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Burnout

All the UK-based reports mentioned previously (see "Early retirement of UK doctors" and "Flexible working") indicated that burnout is a factor in early retirement. The term “burnout” first appeared in the USA. Defined as “a syndrome of emotional exhaustion, cynicism (depersonalisation) and reduced feelings of personal accomplishment in relation to work”, it has been related to decreased productivity.

A 2019 study into the prevalence of burnout amongst UK obstetricians and gynaecologists, conducted by Imperial College London, and supported by the RCOG, found that just under half of trainees and a third of consultants and SAS doctors suffer from burnout. The study found that burnout was associated with increasingly defensive medical practice, a negative impact on physical and mental wellbeing “and is strongly associated with depression, anxiety and suicidal thoughts”. This has clear implications for the retention of doctors as well as on the efficiency and sustainability of the O&G workforce.

A recent editorial in Obstetrics & Gynecology noted that O&G “hovers near the top of any list of burnout among medical specialties”. It agreed that doctors’ resilience may be enhanced by programmes teaching individual skills but also called for a priorities check by institutions: “We must not mistake the call to cultivate resilience as a sign that individual physicians alone can stem the rising tide of burnout”.

Similar problems are occurring in many developed countries. A systematic review of 65 studies (33 from the USA) found doctors’ main reasons for retiring were excessive workload and poor health. In America and Europe, doctors in front-line specialties are most at risk of burnout: Symptoms affect both sexes equally and are more common among doctors than nurses.

Healthcare organisations in the USA have addressed these problems by making new appointments at Director level, with good results. Guidance on late-career transition has been published in Canada and Australia, and the Royal Australian College of Surgeons has modified its CPD regulations with the help of its Senior Surgeons Group.

In some countries like the USA and Canada, many doctors work beyond the age of 70 for financial reasons, and in some specialties, particularly surgery and anaesthetics, doctors are concerned that ageing may affect their technical ability. An international review, however, found considerable individual variation and concluded that assessment of competence should focus on functional ability rather than chronological age.

O&G is a rewarding career but it is also a challenging one. This is well known and more needs to be done to move beyond traditional cultures of endurance and stoicism, which is having a very real and adverse effect on many doctors. There is a specific role here for the NHS and institutions, for them to look at the cultures and processes within their own departments and to honestly ask if they are doing enough to support their workforce.

The consequences of not doing so not only affects the retention of doctors but can lead to avoidable and often tragic outcomes.