Simple ways to afford junior doctors more autonomy

AS the nation looks to our health care industry to chart a course out of the coronavirus pandemic, one cannot help but reflect upon both the remarkable achievements we have made as a collective and the unfulfilled opportunities to improve doctors’ wellbeing and mental health outcomes.

Nowhere was this more apparent than at the recent “The New Horizon” doctor wellbeing event held by Doctors’ Health in Queensland. Having been fortunate enough to attend this event, we can attest that the learnings were both poignant and confronting.

Many attendees were moved by the courage of our colleagues contending with mental health challenges in a professional environment that is notoriously insensitive to change, as well as the inordinate strength demonstrated by medical families that have lost loved ones to suicide.

From these stories emerged earnest conversations that sought to name the challenges unique to our Australian medical training experience, and formulate strategies we might use to overcome them.

We left inspired by the collective optimism, enthusiasm and appetite for cultural change.

We’ve previously written about some of the novel ways doctors might initiate such positive changes throughout our profession. Since then, we’ve continued to recruit the opinions of our colleagues on the topic, detecting a strong shared yearning for improved working conditions. In particular, this appetite is perhaps strongest among junior doctors – a cohort known to be particularly susceptible to burnout.

This conversation became painfully apparent as the COVID-19 situation evolved. Reports of unsafe working hours, professional isolation and inequitable remuneration among health care professionals increased as the pandemic exacted a large and increasing toll on our health system. This experience among our colleagues overseas is perhaps even more damning.

As expected, reported rates of burnout were seen to soar among frontline staff.

The development of burnout is multifactorial, independent of the stresses of a global pandemic; however, many junior doctors often cite a loss of professional autonomy at work as a chief cause of professional discontent.

Should this not prompt us to ask why our junior doctors do not experience a strong sense of professional autonomy? Is this reality a logistical imperative, or a cultural defect?

At first glance, the medical profession is not designed to cater for autonomy among its emerging practitioners. Health care is uniquely hierarchical and, perhaps more than any other industry, relies on experience-based decision making. Its safe day-to-day functioning depends on the making, implementing and revising of sensible and effective management plans. While this process undoubtedly requires a diverse team to make it happen, decisions are often made by the most senior practitioners, who call upon their past experience and deep knowledge of best practice to ensure the patient does not come to harm.

Very seldom would we expect newly minted interns to run a ward on their own. The question therefore remains, how then may we afford autonomy to our junior workforce, granting them a sense of self-mastery and satisfaction?

We argue there are some simple ways this might be facilitated.

The autonomy of junior staff is supported by taking an interest in their professional growth. While junior doctors may not possess the experience independently to manage a patient, they possess influence over their own professional destiny. Junior doctors enrich hospitals with their enthusiasm, commitment to continual improvement, and novel approach to problems. As a result, we believe departments must respect these unique contributions to their service and honour the development of their junior doctors.

This should not be too difficult to achieve.

It starts with simple gestures, such as asking the medical student or junior doctor on your team what interests them. Beyond establishing rapport, anecdotally, this motivates new team members and prompts the broader group to identify learning opportunities related to the identified areas of interest.

For example, the resident interested in otolaryngology on an emergency term might be sought to help manage a tricky epistaxis case. The cardiology aspirant on an anaesthetic term might be invited to assist the registrar on complex preoperative consults and help to evaluate their preoperative fitness from a cardiovascular point of view. The junior doctor interested in a career in emergency medicine can be shown how to reduce fractures on an orthopaedic term. In these examples, the junior doctor’s interest and ever-growing specialty expertise are put to good use, with their enthusiasm in turn benefiting their current department. More so while their skills continue to develop, their role in the team is validated as well as their medical identity.

While these small gestures might seem trivial, we must not discount the cumulative effect they elicit, as well as the broader message they send. Taking a genuine interest demonstrates to junior staff that their growth is as important as their output on a term. It allows junior doctors to recruit senior clinicians on their journey of self-improvement, and affords senior clinicians the privilege to share in junior doctors’ accomplishments as a team. Beyond all of this, it personalises our workplaces and imbues the hospital walls with the humanity for which we all yearn.

So, next time a term changeover rolls around, take the liberty of asking your new team members, “what type of doctor do you want to be?” Their answer might mean more to your team than you think.

Dr Michael Erian and Dr Chris Erian are twin brothers both currently working as orthopaedics senior house officers at QEII Jubilee and the Sunshine Coast University Hospitals respectively. Both share an interest in doctors’ wellbeing, with Chris also serving as an executive on the AMA Council of Doctors in Training.

Dr Natasha Abeysekera is an executive member of the AMA Queensland Council of Doctors in Training. She is working as a resident medical officer at the Royal Brisbane and Women’s Hospital.

The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.