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  • The heavy load of the doctor in training

    While most junior doctors have a rewarding and satisfying career in medicine, it can take a toll. They tend not to prioritise their own physical and emotional health and feel pressured not to miss shifts, or they often feel compelled to take on added shifts for their colleagues with the expectation that the favour will be returned.

    A 2008 Australian Medical Association survey [1] of doctors in training found doctors in training tend to develop a culture of self-reliance and self-care that persists throughout their careers, with only 66% consulting their own GP

    To cope with the demands of changing clinical placements, a high-pressure work environment and long hours, doctors in training said they relied heavily on their relationships for support – which left them vulnerable if they became isolated through relocation or due to heavy work and study demands.

    Long hours, little sleep

    The research also found physical health was commonly compromised by working up to 60 hours a week, with most junior doctors sleeping less than seven hours a night and only one quarter finding the time to exercise for 30 minutes on most days.

    According to one trainee it is not so much the long hours but the lack of autonomy about how and where you spend those hours that is stressful and demanding.

    “It’s not like a corporate environment where you can take a break and go to the gym,” she says.

    Relationships impacted

    The uncertainty over hours and placements can be exacerbated by the lack of time spent at home working on personal relationships. Taking time off is still frowned upon, with residents regularly expected to make up shifts with little or no notice.

    As more people are coming later to medicine and having children during their training years, the workload can take a heavy toll on family life.

    “I have a 20-month-old daughter and some days I don’t see her at all,” says Dr Gareth Crouch, a cardiothoracic registrar and member of Avant’s Doctor in Training Advisory Council (DiTAC).

    Workload balance

    Juggling priorities and the workplace

    “One of the things I constantly struggle with is time management and prioritisation,” Dr Crouch says.

    “Days off are rare and there is a temptation to do research work or work-related activities rather than taking a step back and relaxing. What we really need is to dedicate time for family and losing small white balls on the local fairways.”

    Another threat to the wellbeing of doctors in training is the workplace itself. Uncertainty about their job, inflexible working conditions and occupational hazards such as being exposed to abusive and violent patients in emergency departments, can all add to the stress and compromise the health of young doctors.

    Dr Crouch says doctors in training are experiencing a growing number of claims handled by Avant, mainly relating to workplace and training disputes. DiTAC has surveyed early career stage doctors to gauge how well prepared they are to cope and identify what additional support they need.

    “It can be a massive stress – you put in so much time and effort into achieving your goal to be a specialist so if someone is trying to take that away from you, it can have a significant impact on your health and wellbeing,” he says.

    It’s probably unreasonable to try to change the health system – although there is an increasing acknowledgement of the need for more support for doctors in training to ensure a healthy and sustainable medical workforce. [2]

    Self-care and research are key

    The ability to maintain wellness during the years in training is largely dependent upon doctors’ own attitudes and level of self-awareness. The most important issue is for doctors in training to make their own health a priority, for example by finding a GP before they need one, especially if they are locating to a new area, and by taking time off for sick leave if necessary. The key is in knowing that they are not indispensable, says Dr Brownlow.

    “When you move around it can be really difficult negotiating a new support network, but this is really important. You spend enough time worrying about the health of your patients – you need to spend as much time looking after your own health,” she says.

    It is also helpful to research as much as possible the demands of each specialty so that young doctors can work out ahead of time whether they will fit in with a healthy lifestyle.

    “Find out about the demands, the hours, whether you will have to move around the country. You need to try to work out ahead of time whether that’s something you want, whether it suits your family life and whether you can prepare for it,” says Dr Crouch.

    Finding the time for physical exercise is also essential to preventing fatigue, stress and burnout and improving general good health, he says.

    “Above all, find the area of medicine you are passionate about as this will make working through the difficulties easier and more rewarding.”

    Member Story

    Member Story

     

    Dr Jeremy Chin

    Rotating to different hospitals with new colleagues and procedures can be a particularly stressful time for doctors in training, especially if they are isolated from family and friends. Anecdotally, these are times when doctors can feel particularly anxious or depressed.

    Stress management

    I manage the day-to-day stresses of work by maintaining a close group of friends with whom I can debrief. It helps that my fiancé is a doctor but we also have many non-medical friends and their perspective is often refreshing.

    Mentors

    There is also a formal O&G mentor program at Monash that trainees can utilise. This comprises senior consultants who are available to discuss issues one-on-one; not only clinical issues, but professional and career issues too.

    Outside interests

    I have so far managed to balance work with a number of activities including sport and music. I play in Corpus Medicorum, an orchestra of (mainly ) doctors, with several performances each year, and I am training for the summer triathlon season.

    Working in Launceston has exposed me to the day-to-day lives of consultants, including their private work. Undoubtedly the transition from doctor in training to consultant will bring its own challenges, but right now I am thoroughly enjoying being an O&G registrar. It's great.

    References

    1. Markwell AL, et al. The health and wellbeing of junior doctors: insights from a national survey. Medical Journal of Australia 2009; 191 (8): 441-444.
    2. Csontos A. Fatigue management takes off. NSW Doctor 2010; 2:18.