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COVID-19 has driven much innovation in Australian health care; telehealth services, additional mental health service capacity and additional Medicare subsidisation are the most obvious examples.
The bad news is frontline health care workers are also being driven and not necessarily in a good direction, with concerns about their mental health. How will frontline health care workers access mental health support after the COVID-19 pandemic?
Why are frontline health care workers leaving the jobs they love?
International research shows that 46% of doctors were burned out before COVID-19, and that figure has risen to 64% due to the COVID-19 pandemic.
One thing the pandemic has done is expose the cracks in the health care systems around the world. From inadequate testing and personal protective equipment (PPE) to overcrowded emergency departments, frontline staff are putting their lives at risk to care for highly infectious patients. Regardless of the fact that the odds are stacked against them, the medical workforce are responding to the crisis with characteristic selflessness, resilience and compassion.
For many doctors, COVID-19 was the straw that broke the camel’s back. Being isolated physically from family and friends, and overwhelmed by the surge of sickness and death they face on a daily basis, means that depression, anxiety, post-traumatic stress disorder (PTSD) and secondary trauma are reaching levels that have never been seen before.
On 23 November, a new book from Libyan-born psychiatrist Dr Omar Reda will be published. The wounded healer: the pain and joy of caregiving posits that the act of caregiving is physically exhausting and emotionally draining, and prolonged exposure to human suffering causes high rates of burnout and poor quality of life. Dr Reda also writes that many doctors believe that their feelings do not matter; they should ignore their pain, brush off their trauma, wipe away their tears, and just “suck it up”. This results in toxic stress and silent suffering.
My brother, Dr Andrew Ong, a gastroenterologist from Singapore, was deployed to the front line when Singapore was affected by the first wave of the pandemic. He has experienced isolation from his family, not seeing his children, worked incredibly long hours, daily anxiety and fear, putting on PPE – nine steps on and off and just one missed step increases his risk of getting COVID-19 – the trauma of witnessing people dying in a way he’s never seen before. It’s a snapshot into the future of what frontline staff in Australia may have to experience here.
In the US, doctors are suffering from physical and mental health conditions due to pandemic fatigue and burnout. This has resulted in relationship and financial issues, moral injury and PTSD; however, the fear of stigma and licence compromise is preventing these workers from seeking mental health support. An investigation by The Washington Post has shown 30% of medical workers have considered leaving the profession, and estimates that, by 2032, the US will have a major shortage of doctors and nurses. Is Australia facing the same looming crisis?
Our call to action in the short, medium and long term
We must prioritise finding and implementing a solution to pandemic fatigue and burnout. Government bodies need to show compassionate non-discriminatory leadership to all health care workers by supporting a mental health wellness strategy industry-wide. We need improved communication, relationships and leadership to protect our health care industry from severe retention decline and a dramatic health care system breakdown.
In the short term, we need to be lobbying the government to channel more resources to boost staff so the existing workforce isn’t as overstretched. Resources need to be funnelled towards increased mental health support. We need to be raising awareness in the broader community. We need to be implementing a behavioural contract with the general public so when they come into contact with frontline staff they treat them with respect and kindness.
In the medium term, we need to implement peer to peer coaching, raise awareness of burnout as an issue among frontline staff, and educate them about the symptoms. The health care industry needs to have access to rostered days off, doctors should be allowed to claim overtime, and working hours need to change to protect their wellbeing. The health care sector could also borrow from other successful campaigns that have destigmatised mental health issues such as in professional tennis and in the Australian Football League.
In the long term, hospitals and colleges need to be educating health care workers about self-care, compassion and mindfulness. Hospitals need to focus on becoming an industry “employer of choice”, taking better care of medical doctors and staff, incorporating patient and information flow systems, providing adequate staff to carry the workload, and collaboration in workflow design to demonstrate a culture of support. Metrics to measure a corporate wellness strategy should include quality, safety and patient satisfaction.
In extreme workforce shortage conditions, recruitment and retention will be all that matters. This means taking better care of medical doctors and staff, and providing adequate staff to carry the workload.
Dr Olivia Ong, author of The heart-centredness of medicine, is a Melbourne-based pain physician and keynote speaker on physician burnout prevention. Dr Ong runs programs helping doctors transform their lives from burnout to brilliance. To find out more visit https://drolivialeeong.com/book/
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.
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Strongly disagree with your description of the pathology. Neither the resourcing situation, nor the pandemic are causing this. What’s causing this is the lack of accredited training places per the number of graduates. It’s possible to crawl through a very long tunnel if the light at the end is the exit leading to the promised land. What’s new in Australian Medicine is that, for many of our generation, we will never be accepted onto a training program. It’s a mathematical certainty. For many of our generation, the light at the end of the tunnel is truly the headlight of the oncoming train.
There is no substitute for being on an accredited training program. That’s why most of us are seriously considering leaving. Even if many of our generation deny it when asked.
Australian Chronic shortage of health care workers could have prevented for many years ago if the acceptance, recognition, training and work retention policies of IMG’s has been more fairly done, nil bureaucracy politics involvement and separate from the local medical graduate curriculum performance since all IMG medical education differs but the same goal ‘ Doing no harm to individual unwell patients’.
Its a artificial or man made unfair and in a way indirect discriminatory policies judgement against IMG’s recognition.
Great article ,Olivia
As a doctor who has taught the health profession and doctors about the benefits of mindfulness I can attest to its benefits in reducing their suffering as well as allowing them to work to their optimum. The problem is that doctors continue to regard wellness and see-care as a low priority .
I recently offering peer to peer coaching to surgeons at my hospital for free and found there was little interest.
With “pre-morbid” issues such as ramping and waiting list blow out, I fear that Covid will be the last card on the toppling structure that is the public health service, but far more disastrously, the health of our future doctors.
Unsafe hours awareness began when I was a registrar – over 30 years ago, but has been swept underground rather than meaningfully addressed. There have been countless examples of Departmental heads directing their staff to catch up on paperwork in their own time, and recently I heard yet more stories of junior doctors being directed to avoid accessing PACS when preparing presentations (for hospital meetings!) as it logs time towards fatigue leave! The same registrar told me of a 6 month rotation where they had to drive 2 hours to a regional clinic at 6am every Monday morning after coming off 48 hours as the only on call specialist registrar for all of Queensland south of Rockhampton. How many more young lives will self divert way from our profession (possibly fatally, and even more tragically, if intentional) under yet further pressure from the additional stresses of working during a pandemic – because already recognised, longstanding, underlying problems have not been acknowledged?
Great article Olivia.
It is time to abandon the “Customer is always right” slogan.
It is time to treat doctors with the same compassion and humanity we are required to show our patients.
It is time to guarantee doctors a voice.
It is time to stop the useless platitudes and actually hear what doctors are saying.
there is an old saying that it is only when the tide goes out that you realise who has been swimming naked.
similarly, this crisis has caught the government out.
for years staff have been complaining about understaffing, overcrowded Emergency departments, excessive workloads etc but bureaucrats have ignored us and hidden the problems with clever statistics.
and yet they expect the system to cope with an added crisis