The heavy load of the doctor in training

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.

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).

“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]

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.”

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.