Hospital medical specialists and work-related burnout

Most medical consultants working in public hospitals report robust emotional well-being and healthy work engagement according to research into work-related burnout from the University of Otago, Christchurch.

One of the largest studies of its kind in relation to New Zealand doctors, the research investigated 267 consultants working in Christchurch and has just been published in the New Zealand Medical Journal.

Lead researcher Dr Lois Surgenor from the Department of Psychological Medicine says the positive results were a bit of a surprise as the perception has often been that high levels of burnout is the professional norm amongst hospital consultants.

"It would seem there's still considerable job satisfaction amongst this group of clinicians, at least in Christchurch," she says. "It may have something to do with a particularly supportive work environment, or the benefits of a relatively stable workforce compared with other parts of New Zealand."

Despite the majority of consultants not experiencing work-related burnout the researchers say that a significant minority, between a quarter and a third of respondents are, and this takes the form of high levels of emotional exhaustion and high levels of psychological detachment in relation to their job.

Overall, one in five, or 20% reported high burnout in their job as a hospital specialist.

Of note, burnout risk was significantly associated with long hours of work and the researchers suggest that controlling hours worked may be an important way of reducing this risk, although this needs to be proven in a New Zealand setting.

"Long work hours in combination with low job satisfaction significantly increase the risk of professional burnout," says Dr Surgenor, "and this suggests the need to consider the protective roles of having good working relationships with managers and colleagues, along with professional autonomy."

One of the more interesting findings of this study is that length of time in the job as a consultant appears to be protective of emotional exhaustion. But this appears to work in the opposite direction with regard to evaluation of one's own professional accomplishments, which appears to erode with length of time in the same job.

"Loss and turnover of doctors is a serious problem in New Zealand, but doctors may not be leaving simply because of financial incentives overseas, but because they feel professionally and personally ineffective in their current job."

"It needs to be emphasised however, that most are highly satisfied and not reporting burnout problems. The greater overall protection from burnout that comes with longer experience may arise from developing greater tolerance for clinical stress, or diversifying into leadership and teaching roles."

The study suggests there should be more focus on the 20% of consultants who are reporting significant problems because of possible impacts on patient care and staff turnover.

Solutions to burnout both in New Zealand and overseas have included a range of individual and organisational-level interventions. These include for example, regular peer support, stress management courses, and explicit formal agreements to improve relationships between employer and employees.

The 'Time for Quality' agreement between DHBs and the Association of Salaried Medical Specialists in 2008 is one such approach. While these appear sensible solutions on the face of it, they need to be tested through further research.