The war on GP workload

When everyone around you is working at full pelt and beyond, what do you do if you feel your whole way of working is unsustainable, especially when you feel forced to work in this unsustainable way? Sonia Hutton-Taylor helps explain what you should do if the early signs of burnout start to emerge.

This is a really taxing question to which there are no easy answers. The Catch 22 surrounding burnout is that as one sinks down its' slippery spiral, one ends up with less and less energy to do something about it.

So my first piece of advice would be to spot it early and do not ignore it. Learn more about burnout and how to spot the early signs.

But what to do if you are already somewhere in burnouts' sticky clutches? Again - no easy answers as the solutions for one person will be very different to those for another.
But let me set the scene. Recently I’ve had some GPs come through the career programmes at Medical Forum who have the most ridiculous working weeks, yet they feel totally powerless to change anything. What that does is make them want to resign, and change career. Yet they are also too frazzled to make any inroads into any type of in depth career re-evaluation. Trying to instigate changes to how and where you work whilst also only just hanging on by your fingernails is a non starter.

This intolerable way of working, or being expected to work, is without doubt contributing to the shortage of GPs, and it seems the powers that be can’t replace them fast enough, even from abroad. So those remaining on the hamster wheel just run faster.
My belief is that the only way to stop this is to stand up and be heard. And I don't mean strikes or expecting the medical trade unions to take action either. I mean speaking assertively and honestly to colleagues.

Yet people are fearful of doing this. They have reasons, some well founded, some not. The main objections appear to be that either everyone else is seeing 90 patients in a morning, or none of the partners want to take a drop in income

What - so they will work until they prematurely drop instead? And are hell bent on taking you with them?

90 patients in a morning? OK, I exaggerate, but I have come across doctors who have well over 70 patient interactions in a day (EEC suggests 25). It is just not humanly possible to keep on top of seventy cases a day, let alone have time to follow up the handful that are more complex and warrant additional thinking time.

Whatever the excuses or downsides to speaking up, you have your own health and sanity to worry about along with patient safety, and the two go hand in hand. You only have to look at a standard stress performance curve to see that beyond a certain point, performance drops off dramatically.

I know not everyone will feel they can speak up, and not everyone will need to, but if a few do, it could be the start of a sea change.

And for anyone thinking that doctors just need to be a bit more resilient I would say this (amidst sound effects of my blood boiling): the vast majority of medics I have met over the years ARE very resilient; to get through medical training you need to be resilient. They are working at the top of the resilientometer scale already.

And whatever additional resilience training you do for someone, if they have 70 patients in a day, the problem is not the resilience of the doctor that is under scrutiny, nor time management; it is the simple fact that too much is being stuffed into their day. End of.
I think salaried GPs and locums have a real potential influence here in that as non-partners in a shortage climate, they can start to gently dictate their terms and thereby start a cascade of clotting factor proportions. Eventually, with a will and a headwind, this may begin to rub off on the partners too.

I have had several clients who, when their work went to 15-minute appointments, say that this dramatically affected how they feel about their work. However, there are some for whom this appears to have made no difference whatsoever. So one size of solution will not fit all.

But let me start with the basics. To me, if I am paid for a half day:

  • I arrive at 9
  • I have 15 minutes minimum to do some paperwork
  • I have 15 minutes appointment
  • I get a break mid-morning
  • I finish at 11.30 with another 15 minutes for admin
  • And then I do two visits (not 5)
  • Downing tools at 1 so that I can
  • Have lunch with a friend, or go for a quick swim, or have a walk

Then start my afternoon at 2pm in good time, having eaten something and refreshed to face the busy afternoon clinic. Or something akin to this.
Then there is a shred of a chance that I might arrive home at the end of the day with a smile on my face, happy to see my family and with some energy to enjoy my evening with them or pursue a hobby. Anything less than that sort of work style is no better than the Victorian workhouse, peasants in feudal times or slave labour in plantations.

Notice what I am doing here? I am attempting to reset a very, very faulty thermostat, although perhaps I have swung a little too far the other way.

It is no good anyone talking about work-life balance on GP registrar training days or in GP conferences when a half day starts at 8.30 and continues to 3pm; that's five to 6.5 hours, not half a day!

I know medics don't think like that, but perhaps it is time that we did, or at least started to contain our work to what is reasonable for us, and not what needs to be done as dictated by others or demand. Why should anyone work unsustainably whilst risking their own health, tantamount to industrial injury. It should be part of early medical training that you learn how to protect yourself from the potential bottomless pit of patient care that threatens to swallow you up, if you let it.

So rather than resilience training, I'm more a fan of boundary setting, assertiveness, self preservation and self care...topped with a smidgen of career planning.

This article first appeared in The Sessional GP magazine.

1 Response

  1. The real answer lies in the question-" what is driving doctors to be Martyrs". Could it be such low self esteem that People- pleasing is the only drug available to fill the void that needs to be filled with self love and acceptance? Or is this truth a step too far?

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