More than half of doctors exhausted: workload and related demands most difficult
Medikumppani conducted the Miten jaksat työssäsi (“coping at work”) survey during the Lääkäri 2019 congress at the Helsingin Messukeskus congress centre on 9–11 January 2019. More than 800 physicians, specialists and dentists, as well as fifth- and sixth-year medical students, responded to the survey. Timo Vänttinen, chief physician of occupational health care at Lääkärikeskus Aava, commented on the results.
Over 60% of the respondents said they feel exhausted at work, either constantly or sometimes. Only less than 11 percent said they almost never feel exhausted.
“The results are in line with previous recent surveys. It is very alarming that such a large proportion of doctors feel exhausted at work. It’s a risk to patient safety,” says Vänttinen.
WORKLOAD THE MOST STRAINING
One factor rose above all others—more than 70% of the respondents said the workload caused the most strain. The respondents mentioned the hectic pace of work and too many patients in their responses to the open-ended questions.
Work-related administrative tasks were ticked by 8.5% of the respondents; paperwork and unnecessary work were also mentioned separately. A total of 4.4% felt the work community was a source of strain, and rigid organization, workplace management, and poor leadership were also mentioned.
“The amount of work seems to be the most significant factor contributing to exhaustion, regardless of the respondent’s gender or age. There are often many factors contributing to the workload, in addition to the regular duties, that need to be taken into account: processes, available support, opportunities to influence one’s work, the functioning of IT systems and issues related to the division of tasks. Ineffective processes and lack of support for your decisions increase the workload. In these situations, decision-making takes time, and the workload increases,” Vänttinen says.
The same issues emerged when Vänttinen discussed the work in hospitals and health centres with his colleagues.
“Taking on too much responsibility and having an unmanageable amount of work sometimes cause an excessive workload in the hospital world and its operational environment. Delimiting your work may feel difficult because it may affect a colleague or patient. Excessive workload is also an issue in health care centres, affecting the meaningfulness of work. Young doctors are assigned many patients, but at the same time they need to learn new things and come up with creative solutions while under pressure. Soon they are in a situation where they cannot help the patients well enough.
JOB-RELATED REQUIREMENTS CONSTANTLY INCREASING
Another stress factor that clearly emerged in the survey was the demanding nature of the work, which was mentioned by almost 40% of the respondents.
“Doctors’ work has become very demanding, general awareness and patients’ expectations have increased. These were also major issues when I interviewed my colleagues at Aava,” Vänttinen says.
Organization of medical care and drawing the line between specialist care and primary health care make doctors’ work more demanding. According to one of Vänttinen’s colleagues, many tasks have been delegated from specialist care to primary care without compensating resources. Employees working in primary health care take care of patients with multiple illnesses, while employees in specialist care treat specific illnesses, i.e. they do not treat the patient as a whole. Referrals to specialist care are changed to consultations and, as a result, patients are not given appointments for a visit. Sometimes this is legitimate, but oftentimes it does not help the patient’s problem but prolongs diagnosis and treatment.
WORK COMMUNITY HELPS TO COPE
Based on the survey responses, the work community plays a very important role in coping at work. Nearly 87% of the respondents mentioned the importance of having nice co-workers, and 54% said supervisors who are encouraging play an important role in the work community. Responses to the open-ended questions included support of senior colleagues and the possibility to ask for consultation.
“One of the doctors said that for a young doctor, work in the surgery can feel lonely at times. According to this respondent, good, older colleagues who create a relaxing atmosphere and provide support and concrete answers help to cope with it. Teaching by example is important among colleagues,” says Vänttinen.
FLEXIBLE HOURS AND REJUVENATING LEISURE TIME
Nearly 44% of the respondents said flexible working hours help them cope. There are better opportunities to do other things.
“I find it alarming that so few respondents mentioned leisure, exercise, family, hobbies and sleep as things that support coping at work. However, this may well be explained by the fact that these options were not directly included in the questionnaire. Rejuvenating leisure time is, indeed, very important to doctors, also,” Vänttinen says.
Keeping work and leisure separate does not seem to be a problem. About 97% of the respondents said they are always or sometimes able to keep them apart, and only 3% stated they rarely or almost never succeed in keeping them apart.
In contrast, private life can also put pressure on coping at work—3.6% said it causes additional stress at work.
“One female doctor pointed out that women are often under stronger cognitive pressure in their free time, as well. This means that, in an average family, the mother is still the primary keeper of the house, meaning she takes care of the children’s health care, attends parent-teacher meetings, keeps track of the children’s school performance, communicates with the teacher and takes care of hobby-related things,” Vänttinen says.
WORK APPRECIATION IS IMPORTANT
The prestige of the profession helps more than 35% of the respondents to cope, and a clear salary model was important to nearly 23%. The respondents also indicated interest in their job, success at work, and grateful, satisfied patients in their responses to the open-ended questions.
CHALLENGES FOR INDEPENDENT PRACTITIONERS
A total of 148 respondents answered the question directed at independent practitioners. The percentage of responses for the three alternatives pertaining to workload was nearly the same for all: job insecurity (38%), lack of work community (35%) and taking care of expenses, accounting, and other responsibilities (35%). Responses to the open-ended questions about challenges included IT systems, general practitioners’ need for broad expertise, colleagues, tax authorities, continuity of patient care, and too many patients. Nonetheless, being self-employed also has its advantages.
“One doctor compared his former work in a hospital and health care centre to his current self-employment and said that taking responsibility and making sure things get done are just the essence of the work. Having time to interact with patients creates an environment where seeing the patient again is an asset, not a burden. Being an independent practitioner is part of this responsibility. When you have taken care of your own wellbeing, you have the strength to take responsibility for your patients’ care,” Vänttinen says about his colleague’s experiences.
ABOUT THE SURVEY
The survey was conducted as a multiple-choice questionnaire. In addition to the given alternatives, the respondents also had the option of adding their own alternative(s) in an open-ended response field. A total of 828 people responded to the survey. The respondents’ years of employment ranged from less than a year to more than 20 years. A total of 65.5% of the respondents were women and 30% were Bachelors of Medicine.
Medikumppani is a nationwide health care staffing services company that provides the private and public sectors with physicians and offers physicians interesting jobs. The company has been operating in the field since 2003 and each year employs almost 100 doctors, specialists, and dentists for various lengths of employment throughout Finland.
Lääkärikeskus Aava is a Finnish family-owned health care business, whose experts represent almost all specialised fields in medicine. Aava was founded in 1966 and currently operates in ten different towns and municipalities.