than male doctors. These results support the idea that female doctors’ jobs can be emotionally depleting for them and contributes to their increased risk of burnout.

The ConversationWe need to recognise that doctors face different expectations about empathetic care, depending on their gender. The emotional demands on female doctors puts them at increased risk of poor mental health. Regardless of gender, medical students and doctors should be provided with training that helps them navigate and sensitively address unequal experiences and expectations of delivering empathetic care.

Rajvinder Samra, Lecturer in Health, The Open University

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

The link between nutrition and mental illness



Poor nutrition is contributing to the increasing numbers of people suffering mental illness, a large psychiatry conference has been told.

Professor of Clinical Psychology at the University of Canterbury Julia Rucklidge says a well-nourished body and brain is better able to withstand ongoing stress and recover from illness.

She says it’s time Australian and New Zealand psychiatrists and psychologists “get serious” about the critical role nutrition plays in mental health.

“Not a single study has shown that a western diet that is heavily processed, high in refined grains, sugary drinks and takeaways and low in in fresh produce is good for us,” Prof Rucklidge said.

“The western diet is associated with poor mental health and eating a diet more akin to the Mediterranean diet improves mental health,” she said.

For more than a decade Professor Rucklidge has been leading research investigating the role of nutrition in mental health.

A previous paper – led by Prof Rucklidge – published in the British Journal of Psychiatry showed taking macronutrients improved ADHD symptoms, including attention, hyperactivity and impulsivity, compared to participants on placebo.

Professor Rucklidge told the the New Zealand Conference of the Royal Australian and New Zealand College of Psychiatrists in Tauranga on Tuesday that nutrition matters and that optimising nutrition is a safe and viable way to avoid, treat or lessen mental illness.

People are what they eat, Prof Rucklidge says.

“Every time we put something in our mouths we can choose to offer ourselves something nutritionally deprived or something nourishing,” Professor Rucklidge said.

The Royal Australian and New Zealand College of Psychiatrists (RANZCP) agrees psychiatrists need to think about the “whole person” and the relationship between mind and body, in particular nutrition.

Research has shown people with a severe mental illness die up to 25 years earlier than those without a serious mental illness, often due to preventable physical health conditions.

They experience much higher rates of cardiovascular disease, diabetes and respiratory conditions.

“Psychiatrists have a key role to play in ensuring that people with mental illness are not further burdened by avoidable chronic physical health conditions,” said Dr Kym Jenkins, President of the RANZCP.


Federal money announced for doctors’ mental health

Health Minister Greg Hunt will work directly with doctors to develop a mental health care package for the medical profession.

Addressing the AMA National Conference on May 26, Mr Hunt (pictured) said a recent spate of young doctor suicides – including that of Deputy Chair of the AMA Doctors-in-Training Council Dr Chloe Abbott – has been a cause for great concern.

The Minister said that after speaking with AMA President Dr Michael Gannon and former President Dr Mukesh Haikerwal, he was determined to develop a mental health package targeting doctors.

“One of the main things we introduced in the Budget was prioritising mental health. For the first time, this has been raised to the top level as one of the four pillars of the long-term national health Plan,” Mr Hunt said.

“And we were able to invest significantly in mental health, both in the election, but in particular, in the Budget as well. There’s a very strong focus on suicide prevention with support for suicide prevention hotspots and an $11 million initiative, but also complementing that with the rural telehealth initiative for psychological services.

“Much of this is deeply important preventive health work on the mental health side and it goes with what has to happen in, I think, the medical work force. The case of Chloe Abbott was outlined and I’m aware that many people have been affected by Chloe’s loss, as well as others.

“And Michael and I have been speaking this week, and also been speaking in recent weeks with Mukesh Haikerwal, and I am determined to offer a partnership with the Government and the AMA for us to provide new investment directly into caring for carers.

“And so I want to announce that we will offer a partnership going forward and we will develop the suicide prevention, mental health programs with the AMA and the broader medical work force for suicide prevention and mental health support, specifically for doctors and other medical work force professionals.

“One of the critical roles that you have is psycho-social services. There’s the clinical work with those with mental health issues, but then there is the support services.”

The Minister offered few details of the partnership, stressing that it was still in its conception stage.

But he was determined to take action.

Following his address to the conference, he spoke more to the media about the plan.

“There have been some terrible tragedies in the sector. Michael Gannon and other doctors, Mukesh Haikerwal, have talked to me about that,” he said.

