‘Overworked, burnt out and harassed’ – the study paints a bleak picture of young female doctors
Maltese doctors in general are working an average of 50.7 hours every week, according to a study on their health and the well-being of doctors based on a questionnaire answered by 173 doctors – about 8% of the total registered with the Maltese Medical Council.
The study published in the Malta Medical Journal and led by Marilyn Harney and Jurgen Abela from the Department of Primary Health Care, is the first for which all doctors working in Malta were invited to participate.
But the participants were found to have higher levels of stress, burnout, compassion fatigue and secondary traumatic stress than their international peers, and were particularly prevalent in young female doctors still in training.
Women also reported consistently higher levels of poor mental health including stress, burnout, compassion fatigue and secondary traumatic stress. One of the reasons for this was that female doctors, particularly those in training, have to “combine many other things besides work-related tasks.”
The study found that 81 doctors (47%) worked over the 48 hours per week stipulated in the European Working Time Directive. In Malta, doctors are allowed to opt out of the EWTD and can work longer hours if they wish.
Working hours were the longest among Foundation Year doctors, 81% of whom work more than 48 hours, and among doctors in training, where 62% work over this limit. But working hours tend to decrease as the career progresses, especially with 35% of specialists. The study shows that levels of burnout appear to decrease with advancing career stage, with doctors in the early stages of their careers being hit hardest.
84.3% of the participants also worked at weekends, and 54.7% worked on-call duties or night shifts.
Forty-seven (27.2%) participants reported that they managed to take a minimum 30-minute meal break “all or most of the time” while at work, compared to 49 (28.3%) that they never managed to do.
Belittled and harassed
Participants were asked to indicate whether they had experienced bullying, harassment or sexual harassment in the workplace, indicating the source and whether it occurred ‘sometimes’, ‘often’ or ‘regularly’.
Significantly, 33 doctors (19%) reported being sexually harassed by patients, 15 (9%) reported being sexually harassed by senior medical staff – three of whom experienced this regularly – and 17 doctors ( 10%) were harassed by other health professionals. 13 doctors were sexually harassed by non-medical staff.
133 doctors also reported that they were reduced by senior medical staff, 31 of them on a regular basis.
Of the participants who reported feeling depressed often or regularly, 63.3% were women. 80% of those who reported frequent or regular sexual harassment were women.
The majority of doctors… don’t have a doctor
The study also found that 59.5% doctors said that they do not have their own doctor, and that they provide their own medical care, while 59% do not want others to know if they were experiencing mental health problems with in contrast to 30% who have not. want others to know that they were experiencing physical health problems.
The authors of the study consider the high rate of self-stigma on mental health with particular concern, due to the high rate of doctors who provide their own medical care. “Addressing this attitude in the early stages of training can help to reduce barriers to care, according to the authors of this study. This is especially important considering that the profession medical is associated with a high risk of mental illness, substance misuse and suicide risk.”
A total of 46 doctors (27%) recorded high and very high stress levels. Twenty-nine of these (63%) were women. But lower levels of stress were found among those who had advanced in their careers.
38 participants (22%) reported that their mental health affected their work ‘half the time’, ‘most of the time’ or ‘all the time’. Twenty-four of these (63%) were doctors who were still in training (including Foundation doctors).
Overall, 66 of the participants (38%) fell into the highest percentage ranges for burnout and 39 (59%) of these were women.
59% of male doctors at risk of obesity
47.7% of all survey participants had a Body Mass Index in the overweight or obese range. The obesity rate was higher among male doctors, reaching the mark of 58.9%.
Research in 2014 showed that doctors in Malta who are obese find it more difficult to recommend exercise, with subsequent negative consequences on the patients’ health.
The high percentage of doctors who are overweight or obese suggests that despite their knowledge, doctors are still faced with a healthy lifestyle and that interventions are needed at various levels – personal, professional and organizational, to help doctors improve and maintain their physical and mental health and well-being.
Study recommends confidential mental health service
The study comes with a number of recommendations including better working conditions for all doctors, through shared work, manageable working hours, regular breaks, fair and equal access to holiday leave and sick leave study and measures in favor of the family.
It also recommends structures that allow issues such as redundancy, harassment and sexual harassment in the workplace to be dealt with confidentially and effectively.
In light of the self-stigma around reporting mental health and to a lesser extent physical health issues, the study recommends easy access to confidential medical and psychological services, specifically for doctors, with a weekly clinic afternoon/evening, ideally outside the hospital or government health centers, to ensure privacy, where two doctors are available. “An email address may be available for doctors to contact or set up an appointment. Doctors will do the initial assessment and be available for follow-up, or refer as needed.”
The study also recommends structures to deal with harassment, harassment and sexual harassment in the workplace confidentially and effectively.