how hospital pressures harm doctors’ mental health

Even before the COVID pandemic, which added significant pressure to the health-care workforce, Australian doctors experienced poor mental health at higher rates than the overall population.

The risk is particularly high for medical students, junior doctors and female doctors. A recent review of data from 20 countries found suicide was 76% more likely among female physicians compared to the general female population.

All this is a problem for the doctors themselves, and often for their loved ones. But it’s also a problem because we rely on doctors to provide high-quality health care for the population. If they’re burnt out, or experiencing anxiety, depression, or other mental health issues, this can affect their capacity to look after us.

Our new study published today in BMJ Open explores how doctors’ workplaces and working conditions affect their mental health.

What we did

We interviewed and then “work shadowed” 14 doctors while they were on shift in a public hospital in South Australia between June and October 2021. The doctors who took part were from varying cultural backgrounds, genders, sub-specialties, and at different stages of their careers (junior and senior).

We asked doctors about their roles, duties they perform, training requirements, and hospital regulations or standards that affect their experiences of their work.

We then watched the same doctors working at different times of the day, observing:

• features of their working environments (such as pace and demands)
• interpersonal relationships (team dynamics, mentoring, supervision, patient interactions)
• the types of pressures they contended with alongside delivering clinical care (patient loads, administrative tasks).

During the shadowing, we explored with doctors how their workplaces could better support their mental health.

Administrative burdens on top of patient care

Among several challenges participants reported in their day-to-day work, the burden of administrative processes (such as completing paperwork and gaining approvals required for referrals) was a particularly strong theme.

One doctor said “the hospital processes are more stressful than clinical scenarios”.

The administrative burden required on top of clinical care left doctors feeling disenfranchised and negatively affected their satisfaction with service delivery. One said:

If the [patient’s] outcome is poor because they’ve had a terrible accident or got a terrible illness, I can rationalise that. But if they’ve had a poor outcome because we’ve not been able to deliver them a good service that feels a lot worse.

Workforce and rostering shortages

Doctors also described under-staffing and fragmented teams, which often required them to absorb pressure to provide high-quality care. This, compounded by the effects of shift work, led to exhaustion and took a toll on their mental health.

Despite this, doctors described feeling unable to refuse shifts or take leave for fear of losing professional credibility among colleagues or with senior staff who might control future job opportunities. One participant said:

We just keep taking it, keep taking it, keep taking it […] until we can’t. And I think, particularly doctors who don’t want to be seen as causing trouble or rocking the boat […] or seen as weak. You don’t want to be the one to admit that actually, this is impossible for one person to do.

A combination of pressures

Doctors in our study were highly trained, motivated and proficient in providing clinical care relative to their career stage.

However, their medical practice occurred within work environments characterised by high patient loads, time constraints, geographical challenges (services dispersed across sites) and administrative burdens. As one participant explained:

I think that just bubbles over years and it just makes this horrible feeling of injustice. Which is why I think doctors just feel burnt out, tired, frustrated, because they’re trying to do the right thing, and they’re trying to be better, and the system just doesn’t allow it.

The combination of competing pressures often collided with ambitions of being “a good doctor”. As one junior doctor explained:

In addition to all that knowledge and actual competence that you need to have, it is so important to convey to others that you are this rational, measured human being who is there to get the job done in an efficient way, in the right way. You just have to step up to that role and fulfil all these different tasks, and different expectations within this one job.

What next?

Our study was conducted only in South Australia’s public hospital system, so our findings can’t be generalised to other hospitals or other health-care settings where doctors might work.

But to our knowledge, ours is the first study of doctors’ mental health where, alongside interviews, researchers entered participants’ workplaces to observe their working conditions. In this way, it provides unique insights on the organisation and system-level factors which influence doctors at all career stages.

Our findings indicate doctors’ working conditions can have a direct impact on their mental health.

Protecting doctors’ mental health often focuses on how individual doctors can build resilience and increase their capacity to manage stress, for example through employee assistance programs.

While these approaches are important, they place ultimate responsibility for mental health on the individual doctor. This will not be enough, because doctors’ working conditions are largely outside of their control.

Programs are also not always accessible, for example due to stigma, workplace and professional culture, concerns about confidentiality or perceived risks to registration.

Protecting doctors’ mental health will require system-level changes, including addressing workforce shortages and restructuring leave provisions so that staff feel able to take time off. These changes are a crucial starting point to better look after our doctors, so they can look after us.

If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14.