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11 Oct 2019

BY DR HASHIM ADBEEN, DEPUTY CHAIR, AMA COUNCIL OF DOCTORS IN TRAINING

Being a Doctor in Training (DiT) in 2019 provides many exciting learning opportunities and can be a lot of fun. The ground-breaking technologies and treatments we have today lead to the improvement — and sometimes even cure — of our patients’ ailments. The amazing feeling when a patient or family member is genuinely thankful ought to give us great job satisfaction and put a smile on our faces. But with the increasing external and internal job pressures, it is becoming harder to achieve fulfilment and maintain one’s passion for medicine.

At a recent academic conference I attended, there was a break-out session on the all too familiar topic of Doctor Wellbeing. As the session went on, people listed the familiar perceived contributing factors: long work hours, rostering, exams, selection pathways, poor work life balance, bullying and harassment, and what I believe to be largely a deflection of systemic responsibility – personal resilience. While these are all important risk factors, I couldn’t help but feel that the comments were just listing the problems.

In this article, I have taken a few of these issues and presented my thoughts and some simple solutions.

  1. Exams   

I sat my physician exams only this year. As we banded together in misery, I was acutely aware of my colleagues’ wellbeing (or lack thereof) in the lead up. I saw first-hand how difficult it was for some people to secure normal shifts before the big day: some worked long nights, others busy rotations with excessive overtime. This meant barely a minute to study. Some had significant commitments outside of their working lives, such as looking after children. In the end, some of my colleagues failed, most passed, but all of us were left burnt out to some degree.

I question why it is so hard to get exam or professional development leave. Is it not more sensible to roster exam takers with reasonable and consistent shifts so that your body clock is not totally out of whack? The physical stress of a gruelling schedule combined with the knowledge that some hospitals do not rehire failed candidates, low exam frequency, and the financial costs, all contribute to huge stress that translate to mental exhaustion. 


 2. Selection into Training

Since about the second year of medical school, I have been well informed of the ‘training pipeline bottleneck’ and the ‘medical student tsunami’. I was advised that I would have to work hard to get onto a training program. For many of us, this challenge is something we are willing to accept, after all we are not strangers to competitive processes.

More than the bottleneck itself, it is the parameters around the selection of candidates that is the real source of stress. For me, these parameters are the opaque selection processes with no or minimal feedback to unsuccessful candidates; marking criteria with disproportionate weight placed on non-clinical CV criteria that has little or no correlation to what makes a good clinician; the ‘pre-interviews’ that bias members of the selection panel; gender and family planning discrimination; and the new trend to limit the number of application attempts.

 These selection processes lack uniform oversight and should be reviewed as part of the College accreditation process, which must also include the speciality Societies, to assure some level of standardisation and accountability.

  1. Long work hours

I think most people who enter medical school expect long work hours to some degree. Medical television shows drum into us the life of a busy doctor – not that it is anywhere near as glamorous in reality.

The deeper I get in the medical muddle, however, the more I realise that it is not entirely the long hours themselves that are the issue – it’s the drivers behind them. Where Dr Meredith Grey’s day might be filled with patient contact exclusively, in my day it is the administrative burden that delays my clinical decision making; it is the inefficient processes that cause me to make more than five phone calls to organise a simple task; it is the battle between several specialties and facilities to organise a transfer for a patient desperately in need of service; it is the countless hours spent navigating multiple computer systems and software that do not communicate with each other; and it is the never-ending relearning of these different systems across units, hospitals, and health services. The absence of a simple thank you from hospital administration makes those long hours all the less bearable.

  1. Rostering

We have all heard about that person who couldn’t go to their close friend’s or relative’s wedding due to work (not to mention the stress of knowing if you can even attend your own!). For shift workers, rosters are released two weeks in advance. For me, that’s not enough time to plan my life, whether it be for a wedding or just a day at the beach. The uncertainty takes a toll. While I deeply appreciate that rostering is no easy feat, I think it is one of the main contributors to job dissatisfaction.

To me, these systemic roster issues are extremely obvious. The magnitude of early roster release cannot be understated. Redundancy is necessary so that we can encourage DiTs to call in sick if they need to, or even take a mental health day. It is the first step in challenging our current toxic culture of ‘presenteeism’ at all costs.

 

DiT wellbeing has been a topic of discussion for over two decades. In my view, the answers have been in front of us for too long.

 


Published: 11 Oct 2019