Junior doctors working unsafe hours to ‘earn their stripes’

Morgan Liotta

22/01/2020 3:22:45 PM

New research highlights the need for workplace improvements to help protect junior doctors’ health and wellbeing.

Stressed doctor
Long working hours can have a profound impact on the mental health of junior doctors.

The Black Dog Institute and UNSW Sydney have published Australian-first research examining the relationship between average working hours and the mental health of junior doctors.
And the results are stark.
A quarter of all junior doctors work unsafe hours, which researchers found doubles their risk of developing mental health issues and suicidal ideation.
Associate Professor Samuel Harvey, study co-author and Chief Psychiatrist at the Black Dog Institute said working long hours has been an accepted part of the culture of medical training for decades, but ongoing research is changing perceptions.
‘We’re now starting to understand the human cost behind these excessive workloads,’ he said.
‘Pressure on junior doctors to “earn their stripes” by taking on long work hours has always been common, but what we now know is that this can have profound mental health impacts, with concerning implications for both the individual doctors and our broader health system.’
A cohort of almost 43,000 randomly selected junior doctors in Australia were invited to participate in Beyond Blue’s National Mental Health Survey, with 12,252 providing data to form the research – the largest and most up-to-date national figures available on doctors’ mental health outcomes.
Junior doctors who worked over 55 hours a week were more than twice as likely to report common mental health disorders and suicide ideation, compared to those working 40–44 hours per week.  
The same results applied regardless of age, gender, level of training, location, marital status or whether the doctor was trained overseas or locally, confirming a link between long working hours and poorer mental health among junior doctors.
On average, junior doctors worked 50 hours per week, with more than one in four logging more than 55 hours per week, suggesting a significant proportion of the healthcare workforce may be at risk of mental health issues and suicidality.
Other recent results from a 2016 Australian Medical Association survey indicate a trend in this pattern.
However, increasing concern about the potential mental health impacts of extended working hours, as well as performance issues associated with fatigue and burnout, have brought to light the need to reconsider the hours that doctors are allowed to work. 
But, the solution to the problem may not be as easy as simply restricting junior doctors’ working hours, the researchers warn.
Management of working hours within junior doctors’ complex work environments to help improve their mental health should be the focus, according to the researchers. This includes increasing efficiency of the work environment to reduce the workload of junior doctors, implementing more considerate rostering and work practices, and ensuring adequate staffing to reduce the total weekly working hours of junior doctors.
Other factors such as fatigue, sleep deprivation, conflicts between work and home life, organisational-level workplace stressors and broader regulatory practices should also be taken into account.
The RACGP has a number of resources to support doctor self-care.
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Dr Ian Mark Light   23/01/2020 8:00:45 AM

People are living longer and there are many comorbidities and junior doctors are not yet experienced in all the presentations therapeutic interventions and traps for the inexperienced.
They are a driven group and making errors can affect their psyche badly and they have to be in a supportive team -some units are toxic due in part to pressures of saving severely ill people.
So they need a lot of guidance to avoid error and skills in negotiating complexity .
They need "minders" Vitally iII people need a highly skilled and stable health team and we are not nearly
there yet as evidenced by the Beyond Blue report .

Dr Scott David Arnold   23/01/2020 7:04:13 PM

It fascinates me to see we are still having this conversation! Yes, we are conflicted. One needs to see a certain volume of clinical material to become confident and there's a lot to learn. I don't want this to sound like "When I was young" but when I was an intern (1989) we were doing 80 + hours a week and if you r unit was on for the weekend you could do a 56 hour shift. It was a fairly regular occurrence for resident to drive off the road to Melbourne. I agree there is still work to be done. But lets not lose sight of the progress we have made.