“What we’ll be doing is developing a caring for carers package which will be assisting with specialist channels, because sometimes, and this is what’s been explained to me, those who are doctors or nurses (a) will feel that they shouldn’t be seeking help even though they’re just the same as everybody, and (b) they might feel professionally uncomfortable. Even though they might be in the depths of despair they’ll still feel that professional discomfort at reaching out.

“And so if they have some specialised services for them then they will feel more comfortable, we hope, and that’s what’s been proposed by the profession.”

He did not know if the plan would address the mandatory reporting lines, where doctors might fear they would be reported to the Medical Board when they seek help.

He also promised funds to the partnership, but could not say how much at this stage.

“There’s been no proposal put to me yet, but as I’ve said, in designing of this, what I really want to do is work with the AMA and the GPs,” he said.

“What we’re doing is we’re designing together, and from that we’ll have the outcome.”

This article was originally published in Australian Medicine. Read the original piece here.

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

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.

Doctor burnout: a worldwide epidemic

Burnout is the modern day pandemic affecting the medical profession. It is a condition which leaves many of us in denial. After all, it can’t be seen on a biopsy result or under an electron microscope, so how real can it be?

Very real.

Up to 59% of doctors are burnt out, according to a 2017 Medscape report. Some studies report burnout rates of up to 65% in some specialty groups, and the rates of burnout have increased over the last 10 years. It would be unlikely to consider that this is simply because there is greater awareness of the condition.

50% of medical students and 70% of junior doctors are burnt out.

This is staggering, and these results are across the board globally. Not just the USA and not just UK. These are overall global professional rates of burnout and the rates are deeply alarming.

Even if we had 30% of the profession suffering from burnout, this would still be a pandemic, yet there is not the global attention to this matter that it deserves.

If there was an outbreak of influenza or a critical disease globally that was wiping out even 5% of people and removing them from the work force, there would be a worldwide inquiry.

Yet here we have matters where there are up to 65% rates of burnout, over half of the entire medical profession, including students, and there is no worldwide inquiry into what is going on in medicine.

Certainly there is no vaccine likely to be available, but the matter is critical.

Ought not the World Health Organisation be taking a key interest in this matter?

The WHO has released a report stating that there is a worldwide epidemic of chronic non communicable diseases, yet there is no report stating that there is a worldwide epidemic of high level dysfunction in our doctors, the very people who are caring for those with illness and disease.

The health of our global population is clearly in crisis with increasing rates of illness and disease to the extent that the WHO has said there is a worldwide epidemic of chronic non-communicable diseases.

We need healthy health care providers to lead the way

If our health care providers are in a state of ill health, which is what burnout is, then we have an even bigger crisis on our hands.

These rates of burnout show that the medical profession is in crisis, and with it our global future health care is in crisis, at a time when we need healthy healthcare providers more than ever.

Burnout is not a simple matter of being a little bit tired. It is associated with higher rates of:

  • Depression
  • Anxiety
  • Fatigue – both physical and emotional
  • Increased risk of medical errors
  • Decreased rates of patient satisfaction,
  • Causes people to leave the medical profession
  • Higher rates of suicidal thoughts and increased risk of suicide (in a profession where the rate of suicide is already at least 2 times higher than the general population with some studies reporting up to 5.7 times higher rates)
  • Higher rates of cardiovascular disease and musculoskeletal pain
  • Deep professional unhappiness and cynicism
  • De-personalisation and decreased understanding and compassion

Neither of which are features desirable or sustainable in someone who is dealing with people in situations that are incredibly trying.

Burnout is not something that is random affecting a few ‘sensitive’ people with ‘poor coping skills’. It quite specifically affects over half of the medical profession, people who specifically enter a profession because they are dedicated to caring for others.

We need to stop and ask not only why, but how.

Are we to blame the ‘nature of the person’ choosing to do medicine, and blame them for simply ‘not coping’? Or perhaps rather is it time to take a wider look at the global culture of medicine that fails to nurture the people that do medicine?

Being in a war zone and in the armed forces is highly stressful, as I am sure that we would all agree and understand. Yet people who have been in the army and in a war zone report that medicine is far more stressful. This does not make sense given that we say that we are a caring profession that values and cares for people.

I have heard people formerly in the army say they were more cared for as people in the army and given greater respect and compassion as people than they have been in medicine.

It is clear that there is a big issue here.

Doctors are people too. If we are to be true to medicine and its foundations of care for all people, then we must equally care for the health and well-being of those who are doing their best to care for others, those within the profession.

Literally over half of our medical profession is burnt out. This is not simply a matter of a few people being a bit tired from too much work to be decried for ‘not coping’. This is an institutionalised issue, a worldwide crisis and one that global attention needs to be paid to.

