Across the globe, increasingly evidence is coming to light that people in our profession are suffering.
Its considered that we have about twice the rate of suicide as the general public. With reported rates being anywhere between 1.1-5.7 times higher than the general public6. It is known that our suicide rate is higher than any other professional group.
We have a higher rate of suicidal ideation than the general public, with 25% of doctors at any time having thought about killing themselves3. 10% in the last 12 months3.
We have a higher rate of both high psychological distress and higher rates of anxiety than the general public3.
We have far higher rates of burnout than anyone else in society. In fact, between 40-55% of the profession are burnt out with rates increasing over the last decade9. Burnout is not a benign condition. It is associated with exhaustion, depersonalisation and a feeling that the work is not worthwhile, and perceived errors. It is associated with higher rates of cardiovascular disease, depression, anxiety, diabetes, suicidal ideation and musculoskeletal complaints1. Furthermore, it is associated with higher rates of medical errors and lower rates of patient satisfaction2,7.
Our profession has relationship unhappiness like everyone else.
We have rates of depression like everyone else3.
Many people are considering leaving the profession.
The profession is increasingly unhappy with the direction that health care is taking.
Many doctors are traumatised by the punitive regulation system. Many describe the process as bullying, accusatory and intimidating4,6. The system is abused by vexatious complainants to target and eliminate rival or disliked colleagues or doctors, and the system is weighted in favour of the person making the complaint, who has no accountability if the complaint is false. Careers can be ruined by the destruction of reputation associated with an investigation and there are no barriers to ‘trial by media’. There is no compensation for doctors whose lives are destroyed by vexatious or false complaints, either financial, or reputation restoration.
80% of doctors practice more defensively in response to the traumas of either being investigated, or seeing someone go through an investigation4. This causes $124billion per year in the USA in unneeded health care costs9, and also results in more prescribing, more investigations and more referrals and earlier referrals7. All of this places the public at greater risk of side effects, and greater costs personally in health care as well as increased costs to government and health care insurers. In addition, 33% of doctors facing medico-legal issues contemplate leaving medicine, 32% contemplate cutting back their hours and 40% contemplate earlier retirement8.
The NHS is replete with horror stories of discontent where the government are imposing more demanding contracts on doctors for less pay.
Looking at the picture of our health and well-being, the diagnosis can only be: Profession in Distress!! And globally so.
The higher rate of suicide has been known about since 1858, but nothing has been done about it5.
The higher rates of burnout in medicine have been known for 20 years yet nothing has been done about it.
Our health and well-being is suffering, yet the very systems and the culture that we work in are so inordinately stressful that it has been said by more than one person that doing medicine and being in medicine is more stressful than being in the army. Bullying, harassment, competition and discrimination are rife in the profession, and this is increasingly coming to light.
Our profession is not well and our healthcare culture is not well.
There is as of yet not a true care for people in the medical profession.
Instead of care, our culture is replete with abuse.
How much longer can we let our health care profession exist in such a state of ill health?
And come to think of it, why is our health is not thriving being in profession that cares about health?
And, how can we optimally care for the health and well-being of the public if we ourselves are not well…..
The data is speaking very loudly. If this were an infectious disease, the CDC and the WHO would be collaborating a global effort to get to the bottom of things and return the population to good health. Yet there are no big global symposia on this important matter. There is no state of urgency.
Our condition may not be infective, but we are affected and our poor health and well-being, and the poor health and well-being of the systems that we are in and govern us, is affecting the people that are seeing us.
Our profession is in crisis and with it the health care of us all is in crisis. It’s time for global collective action. We need to return a true care and well-being to health care, beginning with us doctors. We need to address all aspects of our systems and culture that are contributing to ill health and be willing to make needed changes.
Until an equal care and concern for the well-being of doctors, all health care professionals, patients and even administrators is lived, we will not have a truly healthy health care system.
- Bailey DS (2006). “Burnout harms workers’ physical health through many pathways” American Psychological Association 37(6): 11.
- Balch CM, O. M., Dyrbye LN, Colaiano JM, Satele DV, Sloan JA, Shanafelt TD (2011). “Personal Consequences of Malpractice Lawsuits on American Surgeons.” American College of Surgeons(213): 657-667.
- Blue, B. (2013). “National Mental Health Survey of Doctors and Medical Students.”
- Bourne T, W. L., Peters M, Van Audenhove C, Timmerman D, Van Calster B, Jalmbrant M “The impact of complaints procedures on the welfare, health and clinical practise of 7926 doctors in the UK: a cross- sectional survey.” BMJ Open(5(1)): e006687.
- Hampton, T. (2005). “Experts Address Risk of Physician Suicide.” JAMA 294(10): 1189-1191.
- Horsfall, S. (2014). “Doctors who commit suicide while under GMC fitness to practise investigation.” General Medical Council.
- Lindeman S, L. E., Hakko H, (1996). “A systematic review on gender-specific suicide mortality in medical doctors.” British Journal of Psychiatry 168(3): 274-279.
- Nash LM, W. M., Daly MG, Kelly PJ, Walter G, can Ekert EH, Wilcock SM, Tennant CC (2010). “Perceived practice change in Australian doctors as a result of medicolegal concerns.” Med J Aust 15(193(10)): 579-583.
- Society, M. M. (2008). “Investigation of Defensive Medicine in Massachussets.”
- Peckham C (2016). “Medscape Lifestyle Report 2016: Bias and Burnout.” Medscape.
- Shanafelt T, Bechamps G, Russell T, Dyrbye L, Satele D, Collicott P, Novotny P, Sloan J, (2010). “Burnout and Medical Errors Among American Surgeons.” Annals of Surgery 25(6): 995-1000.