One in three UK doctors working in obstetrics and gynaecology may suffer from workplace burnout.

This could affect their well-being and how they treat patients.

This is the finding of new research, published in the journal BMJ Open, led by scientists at Imperial College London.

These results point to an environment in UK hospitals that makes staff unwell and less able to carry out their jobs safely Professor Tom Bourne Study author

Burnout is a condition triggered by long-term stress and overload at work, and in particular is associated with emotional exhaustion, lack of empathy and connection with others, and feeling a lack of personal accomplishment. Although burnout can affect individuals in any career, it particularly affects those in those in high-stress jobs – with previous studies suggesting that doctors are twice as likely to suffer burnout compared to those in other professions.

The study, a collaboration between Imperial College London, KU Leuven in Belgium and the Royal College of Obstetricians and Gynaecologists, also revealed that 43 per cent of trainee doctors met the criteria for burnout.

Mental health concerns

The research, which is the largest UK study on this topic, used a well-accepted tool, called the Maslach Burnout Inventory, to measure burnout on over 3000 doctors. In addition, the research asked doctors specific questions about their physical and mental well-being, as well as how they practice medicine– focusing particularly on so-called defensive medicine. The research was carried out on doctors in the field of obstetrics and gynaecology – these specialists are responsible for treating women who are pregnant, delivering babies, as well as treating conditions such as ovarian and cervical cancer.

The team surveyed doctors in obstetrics & gynaecology

The study found 36 per cent of doctors met the criteria for burnout. The doctors who met the criteria for burnout were six times more likely to experience suicidal thoughts, four times more likely to report depression, and three times more likely to report anxiety, irritability and anger. They also suffered from sleep and relationship problems.

The work also revealed that doctors with burnout were four times more likely to practice ‘defensively’ – meaning a doctor may avoid difficult cases or procedures, over prescribe medications, or carry out more investigations or treatments than necessary, for fear of making a mistake or missing a diagnosis.

Patient safety

Previous studies have also linked burnout to lower standards of patient care and reduced patient safety explained Professor Tom Bourne, lead author of the research from the Department of Metabolism, Digestion and Reproduction at Imperial: “We found the results of this survey very worrying. The levels of burnout were high, particularly amongst younger doctors. This has serious implications for patients, as we know burnout reduces patient satisfaction, safety and standards of care.

“These results point to an environment in UK hospitals that makes staff unwell and less able to carry out their jobs safely. There is a clear need to address both the workplace and culture.”

It is vital the issue of burnout is addressed, so we can sustainably deliver the very best care for our patients Dr Alison Wright Vice President of the Royal College of Obstetricians and Gynaecologists

The research team caution that people who are suffering from burnout may have been more likely to respond to the survey, which may have affected the result – but equally people experiencing symptoms may have been less inclined to answer questions on the subject.

Professor Bourne explained there has been little research investigating levels of burnout in other medical specialities in the UK.

However, US studies show it is prevalent in staff across all areas of medicine, and this situation is likely to be mirrored in the UK.

Reducing workload

He explained these current findings add to increasing evidence that suggests the NHS needs to urgently investigate strategies for preventing burnout: “Improving our understanding of doctor burnout must become a priority. Reducing burnout will improve doctors’ well-being with resultant improvements in staff retention, productivity and patient safety. The report adds critical evidence to the recent review into Doctors Well-being published a week ago by the General Medical Council in the UK.”

Professor Bourne, a consultant gynaecologist, added: “The solutions lie in improving the environment doctors work in, and relate to reducing workload, rebuilding supportive teams, compassionate leadership, improving the values and culture of hospitals, and giving doctors more autonomy and fairness”.

Increasing support

Dr Alison Wright, Vice President of the Royal College of Obstetricians and Gynaecologists, said: “The potential impact of workforce burnout is crucial to our national health service and to patient care. This important study provides compelling evidence that there is an urgent need to improve the workplace environment for doctors. We know burnout is associated with worse outcomes for patients, as well as a lack of empathy and rapport. It is vital the issue of burnout is addressed, so we can sustainably deliver the very best care for our patients.

The research team call for more manageable workloads

“A key priority for the RCOG is to ensure the obstetrics and gynaecology workforce is properly supported. We have established a ‘Supporting our Doctors’ task Group, which includes a ‘peer to peer’ support service and a network of workforce champions to provide pastoral and practical support to doctors and employers.

“This task group advocates for the changes that need to be made to minimise burnout and attrition. These include all clinicians having acceptable working patterns, for their workload to be controlled, for adequate peer and senior support within teams and for leadership in hospitals to be more compassionate. This will require a real change in culture.

“The RCOG is collaborating with other Colleges, the GMC and government organisations, to understand and address the systemic issues which are associated with burnout so we can, both improve the well-being of doctors and the care we provide for women and their families.”

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'Burnout, well-being and defensive medical practice among obstetricians and gynaecologists in the UK: cross-sectional survey study’ is published in BMJ Open. DOI: 10.1136/bmjopen-2019-030968

See the press release of this article