Health departments should support the professional training they require and show that their employees are value

Glozier, Nicholas

The Medical Journal of Australia

Sydney eScholarship

Ms No .mja22.01402.R1 Section: Editorial Med Ed: Wendy Morgan Filename:glo01492-002_V3 Pub date: 03/04/23 Asst Ed: Paul Foley Pg: 3 Date last edited: 12/03/24 Go with:  Distress and career regret in doctors: are we really that different to other professions?  Health departments should support the professional training they require and show that their employees are valued  [Authors: Editorial authors are invited to supply head-only photographs (JPG or TIFF:  uploaded to Scholar One or forwarded directly to pfoley@mja.com.au.].  The COVID-19 pandemic has again focused attention on the mental health and wellbeing of doctors, particularly those in training. An earlier meta-analysis (54 studies during 1963– 2015 that included a total of 17 560 trainee doctors) found that 21–43% (pooled estimate: 28.8%) had symptoms of depression during residency.1 The cross-sectional online survey of Australian orthopaedic trainees in late 2021 reported by Author and colleagues in this issue of the MJA2 found even higher rates of distress and burnout: 39 of 88 respondents (44%) met the Physician Well-Being Index criterion for distress (a short 7-item measure); 55 (63%) had experienced burnout during the preceding 30 days. Those who reported distress were more likely to regret having chosen medicine as their career.2 How concerning are these findings? Survey rates of various indicators of poor wellbeing (distress, depression, burnout) derived from nationally representative population-based surveys are generally 30–50% lower than reported for doctors3, leading to the conclusion that poorer wellbeing is more frequent among doctors than other adults. However, there are reasons why junior doctors should have better mental health than other workers,3 including the fact that they are often socio-economically advantaged,4 are by definition well educated, have successfully negotiated early adulthood (when most chronic mental illness emerges), and have a vocation with purpose and minimal likelihood of unemployment. [Author: The overall effect of the initial question and what follows in this paragraph might suggest that the findings in ref. 2 are not very concerning. Is this intended?] One explanation for the discrepancy is that single occupation surveys have important limitations. Most surveys have relatively low response rates (38% in the study by Author and colleagues2), raising the problem of respondent bias producing a “grumpy worker effect”. A United Kingdom meta-analysis covering a broad range of professions found rates of distress in single occupational studies to be fairly consistent at one-quarter to one-third of respondents, significantly higher than rates for the general adult population.5 The authors concluded that being recruited to “stress surveys” may lead to selection bias or over- reporting, and that this problem is shared by many occupations.5 When we examined rates for various professions derived from repeated national representative surveys in Australia with very high response rates (greater than 90%), the prevalence rates of mental ill-health were in the range 4–22% in 2019, and 8–22% in 2020 6; [Author: OK? To match Table 1.] the prevalence was lowest for doctors, with higher rates of pay and of life satisfaction, than for the other professions examined (lawyers, engineers, accountants, nurses and midwives, and teachers).6 Over the past few years, even before COVID-19, professional bodies in Australia have reported similarly low morale, burnout, and job dissatisfaction among emergency service workers,7 architects,8 and teachers.9 So are doctors any different to other professionals? We do differ in two key ways: the length and depth of our apprenticeship, and who pays for our professional training. Medical schools in Australia have changed radically in recent decades: thirteen of twenty-one [Author: On re-examination, I think your original number of 21 is correct] medical programs are now graduate entry degrees, often providing accelerated four-year, instead of five- or six-year, programs. To compete internationally, most graduate programs provide MD qualifications, cramming into these shorter courses a research project that once      MINIMUM 300dpi resolution, 1000x1000 pixel) to accompany their article. They can  Ms No .mja22.01402.R1 Section: Editorial Med Ed: Wendy Morgan Filename:glo01492-002_V3 Pub date: 03/04/23 Asst Ed: Paul Foley Pg: 4 Date last edited: 12/03/24 Go with:  [Author: OK?] Injury Commission and several private companies providing income protection and total permanent disability insurance. . I have been an advisor to the World Health Organization, Safework NSW, the NSW Personal required an extra year. Recording “learning experiences” and continuing workplace assessment fill students’ days, while professionalism, communication, and ethics courses compete for time with pre-clinical and ward-based learning, with (at my university, at least) extensive attendance requirements. As a result, medical students are older when they graduate and have acquired more debt than earlier generations;10 more have competing family and parental responsibilities than younger undergraduate medical