‘Overworked, burnt out and harassed’ – the study that paints a bleak picture of young, women doctors

Maltese doctors in general are working an average of 50.7 hours every week, according to a study on their health and wellbeing of doctors based on a questionnaire answered by 173 medical doctors – approximately 8% of the total registered with the Malta Medical Council.

The study published in the Malta Medical Journal and conducted by Marilyn Harney and Jurgen Abela from the Department of Primary Health Care, is the first for which all doctors working in Malta have been invited to participate.

But participants were found to have higher levels of stress, burnout, compassion fatigue and secondary traumatic stress than their international peers, and were especially prevalent in young female doctors still in training.

Females also reported consistently higher levels of mental ill 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 juggle many other things in addition to 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 are able to work longer hours if they so wish.

Working hours were longest among Foundation Year doctors, 81% of whom work over 48 hours, and amongst doctors in training, where 62% work over this limit. But working hours tend to decrease as 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 earlier stages of their career being impacted the most.

84.3% of participants also worked during 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 lunch break “all or most of the time” while at work, compared with 49 (28.3%) who never managed to.

Belittled and harassed

Participants were asked to indicate whether they experienced belittlement, harassment or sexual harassment at the workplace, and to indicate the source and whether this 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 – of which three 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 being belittled by senior medical staff, 31 of which on a regular basis.

From the participants who reported that they felt belittled often or regularly, 63.3% were females. 80% of those who reported sexual harassment which happened often or regularly were females.

Majority of doctors… do not have a doctor 

The study also found that 59.5% doctors said they do not have their own doctor, and that they provide their own medical care, while 59% would not want others to know if they were experiencing mental health problems in contrast to 30% who do 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, given the high rate of doctors who provide their own medical care. “Addressing this attitude in early stages of training may help to reduce barriers to care, according to the authors of this study. This is especially important when considering that the medical profession is associated with a high risk of mental ill health, substance misuse and suicide risk.”

A total of 46 doctors (27%) recorded high and very high stress levels. Twenty-nine of these (63%) were females. But lower stress levels were found among those who had progressed in their career.

38 participants (22%) reported that their mental health affected their work ‘half the time’, ‘most of the time’ or ‘all of 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 percentile ranges for burnout and 39 (59%) of these were females.

59% of male doctors at risk of obesity

47.7% of all participants in the survey had a Body Mass Index in the overweight or obese range. The obesity rate was higher among male doctors, reaching the 58.9% mark.

Research in 2014 showed that GPs in Malta who are obese find it harder to recommend exercise, with subsequent adverse consequences on the health of patients.

The high percentage of doctors who are overweight or obese suggests that despite their knowledge, doctors still struggle with a healthy lifestyle and that interventions at various levels – personal, professional and organisational, are needed 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 a shared workload, manageable working hours, regular breaks, fair and equal access to vacation leave and study leave and family-friendly measures.

It also recommends structures that allow for dealing with issues such as belittlement, harassment and sexual harassment at the workplace in a confidential and effective manner.

In view of the self-stigma on 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 afternoon/evening clinic, ideally outside of hospital or government health centres, to ensure privacy, where two GPs would be available. “An email address can be made available for doctors to make contact or set an appointment. The GPs will make the initial assessment and be available for follow-up, or refer as needed.”

The study also recommends structures to deal with belittlement, harassment and sexual harassment at the workplace in a confidential and effective manner.