Canadian Physicians Report Happiness, Acknowledge Challenges

Canadian physicians reported a high rate of happiness at work and in their home life in a new physician wellness survey conducted by Medscape Medical News. At the same time, many physicians acknowledged experiencing work-related burnout and depression.

The national survey included information submitted by 744 respondents (66% specialists, 34% general practitioners [GPs]). Most respondents lived in Manitoba (42%), followed by Alberta (17%), Prince Edward Island (13%), and Newfoundland/Labrador (12%). Smaller proportions came from Ontario and Quebec, the country’s most populated provinces.

While 37% of respondents reported working in hospitals, 24% were based in GP groups or private practice settings, 19% were based in clinics, 15% were based in other settings (including virtually, working from home, and long-term care), and 5% were in academic settings.

More than half (57%) of respondents identified as men and 41% as women. The majority (91%) were aged 45 years or older, including 24% who were aged 70 years or older.

Widespread Happiness

While most respondents reported being very or somewhat happy with their work life (68%) and personal life (74%), 24% reported experiencing burnout, 3% reported depression, and 11% reported both. The remaining 62% reported experiencing neither condition.

Burnout was more commonly reported by respondents younger than 45 years (about 40%) compared with older respondents (23%). Women reported a higher rate of burnout than men (35% vs 17%), and respondents based in an office practice were more likely to report burnout than those working in a hospital setting (33% vs 23%).

While 57% of physicians who reported burnout or depression attributed some of it to personal life, 73% attributed all or most of it to work. About 69% said that work burnout had negatively affected their personal relationships. This effect on personal relationships was most evident in respondents younger than 45 years (90%), compared with those aged 45 years or older (65%).

Health and wellness were a priority or somewhat of a priority for 91% of respondents, with exercise being a commonly reported activity to achieve them (72%). Exercise was a daily activity for 17% of respondents. About 30% reported engaging in it two or three times a week, and 26% reported exercising four to five times weekly.

Slightly more respondents (73%) reported spending time with family and friends and pursuing hobbies as their way to stay well. Healthy eating was reported by 64%, and 58% reported getting enough sleep.

Yearly vacation time totals of 3-4 weeks were common (36%), and many respondents (42%) had more weeks of vacation than that.

Almost half (48%) of respondents said that they would take a salary reduction to achieve better work-life balance, while 27% said that they would not, and 25% said that they were not sure. Respondents younger than 45 years were more likely to endorse this option than older respondents (61% vs 47%).

A desire to spend less personal time online was reported by 49% of respondents, with 56% reporting spending 2-4 hours a day online for personal reasons, including social media, texting, movies, news, and other interests.

Poor Self-Assessment?

Commenting on the survey results for Medscape Medical News, Catherine Pound, MD, director of Physician Support and Wellness at the Canadian Medical Protective Association (CMPA), said the rate of burnout and depression in the survey is likely an underestimate.

The CMPA recently launched the Physician Well-Being Index, a validated tool that has found higher rates of physician depression and burnout, said Pound. “The level of distress we are seeing is about two thirds of physicians who are struggling or in distress, and that level was a bit lower in the Medscape survey.

“What was super interesting to me is that the Medscape survey asked people to self-assess, as opposed to the Well-Being Index, which gives you a result of well-being based on the questions they ask,” Pound added. Physicians are not good at assessing their own mental states, she said. “If I ask a physician if they’re distressed, they may say no, but if I give them a validated tool, the result may be different.”

The Well-Being Index has thus far collected almost 4000 responses from 117,000 CMPA members. While those responses might reflect a self-selection bias of respondents who are feeling higher than average levels of distress, Pound said that the findings dovetail with the results of the Medscape survey.

“All across Canada, there’s a human resource crisis. We know that physicians are working really hard. They’re working long hours, and we know that there’s a lot of emotional distress and burnout. Physician wellness is a pillar of the healthcare system. If you don’t have physician well-being, then we know there’s an increased risk of patient dissatisfaction, there’s an increased risk of patient safety events, and there’s an increased risk of burnout, and the more physicians who leave the system because they’re burnt out. It’s a vicious cycle.”

Small Numbers

Margot Burnell, MD, president of the Canadian Medical Association, said the Medscape survey provides more information on this area and is consistent with research underway by her organization, but it includes a relatively small sample size.

“We will be releasing our national physician health survey results in the fall, so seeing something a little more robust will be good to add to all of these data points on this important topic,” she told Medscape Medical News.

Burnell identified four main opportunities to alleviate physician burnout and improve well-being, including facilitating physician autonomy, easing administrative burden, streamlining team-based care models, and improving access to patient health data through electronic medical health records.

“There were several bills that died when government was prorogued, and one was on connected care and data interoperability,” she explained. “There is an imperative to get that back onto the legislative table. We will be working with all parties to identify solutions that we can move through with our stakeholders — federal, provincial, and territorial medical societies and governments — to keep healthcare at the forefront.”

Pound and Burnell reported having no relevant financial relationships.

Kate Johnson is a Montreal-based freelance medical journalist who has been writing for more than 30 years about all areas of medicine.