students, and with less of the downtime many older clinicians had when they were studying. The number of medical graduates in Australia increased from 2733 in 2010 to 3637 in 2019 [Author: OK, to match reference?] (33% over nine years);11 and career progression in many specialities is slowed by bottlenecks, while other areas, including general practice and psychiatry, struggle to fill training roles. Nevertheless, in 2019 more final year students wanted to pursue surgery as a career than any other speciality except “adult medicine”, and only one final year student wanted to work in addiction medicine!11 After graduation, junior doctors face a mixture of excessive and conflicting demands. The social connections and support that help deal with long and stressful work hours are undermined by training rotations to far-flung hospitals and frequent early year job changes. We do not know the ages of the surgical trainees in the survey by Author and colleagues,2 but most were probably in their thirties. Career regret and jealous glances at schoolfriends in professional careers, often fully qualified and many earning six figure salaries in their late 20s, paying their personal trainers more per hour than a junior doctor receives, are understandable. Given the similar rates in other professions, distress and career regret are likely to affect a minority of trainees. However, the authors of a new meta-analysis of longitudinal studies12 suggested that increasing resources and reducing work demands for junior doctors would improve their work engagement and clinical care. The same may be true for students, who may also need guidance about career pathways and community needs. After demanding weeks in hospitals, junior doctor’s weekends are regularly spent preparing for expensive exams (and paying HECS debts), unlike most other young professionals who have had protected study leave and for whom exams are paid. Surely it is time that health departments act like good employers, and fund and support the professional training they require and show that their employees are valued? Acknowledgements: I am supported by the Australian Research Council through the Centre of Excellence for Children and Families over the Life Course (project CE200100025). Competing interests:   Provenance: Commissioned; externally peer reviewed.   Author details Nicholas Glozier The University of Sydney, Sydney, NSW. nick.glozier@sydney.edu.au doi: 10.5694/mja22.01402 See Research (xxxx)  References 1 Mata DA, Ramos MA, Bansal N, et al. Prevalence of depression and depressive symptoms among resident physicians: a systematic review and meta-analysis. JAMA 2015; 314: 2373-2383. 2 Author, et al. Distress and career regret in Australian orthopaedic surgical trainees. Med J Aust 2023; 218: 000-000. 3 Harvey SB, Epstein RM, Glozier N, et al. Mental illness and suicide among physicians. Lancet 2021; 398: 920-930. 4 Steven K, Dowell J, Jackson C, Guthrie B. Fair access to medicine? Retrospective analysis of UK medical schools application data 2009-2012 using three measures of socioeconomic status. BMC Med Educ 2016; 16: 11. 5 Goodwin L, Ben-Zion I, Fear NT, et al. Are reports of psychological stress higher in occupational studies? A systematic review across occupational and population based studies. PLoS One 2013; 8: e78693. 6 Hoang KTA, Morris RW, Naehrig DN, Glozier N. The comparative mental health of Australian doctors before and during COVID-19: a population-based approach. Aust N Z J Psychiatry 2023; doi: 10.1177/00048674221106677 [online ahead of print.] 7 Kyron MJ, Rikkers W, Bartlett J, et al. Mental health and wellbeing of Australian police and emergency services employees. Arch Environ Occup Health 2021; 77: 282-292. 8 Shea T, Cooper B, Gusheh M, et al. The wellbeing of architects 2021. 2021 Practitioner survey, primary report. 2022. https://thewellbeingofarchitects.org.au/publications/the-wellbeing-of-architects-2021-practitioner-survey- primary-report (viewed Feb 2023). Ms No .mja22.01402.R1 Section: Editorial Med Ed: Wendy Morgan Filename:glo01492-002_V3 Pub date: 03/04/23 Asst Ed: Paul Foley Pg: 5 Date last edited: 12/03/24 Go with:  9 Thomson S, Hillman K. TALIS 2018. The Teaching and Learning International Survey. 2018. Australian report, volume 2. Teachers and school leaders as valued professionals. Australian Council for Educational Research, 2020. https://research.acer.edu.au/cgi/viewcontent.cgi?article=1007&context=talis (viewed Feb 2023). 10 Owler BK. Medical degrees being priced out of reach [internet]. Australian Medical Student Journal, 1 Sept 2015. https://www.amsj.org/archives/4241 (viewed Dec 2022). 11 Medical Deans Australia and New Zealand. Student statistics. https://medicaldeans.org.au/data (viewed Dec 2022) 12 Teoh K, Singh J, Medisauskaite A, Hasard J. Doctors’ perceived working conditions, psychological health and patient care: a meta-analysis of longitudinal studies. Occup Environ Med 2023; 80: 61-69. 

Distress and career regret in doctors: are we really that different to other professions?

Nicholas Glozier

Crossref

https://ses.library.usyd.edu.au/bitstream/2123/32343/3/Distress%20and%20career%20regret.pdf

Distress and career regret in doctors: are we really that different to other professions?

Abstract

Similar works

Full text

Available Versions

Sydney eScholarship

Crossref