Medicine and parenting: Significance of stress and burnout

When Dr Rebekah Hoffman embarked on her PhD, she was a GP, a practice owner, and a mother of two young children.
 
She was also experiencing firsthand the stress and burnout that can come as GPs strive to strike the right balance between work and family.
 
Seven years later and Dr Hoffman is now the RACGP NSW&ACT Chair, those two children are in primary school, and last month, she handed in that PhD thesis – one that will likely resonate with many GPs and GPs in training.
 
Titled Medicine and Parenting: Significance of stress and burnout. A study on the impact of parenting on stress and burnout amongst general practice registrars, the research explores the experiences of GPs in training and calls out what needs to change moving forward.
 
‘Initially I was looking really specifically just at women, parents, and their levels of burnout and stress around parenting,’ Dr Hoffman told newsGP.
 
‘At that point, I had two children under two, and I was incredibly stressed, and I’d thought that there must be a link between parenting and stress and burnout.’
 
However, Dr Hoffman’s research quickly took a turn when she found the opposite of what she had expected to, discovering that ‘parenting was protective against burnout’.
 
‘We really found that those that had kids during training, or those that already had kids before training, had really good protective factors, had really good strategies for reducing stress and reducing burnout,’ she said.
 
‘I was really, really surprised, but in hindsight, it really makes sense and that’s because parents have to have really good support networks, and they have to be able to ask for help, and be able to say no, and have firm boundaries.
 
‘It’s much easier to do that when you’re doing that for someone else, when you’re doing that for your child, or when you’re doing that because you’re pregnant.
 
‘It’s really hard to have firm boundaries and to ask for help when you’re doing it for yourself.’
 
The study found that more than 75% of GPs in training interviewed were experiencing moderate-to-high levels of burnout, and all had experienced episodes of stress and burnout in their training.
 
They said this was caused by several factors, including time and financial pressures, isolation, lack of support from both the workplace and personal networks, and worry and guilt across both professional and personal roles.
 
‘Balancing a career and a family is challenging due to the significant physical, mental, and emotional demands,’ Dr Hoffman’s research states.
 
‘This balance can be particularly troublesome when juggling simultaneous training towards a medical specialty fellowship and a young family.
 
‘The timing for these training years often coincides with the years typically associated with reproductive and early family life.’
 
The research highlighted to Dr Hoffman the importance of having a village or support network, as well as the confidence to ask for help.
 
‘What actually reduces your stress, and your burnout is probably not the kids themselves, but all of the other supports that you have along the way,’ she said.
 
‘Generally, workplaces have shifted through COVID, and probably shifted to a good thing with more flexible working hours, more flexible training arrangements.’
 
It has also led her to advocate for a more individualised approach to healthcare training.
 
‘We don’t have universal things that are going to work for everyone’s solutions. This is a single person’s journey, and we need to have a training program that’s dynamic, and adaptable, and works with the individual,’ she said.
 
‘We can’t force the individual to fit into our mold, because that’s not what general practice is.
 
‘General practice should be dynamic and family friendly, and that’s going to produce long-term GPs.’
 
Dr Hoffman said a long list of changes is needed to make general practice more family friendly, especially for mothers.
 
‘For female GPs, the latest evidence is that they see more mental health patients, they see longer consults,’ she said.
 
‘There is a definite wage gap because of the reduced level C and D Medicare rebates, which means female GPs are often working for less than their male counterparts, or they’re having to work for longer hours for the same pay.
 
‘There should be a rebate that respects time and value for the patient’s rebate, irrespective of how long they spend with the doctor – if we’re doing slow, long medicine, then that shouldn’t be reimbursed any poorer or any less than quick six-minute medicine.’
 
The research also stated that current maternity and paternity leave policies across specialty training programs in Australia do not allow parents to undertake a variety of flexible work options around pregnancy, paternity leave and return to work.
 
‘Specifically, in general practice training there is an inequity in comparison to other speciality training programs as there is no paid leave entitlements,’ it said.
 
But what Dr Hoffman has taken away from her research is the need to make general practice a long-term, sustainable career, at a time when GPs are more important than ever before.
 
‘We can actually work together and make general practice sustainable and do shared, team practice, because that’s what we enjoy,’ she said.
 
‘It doesn’t need to be a seven-day, 24-hour, on-call job anymore because that’s not sustainable, that’s not what we enjoy doing.
 
‘We enjoy general practice, but we also need to enjoy our family time too.’
 
Moving forward, Dr Hoffman said additional research is needed to further investigate the effects of different support systems in mitigating burnout, as well as to gain a greater understanding of the limitations around recruitment and retention of GP registrars.
 
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