Burnout among GPs can be an occupational hazard and is believed to be increasingly common. Dr Rachel Birch, medicolegal consultant at Medical Protection, discusses burnout and the steps that sessional GPs can take to avoid it.
Dr A is a locum GP undertaking 5-6 sessions per week in different practices. She has chosen to do locum work, to balance her work life with that of bringing up her two small children. She has always felt passionately that, as a locum GP, she can contribute positively to practices by drawing on her experiences of working in different practices - ensuring that patients receive the same level of care from her that they would from their regular GP.
However, recently Dr A has felt overwhelmed at work and has found herself coming home exhausted physically. She no longer looks forward to work and has started to doubt herself, believing that nothing she does makes a difference to patients. She no longer takes pride in her work and feels numb when she thinks about her patients.
It is clear that Dr A is suffering from burnout.
What is burnout?
Burnout is an occupational hazard and can occur frequently among health professionals. According to mindtools.com, “burnout occurs when passionate, committed people become deeply disillusioned with a job or career from which they have previously derived much of their identity and meaning. It comes as the things that inspire passion and enthusiasm are stripped away, and tedious or unpleasant things crowd in”.
The Maslach Burnout Inventory (MBI) describes three domains that make up burnout:
- Emotional exhaustion
- Depersonalisation - a cynical attitude with distancing behaviours
- Low sense of personal accomplishment.
In the case scenario above, Dr A has symptoms in all three of the domains.
How common is burnout in GPs?
A survey of 500 GPs in the UK in 2012 found that 46% were emotionally exhausted, 42% were depersonalised and 34% felt that they were not achieving a great deal. A 2013 Pulse survey of 1,784 GPs revealed even higher levels of burnout - 74% were emotionally exhausted, 43% were depersonalised and 20% had a low sense of personal achievement. Since primary care continues to experience increases in both workload and expectation, it is likely that a high incidence of burnout remains.
What are the causes of burnout?
Research defines six key areas of work where an individual’s relationship with their working environment may be causing difficulty. Considering GP work, examples might be:
- Workload - too much work for the number of hours; unexpected emergencies; lack of resources.
- Control - micromanagement, lack of influence over decisions affecting their work.
Reward- not enough pay for the level of responsibility, lack of thanks or acknowledgment of their work.
- Community - Isolation at work, conflict, lack of supportive relationships at work, difficulty with a colleague.
- Fairness - Feeling of discrimination, lack of transparency of pay scales.
- Values - Feeling that administrative aspects of work are meaningless, ethical conflicts.
By examining these six key areas, it may be possible to identify one or more mismatches between the nature of the job and the individual’s own personality and attributes, which may lead to burnout.
What are the risks of burnout in a GP?
There are personal risks of suffering from burnout. If unrecognised or poorly addressed, burnout could predispose the individual to developing mental health problems such as anxiety or depression. Relationships and family life could also be adversely affected. The GP may feel disillusioned or develop feelings of low self-worth and this could lead to them leaving the profession. Experiencing burnout may also feel unpleasant.
There may be risks to patients too, as an emotionally exhausted doctor may make mistakes or miss diagnoses. Patient satisfaction may be affected too, a GP who no longer enjoys their work may inadvertently project some of their dissatisfaction on to a patient, and lead the patient to believe the doctor lacks empathy.
There are medicolegal risks too; doctors experiencing burnout may attract patient complaints or litigation, should a patient come to harm.
How can sessional GPs prevent burnout?
Prevention is better than cure. Being aware of burnout and its possible causes can help doctors to avoid it.
It may be that salaried and locum GPs have lower incidences of burnout than GP principals. The reason being that they can vote with their feet and include variety in their working lives, as well as avoiding working in practices they feel don’t suit their working styles. Also many sessional GPs may be members of locum chambers or sessional GP groups, giving them opportunities to meet with their peers, discuss local practices, and obtain support when needed.
If sessional GPs find themselves experiencing symptoms of burnout, then it is important to recognise this and consider making personal changes to build their individual resilience. However, since it is primarily the workplace environment that creates the occupational hazard of burnout, unless the practice makes changes too, it would be unlikely that the symptoms of burnout would be reversed.
Sessional GPs would be advised to raise the issue with their employers. If they are reluctant to do so, or if the issue is met with apathy or adversity, then one option, although difficult, may be for them to leave and find a safer workplace. A safe working environment is a practice where there is a clear understanding of staff wellbeing, with procedures in place to support the GP’s own resilience strategies.
By identifying possible contributing factors to burnout, the sessional GP could consider what they want from a practice. Examples of supportive measures could include:
- Workload - provide a manageable GP workload with built in break periods.
- Control - be flexible over start and finish times.
- Reward - have a culture of appreciation and thank staff for their hard work.
- Community - consider social events to enhance teamwork and a sense of belonging.
- Fairness - have a blame-free culture with regular meetings to learn from events.
- Values - celebrate achievements within the team.
Personal changes that GPs may consider making involve developing self-compassion. This is not always easy for GPs, who pride themselves on caring for others and may neglect to care for themselves. GPs can take care of their physical wellbeing by making changes at work and home respectively; by taking breaks, remembering to stay hydrated and not skipping lunch, eating healthy meals, exercising regularly and having enough good quality sleep. As general practice can be stressful, GPs may also need to nurture their emotional wellbeing, perhaps through meditation or the practice of mindfulness.
Finally, taking time to revisit their own sense of calling, the reason they chose to become a doctor, can be empowering and help sessional GPs to rediscover their passion and enthusiasm for their work and stay resilient.
In conclusion, burnout is an occupational hazard for GPs, and sessional GPs need to maintain an awareness of the symptoms and causes. Salaried and locum GPs are an essential part of the GP workforce and should be valued as such. It is important to choose practices they can thrive in, for the good of both themselves and their patients.
GPs that recognise feelings of burnout can contact Medical Protection to attend the building resilience and avoiding burnout workshop.
Writer and editor at MPS. MPS’s educational risk management workshops, ‘Mastering Professional Interactions’ and ‘Medical Records for GPs’ provide further information on the risks to patients and doctors when patient care passes between doctors, and on good record-keeping. They are free as a benefit of membership to MPS members too.