The ramifications of burnout present an increasing crisis in the healthcare system, which carry consequences on all levels, with personal, professional, institutional and societal costs.

A doctor is expected to work long unpredictable hours, usually under immense pressure, often with inadequate support, requiring a lot of resource management.

Burnout is universal, but especially worrying in the healthcare sector because of the type of work and type of people working in the sector. “We’re facing a mental health crisis,” said the South African Society of Anaesthesiologists (SASA) CEO Natalie Zimmelman.

Under-diagnosed and treated, SASA recently shone a light on burnout among SA’s clinicians. Focussing specifically on those working in the demanding field of anaesthesia, experts backed by solid data argued that doctor wellness is not viewed as a priority in SA compared to other nations.

“A doctor is expected to work long unpredictable hours, usually under immense pressure, often with inadequate support, and most definitely, in this day and age, requiring a lot of resource management,” said private sector anaesthetist Dr Caroline Lee. “On the home front, the doctor is expected to be a loving partner, a doting and available parent, a sympathetic friend, a caring child to ageing parents, and an upstanding member of the community.”

This leaves little wonder at the fact the rate of burnout, depression, and suicide among medical professionals is reaching such alarming proportions. “If we don’t tackle this issue urgently, quality patient care may become unsustainable in the future,” warned Dr Lee.

PREVELANCE

Burnout rates vary between different specialties and different career stages. “The highest rates of burnout are amongst those at the front line of doctor-patient care interactions,” said Dr Lee. “Female doctors report more burnout symptoms than men and the mid-career doctors are more stressed and burned out.”

Professor Johan Coetzee of the University of Stellenbosch said that according to a 2018 survey, 18% of anaesthetists working in SA’s public sector suffer from extreme burnout, with 7% of their private-sector counterparts affected too. The international average for anaesthesiologists suffering from extreme burnout is 6.2%.

“At least three anaesthesiologists have taken their lives in the last three months,” reported SASA CEO Natalie Zimmelman. “These are just the cases we know of. I’m afraid it is a far too common story, we are facing a mental health crisis.” The SASA Wellness Support Group was formerly created in 2015 after six suicides in an 18-month period.

DIAGNOSIS OF BURNOUT

Unlike depression, with definitive DSM5 diagnostic criteria, there is no clear definition of burnout and as a result, it is not clear how it can accurately be diagnosed and there are no well-studied methods to assess it. “It is very difficult to diagnose burnout because there is such a wide range of symptoms and the onset can be insidious,” said Dr Lee. “It is also not an endpoint.

There is a continuum and severity of symptoms, from stress, chronic stress, exhaustion, disillusion, detachment, isolation to burnout. As a result it is often missed and goes untreated until it is severe.”

SUBSTANCE ABUSE

“In the US, the death rate among anaesthesiologists is twice that of other doctors, and anaesthetists are overrepresented by a factor of seven at rehab facilities,” said University of Cape Town registrar Dr Justine van der Westhuizen. “This is what makes it so important to understand the prevalence of substance use in anaesthesia practitioners in SA.”

Until recently, no data existed on substance abuse among SA’s anaesthesia practitioners, but a recent survey yielded telling results. “While only 1% of respondents fell into the high-risk category of substance abuse (alcohol only), there is still a relatively high use of alcohol and sedatives,” said Dr Justine van der Westhuizen. “What is clear is that the country’s doctors are sacrificing themselves – and will continue to do so – before they allow patient care to suffer.”

ROAD AHEAD

“To achieve systemic change in the health sector and expand support to doctors, SA needs collaboration among administrators, regulators, hospital groups, policymakers, and other bodies, as well as a culture change,” said Dr Lee. “It’s time to recognise that the health of our healthcare providers is critical. Everyone must invest in creating and maintaining a healthy, sustainable healthcare workforce. Doctors must be involved in healthcare policymaking at every level in the public, private and academic sectors to achieve this.”

Dr Lee said SASA is committed to helping its members look after their physical and mental health, achieve a better work/life balance, and recognise the signs of burnout.