Burnout common throughout medical career

By Roger Collier | CMAJ | Aug. 24, 2016

Improving resiliency in medical training and practice is an important step to promote well-being throughout a doctor’s career. (SolStock/iStock)

Many medical students burn out. Same goes for resident doctors. And for doctors just starting out. Actually, physicians can experience burnout, or other mental health problems, at any stage in their careers, said presenters at a session on strengthening resilience in medical training and practice at the Canadian Medical Association (CMA) General Council.

“Although important strides have been made, a growing body of literature reminds us that serious personal and professional barriers to physician health remain,” said CMA President Dr. Cindy Forbes.

Every year, hundreds of medical students are affected by burnout, depression, substance abuse and suicide ideation, noted presenter Marie-Pier Bastrash, a medical student at McGill University. “We have to talk about it — loudly,” she said.

There are numerous contributing factors to the stress medical students experience, including the volume of knowledge they must acquire, the skills they have to attain in complex medical settings and the emotional demands of working with ill people for the first time. Even students who start out with a full “gas tank” of resiliency will eventually need to learn how to refill that tank.

Bastrash presented information from a survey of 5000 medical students conducted by the Canadian Federation of Medical Students and the Fédération médicale étudiante du Québec. Though the results won’t be formally released until September, Bastrash shared that the burnout rate among medical students was discovered to be around 37%. The survey also found that Canadian medical students have higher rates of anxiety and mood disorders than peers of similar age and education.

It’s time that the medical community recognizes health-seeking behaviours as a sign of resiliency rather than a sign of weakness

Strengthening resiliency among medical students will take action on many fronts. It will require the day-to-day promotion of healthy living. Students will have to learn to address their irrational fear of failure and exaggerated sense of responsibility — to recognize that, though they have enjoyed considerable academic success just to gain entry to medical school, they are still fallible. They will on occasion fail, make mistakes, and must not let doubt or guilt overwhelm them. Older medical students, residents and staff also have a role to play.

“We need role models of resilient people who steer away from cynicism and instead react to their environment’s challenges with innovative ideas, striving to make things better,” said Bastrash.

It also wouldn’t hurt, she noted, if the following question never again surfaced in interviews for residency positions: Have you ever taken time off from medical school for any reason? Because if the answer is “yes,” and the reason was to get healthy, it only further stigmatizes seeking care to address mental health issues.

“It’s time that the medical community recognizes health-seeking behaviours as a sign of resiliency rather than a sign of weakness,” said Bastrash.

In their postgraduate years, doctors also experience burnout — as many as half, said Dr. Jonathan Dean, an internal medicine resident at the University of Saskatchewan. There is evidence, he noted, that suggests residents who experience burnout provide less-than-optimal patient care, and make medical errors at a rate seven times higher than their healthy colleagues.

“In other words, our burnout affects our patients,” said Dean.

He recommended that residents be taught to recognize the signs of burnout, and stressed the importance of formalized resiliency training.

At the end of the session, a motion passed to have the CMA undertake a nationwide study to analyze the working and practice conditions of medical students and residents.

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