The survey measured an assortment of variables that are critical to physician well-being, including burnout, work engagement, workload and fairness. The survey results confirmed that a vast majority of physicians who responded felt overextended, disengaged, ineffective and/or fully burnt out. The scores on the burnout measure were significantly in the burnout direction relative to the scales’ norms and to the Canadian Medical Association’s (CMA) 2008 Canadian Physician Health Survey.
The analysis found indications of burnout associated with physical and mental health problems that interfered with physicians’ capacity to do their work. The quantitative analysis and the extensive written comments from participants related physicians’ distress most directly to the basic organization of work rather than to personal failings regarding inadequate self-care or poor work practices.
Dr. Leiter’s research suggests that the issues of burnout present in the Nova Scotia physician community are systemic and not related to individual failings or lack of self-care. He concluded that the root cause of much of the burnout, and therefore the most effective route for addressing the burnout, is through addressing physicians' relationships with the Nova Scotia Health Authority (NSHA).
The Nova Scotia study was compared to data about health care providers from other reference points: 2017 Maslach Burnout Inventory and 2015 Areas of Worklife Scale. Also compared results to data from the CMA’s 2008 Canadian Physician Health Survey. The following emerge as distinct issues for Nova Scotia:
- Physicians are struggling to manage workload.
- The scores on exhaustion, cynicism and efficacy were significantly more negative than relevant norms.
- A specific strain related to both cynicism and low efficacy pertains to physicians’ perception of lack of respect for their professional expertise and autonomy.
Summary of other key findings
|“I feel that government/health authorities respect my professional autonomy as a physician.”||30%||40%|
|“It is possible to provide high quality care to all of my patients.”||36%||40%|
|“I feel that I am in control of my work environment as it relates to patient care.”||45%||38%|
|“I feel that I have a good balance of work and other activities in life.”||44%||37%|
|“If you re-lived your life, would you still want to become a physician?”||22%||59%|
The main themes identified in the qualitative comments about causes of burnout were:
- Administrative hassles such as excessive paperwork and meetings
- Financial concerns re: uncompensated time for the paperwork and meetings and financial demands related to student debt, maintaining a practice and retirement planning. Current financial situation was described as strained and as worse than it used to be
- Constraints on physician autonomy by NSHA; billing constraints on amount of time that can be spent with patients who require more than 15 minutes of care
- Workload related to how physicians are organized around the province (for example, few specialists in rural areas mean longer hours; inability to recruit)
- Most effective route for addressing issues found in the survey is through improving physicians’ relationship with NSHA. Issues are systemic, not related to individual failings or lack of self-care.
- Reduced workload is only part of the problem and would not benefit those feeling burnout related to disengagement from the system or feeling ineffective.
- An element of burnout is related to the level of disrespect physicians feel is directed toward their profession.
The invitation to participate in DNS’s Physician Burnout Survey was sent to 2,287 physicians; 1,088 members opened the message, 372 physicians completed the survey giving a response rate of 16 per cent. Dr. Leiter believes this to be significant enough to conclude that burnout is a serious issue for Nova Scotia’s physicians.
Dr. Michael Leiter, PhD is an organizational psychologist who studies the relationships of people with their work.