Dr Maxine Szramka is a Sydney-based rheumatologist and Clinical Senior Lecturer at the University of Wollongong. She blogs regularly at Dr Maxine Speaks.

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

For further support and information, call Lifeline on 13 11 14

Why don’t we speak openly about doctor suicides?

Why don’t we speak openly about doctor suicides?


Just over a week ago, I read an obituary in a medical publication about a young talented and clearly lovely junior doctor. Her life and achievements were celebrated, but no mention was made of the cause of her untimely death. Some colleagues and I surmised it was suicide, but then we wondered why it was it was not mentioned in the obituary.  Subsequently, suicide was confirmed, but at the time it felt as though there was an embargo on talking about doctor suicide. There is a shame about discussing it in public, and if this is the case, how can we possibly learn about the things that lead to suicide in our colleagues? We discuss medical cases openly so that we might learn, but why not of our colleagues who reach a point of no return?

It is well known that doctors do have a higher rate of suicide than the general public. These results have been reported as being up to 5.7 times higher than the general public. Female doctors are at the greatest risk with rates 2.27 – 5.7 times higher.

These results are staggering, but the fact that we have suicide at all in the profession is indicative of a deep dis-ease in our profession.

How is it that we can have people who are caring by nature, who choose to do medicine to care for people, but ending up so despairing that they take their own life?

And worse, that their colleagues and medical friends do not notice their decline to that point and are often completely surprised to hear of the death of a colleague in such a fashion?

These suicide statistics have been known for some time, yet until now, no true action has been undertaken.

In response to recent matters, last month the NSW Health Minister Brad Hazzard, instructed his staff that they have one month to come up with a plan for the doctor suicide crisis. It is great to see urgency brought to this matter, but is one month really enough and will it really get to the root of the cause?

What we are looking at here are ingrained issues, where for so long suicide has been accepted as a “sad yet inevitable”, or an “occupational hazard”. I was taught the statistics as though it was an inevitability that could not be altered. But is this really the case, and is this the way we would or ought to approach other health issues?

As doctors, we care about the health of people in medicine, yet we do not appear to be taking the same care and attention to the health of people in our own medical community.

Doctor suicide occurs within the context of the health care system and culture

Increasingly the culture of medicine is being revealed as replete with bullying and harassment. Far from caring for health care professionals, the culture of medicine is that of judgement, critique, condemnation, blaming and shaming. There is no true care and attention brought to the health and well-being of doctors and we are not trained in any suitable way how to deal with the emotional demands of the job, nor are we taught how to look after our own health and well-being.

Medicine is not a culture of peer support, but rather of peer competition and judgement. Any sign of human vulnerability and feelings is seen as a sign of failure. Medicine teaches you to be a “doctor” and not who you are as a human being. You are taught to “toughen up”. You learn that only the tough survive. There is stigma for those with mental health issues. People become isolated, hiding what they are going through. There are definitely some cultural factors that need addressing.

I have heard it said more than once that medicine is more stressful than being in the army or in a war zone, and that there is more compassion for your well-being when you are a soldier. In such a harsh environment, does it really surprise us that people do not survive?

As health care experts, why are doctors ‘surviving’ and not thriving?

Doctor suicide is the end of a long line of health issues for doctors, who are well known to have worse mental health than the general population on a number of counts. For every doctor who actually dies by suicide there are many who make an attempt but survive. Statistics show that  40-55% of the profession are burnt out with all of the personal health issues that entails such as higher rates of cardiovascular disease, anxiety, depression, diabetes, musculoskeletal disorders and suicidal thoughts. 25% of the profession have thought about killing themselves.

Doctor suicide exists in a longstanding culture that is well established to be uncaring and, at times, frankly abusive towards its own professionals. Suicide is an absolute tragedy but the day-to-day ill health of the medical profession is also a serious issue that needs to be recognised.

If we are serious about dealing with doctor suicide, we need to address the entire medical culture and system including the educational, medico-legal and regulatory aspects as well as personal factors at play. We need to be willing to make the needed changes. But we cannot do that until we are completely open about it and willing to examine the issue in absolute fullness.

Given the long association of suicide with the medical profession, there is clearly something amiss and thus something that can potentially be rectified. Let’s not look for short term solutions. Let’s aim to truly address the situation in full and get to the roots of the matter. Lives depend on it.

Dr Maxine Szramka is a Sydney-based rheumatologist and Clinical Senior Lecturer at the University of Wollongong. She blogs regularly at Dr Maxine Speaks.

Doctorportal hosts a dedicated doctors’ health service providing support and information about suicide prevention in the medical community.

For support and information about suicide prevention, call Lifeline on 13 11 14