CDT Chair update - June
Junior doctors are at the highest risk of distress, burnout and suicide compared to other medical professionals at later stages of their career and the general public. This fact would come as no surprise to any current doctor in training.
We are often on the frontline, directly liaising with distressed patients, irate family members and managing challenging interprofessional circumstances from the bottom of a well-established hierarchy. At times we are thrown out of our depth with limited clinical supervision and oversight, and redeployed on a whim where service delivery requires. We are held hostage to end-of-term reports, references, and the positive regard of senior doctors in training and managing areas we aspire to train in. This dependence makes us incredibly vulnerable, creating additional barriers to advocate for ourselves, speak up for safety and assert our rights.
Our Resident Hospital Health Check survey has identified over the past seven years that doctors in training are managing an increased workload in the face of escalating staff shortages worsened by the COVID pandemic, and that bullying and harassment remain rife, particularly for Aboriginal and Torres Strait Islander doctors in training. While many programs and health services are doing their best to offer quality support, supervision and training, entrenched systemic and cultural factors that adversely impact on junior doctors endure. This is reflected in the high incidence of mental illness and suicide among doctors in training, and a current exodus of junior doctors with 20 per cent reporting they are currently considering a career outside of medicine.
Faced with this challenge, the institutional response has been typical. Practice self care. Do some yoga. Eat healthily. Treat yourself to a 5-minute bathroom break during the day. Foster resilience. Ask a friend R U OK. While all these factors are important in maintaining positive wellbeing, this approach neglects to consider the systemic factors at play – lack of control at work, fatigue, moral injury, shift work, overtime, traumatic patient encounters, bullying and harassment, excess workload compounded by staff shortages – the list goes on. By negating these factors, the onus of responsibility is placed squarely on the doctor’s shoulders, and the unspoken implication that succumbing to distress or mental illness is thus a personal and not a system failure is clear. If we could all just be more strong, more resilient and fit just a bit more yoga around 15 hours of overtime a week, we would be able to endure any manner of challenges thrown our way at work.
Thankfully, the past weeks have seen a positive shift in the right direction. Following the sustained advocacy of the Committee of Doctors in Training (CDT) and AMA Queensland, Queensland Health committed to a wellbeing summit held in November 2022. And in the past few weeks, the Queensland Government has delivered on the promise made at the summit to amend legislation and make Hospital and Health Services (HHSs) responsible for the psychosocial safety of their employees at work. This move complements the recent implementation of a new occupational Code of Practice around managing psychosocial hazards in the workplace, strengthening these provisions and ensuring improved protection for doctors at work.
While this change alone won’t radically shift the culture in medicine, it is an important first step in publicly and legally acknowledging that our workplaces play an important role in shaping our sense of wellbeing. Doctors in training, and our healthcare colleagues, deserve to work in a safe environment as we strive to deliver the best outcomes for our patients. The tides are also turning at a national level, with FRACMA recently commencing a government-funded review of culture in medicine aimed at remediating some of the current deficits in this area.
In response to these changes, the CDT has written to each HHS in Queensland, identifying short and long term goals to enhance the wellbeing of doctors in training. We identified practical short term strategies, such as adequate bike and scooter storage facilities and safety processes around carpark access after hours, as well as systemic factors such as tackling workload and cultural barriers to reporting bullying and harassment. We invited HHS leadership teams to collaborate with us to develop and implement wellbeing strategies, and are pleased to report a number have already taken us up on this offer. The CDT looks forward to continue to advocate for positive outcomes in this space, and to work to enhance the wellbeing of doctors in training across Queensland.
