This article originally appeared in the Spring 2023 issue of the Ontario Medical Review magazine.
Burnout, already a problem for physicians before COVID-19, has escalated and is sticking around as the pandemic winds down.
In her clinical practice treating physicians, her coaching practice with physician leaders, and her work with medical organizations as a physician wellness advocate, psychiatrist Dr. Mamta Gautam is familiar with the personal and system-wide toll current conditions are taking.
Dr. Gautam is a psychiatrist at The Ottawa Hospital and in the Department of Psychiatry at the University of Ottawa, as well as chair of the OMA Burnout Task Force. She is the founding director of the University of Ottawa Faculty of Medicine Wellness Program and served as an expert adviser to the Canadian Medical Association Centre for Physician Health and Wellbeing. In 2008, she founded the International Alliance on Physician Health.
As president and CEO of Peak MD Inc., Dr. Gautam acts as a speaker, leadership coach and consultant. And she has written two books: IRONDOC: Practical Stress Management Tools for Physicians and THE TARZAN RULE: Tips for a Healthy Life in Medicine.
“The culture of medicine has been one in which we’re expected to just show up and do what needs to get done and put our own needs aside because the patient needs come first.” — Dr. Mamta Gautam
The Ontario Medical Review talked to Dr. Gautam about the effects of physician burnout and how they can be addressed.
OMR: Surveys show that physicians are working more days than they were before the pandemic. Do you see that rising workload reflected in burnout amongst your patients as a psychiatrist treating physicians, and in the system in general?
Dr. Gautam: I absolutely see increasing rates of burnout. They were pretty high even before the pandemic and increased a lot. We’re seeing a rising amount of workload because a lot of things had been put aside so that we could focus on COVID. All the chronic conditions that we had not had time to pay as much attention to are coming to the forefront and we’re also seeing a huge increase in mental health issues in the population.
We’re also seeing a shortage of staff. Throughout the pandemic, some staff have chosen to retire. We’re seeing the great resignation in society at large and also within health care. So, we have this perfect storm.
Burnout is an occupational problem, and it is related to different mismatches in the system. One of the key ones is workload — when we have an increasing workload and we don’t have the resources to support that need.
OMR: Is there a cycle developing that could lead to more physicians leaving practice because of burnout? And if that’s the case, how will this impact the system and patients?
Dr. Gautam: As people are being pushed to give more and more and not have the time to recover, they are starting to question what they want to do, are able to do and for how long. In the last stage of burnout, there is a reduced sense of accomplishment. People have lost a sense of connection to what it was that made them choose this profession in the first place. Some colleagues, if they don’t leave, are looking at reducing the amount of commitment and reducing the number of hours and days that they’re working.
The short-term impact is going to be on the physicians. We come into this (profession) to do the right thing to take care of our patients. Physicians want to do good. So, when we get to a point where we feel like we’re not doing that anymore, or we can’t continue to function at that high level that we would like to, we look at whether this is something we can continue to do.
We also need to look at the impact of physicians choosing to leave their practice on patients and health care. (The decision) is going to impact access to care in a timely fashion and perhaps in a geographic location.
In the long term, I honestly don’t know what could happen. My hope is that we see this as an important warning and we start to look at what we can do to address some of these issues so that we continue to retain and take care of our physicians and other health-care workers and attract new young colleagues into the profession.
OMR: What are specific measures within the system that can be implemented to help reduce burnout?
Dr. Gautam: The burnout task force was struck in 2019 in recognition that burnout was increasing and to look at what the OMA can do on behalf of physicians to drive system-level change.
The task force wanted to hear directly from the physicians about what they felt contributed to burnout and perhaps what the solutions are. Not knowing that the pandemic was going to happen, our first survey went out in March 2020.
In 2021, the task force released a seminal paper (Healing the Healers: System-Level Solutions to Physician Burnout) making system-level recommendations. We looked at the top five solutions that members ranked. Physicians talked about what the system needed to address. So, looking at the high amount of administrative burden physicians are under and what the system can do to reduce that level of burden. What can be done to allow flexibility for how we take care of patients when we take care of patients and in what settings? What about streamlining forms? The forms can add a couple of hours to the workday. What can we do to integrate some systems, including our EMR electronic records system?
There certainly are some system-level supports identified by our members, for which we are advocating through the task force.
OMR: What has the task force accomplished since it was first instituted?
Dr. Gautam: It has allowed us to release the white paper, which really is a landmark. That paper allowed us to demonstrate a sense of urgency, especially when it comes to looking at how the government does and could better support health care. One of the things that the paper called for was the creation of a bilateral task force with the Ministry of Health to identify and drive system-level changes. That was actually struck in 2022.
OMR: How do you help the physicians coming to your practice combat burnout?
Dr. Gautam: I would assess someone’s mental status and recognize whether they need further treatments such as medications or psychotherapy. During psychotherapy, we talk about this being reality — this is a difficult time to practise medicine in Canada. Part of my work involves validating how they feel, helping them see that their response is a normal response to a difficult situation. I remind them to know their own value and to offer self-compassion — the compassion that they would give to someone else that they cared about.
We also go through the five Cs of resilience. These (include) Control: reminding people of what they can and cannot control and encouraging them to focus on the things they can control. The importance of Connections: it’s the caring connections in our life that offer us support. Helping people learn techniques to Calm themselves, such as journalling, exercise, mindfulness, meditation, relaxation exercises, visualization, spirituality and gratitude. Encouraging people to Care for themselves. Going back to the basics of making sure they eat well, exercise, have a good night’s sleep, and take moments for breaks to re-energize. And Commitment, to reconnect to their purpose, to remind themselves, as they see patients and take on leadership, research or educational roles, that they are making a difference.
OMR: How can associations like the OMA help normalize the discussion of burnout, both for individual doctors and within the wider medical workplace culture?
Dr. Gautam: The culture of medicine has been one in which we’re expected to just show up and do what needs to get done and put our own needs aside because the patient needs come first. I don’t think that any of us doubt that it’s important to take care of our patients, except that we need to be in the best possible shape to continue to come and do that every day.
The burnout task force has been instrumental in starting some key conversations. Through the pandemic, the task force started a series of podcasts, available to members. Many members have told me that they not only listened to those but then brought them into their workplace environment to start a conversation, not just about these issues but also how can this lead to action to address (burnout) in a very local way, in our division or in our department or in our clinic.
The task force created a burnout toolkit, which has resources for the physician leading wellness or well-being initiatives within their organization. We were able to also identify best practices and programs that other organizations have used, such as a buddy system or a peer support group. We were able to give people some guidelines on how to set those things up.
This interview has been edited for length.
Katherine Kerr is an Edmonton-based writer.
Experiencing a work-life conflict is common in burnout. You may also feel a lack of control or satisfaction in work. Physicians experiencing burnout may believe that they are performing a disproportionate share of the workload and feel underappreciated.
Here are the three main components of burnout, as developed by American social psychologist Christina Maslach and colleagues:
Reduced sense of accomplishment