The levels of stress and long working hours among SA anaesthetists are increasingly unsustainable with 40% of those in the state sector suffering from burnout, found a Stellenbosch University study. Levels of severe burnout are three times the international average, with resultant high risk of suicide.
The Times reports in the past six months, the SA Anaesthetist Society (SASA) has been made aware of three anaesthetists who committed suicide.
In 2015, SASA started a wellness group for 2,000 members, including some general practitioners who also act as anaesthetists, after five suicides were reported in 18 months. And, the report says, SASA has now released research by Stellenbosch University professor of anaesthesiology Johan Coetzee, which showed that 40% of state-sector anaesthetist are suffering from burnout. He found severe burnout in the state sector among 18% of all anaesthetists – much higher than the international average of 6.2%.
The report says in the US, the suicide rate among anaesthesiologists is twice that of other doctors. The implication of high stress on anaesthetists and their high level of burnout could affect the care they provide. “If we don’t tackle this issue urgently, quality patient care may become unsustainable in the future,” said Dr Caroline Lee, an anaesthetist and founder of the of the SASA Wellness Support Group. Lee said that, for now, patients receive good care, but she had a message for medical aids, patients and government officials and policy makers: “We need to care for doctors so they can care from you.”
Coetzee said the levels of stress and long working hours were increasingly becoming unsustainable, saying many students went abroad after qualifying. Working as an anaesthetist is highly stressful job requiring intense concentration and extremely quick reactions. It is known to be a risk for suicide.
Lee said: “The actual work alone is stressful. You work long hours in public service. But you are required to work that. You have a patient’s life in your hands. At two o’clock in the morning it is very difficult to keep 100% concentration, but you have to.”
Coetzee said: “A doctor such as a GP sits and consults a patient. He has time with which to decide what special investigations to do. As anaesthetists, if something happens, you have to think on your feet and take action, in seconds or minutes.”
State hospitals need anaesthetists so that surgeries can be performed or the hospital will grind to a halt. The report says this places more and more pressure on anaesthetist registrars who are specialists in training and work up to 48 hours a shift. Without them many other doctors can’t do their work.
Lee said that what affected doctors the most was not their work or hours, but not being able to give patients the best care. There were many hurdles, such as some medical aids pushing for the use of ineffective generic drugs, and under-resourced state hospitals.
“You have a value system. You want to give the best possible medical care,” Lee is quoted in the report as saying.
For medical aids, the focus was on cost-effective care. For governments it was about sticking to the budget and meeting the growing needs of patients with diminishing resources – and for the private sector, care was about profit margins.
SASA’s Natalie Zimmelman said in a Health-e News report that the profession was facing a mental health crisis. “These are just the cases we know of. I’m afraid it is a far too common story,” she said.
Burnout, and related mental health issues, not only endangers individual healthcare workers but threatens the entire health system as anaesthetists are critical for the functioning of any hospital, according to Zimmelman.
The report says there are roughly 1,300 registered specialist anaesthesiologists in the country and only a fraction (about 250) are estimated to be working in the public sector.
Zimmelman said that the recent suicides suggest all anaesthetists should pay attention to their mental health: “These doctors ranged from a young black woman in the beginning of her career to a white man in his 60s.”
Anaesthetists make life-and-death decisions on behalf of teams of surgeons, but the majority of SASA members fear seeking therapy because of how stigmatised mental illness is. This stigma has real-world consequences, added Zimmelman.
The report says a SASA member who shared her experience with burn-out in the media recently returned to her practice on a Monday morning to find cancelled appointments from patients who happened to read or hear about the newspaper article.
But the deaths – there have been at least six specialists who have committed suicide in the last 18 months – have caused some health professionals to start to break the silence on the issue.
7 April marks World Health Day and SASA urged South Africans to take note of the mental health crisis.
Studies that had been done overseas also showed high numbers of anaesthetists experiencing one or more of the dimensions of burnout. City Press reports that in France, 16% of anaesthetists and 31% in the US suffered from high degrees of emotional exhaustion. At least 18% of the practitioners in France, 11% in the US, and 20% in Australia had feelings of low accomplishment.
In certain European countries such as Sweden, a diagnosis of burnout makes one eligible for sick leave and government support. In the Netherlands it is regarded as a disease and employers are required by law to pay 70% of a person’s salary for 104 weeks. In the US it is accepted as a billable condition. The report says in South Africa however, it isn’t accepted as a condition that justifies sick leave.
Explaining the role of the anaesthetist and why it was such a high pressured job that led to many professionals experiencing burnout, Coetzee said, “An anaesthetist is a specialist’s specialist… the surgeon places their patient under the care of the anaesthetist and we take on the patient to evaluate the problem for which they are being operated on but also other health problems they may have, like heart problems. Anaesthetists take over that patient’s bodily functioning completely. It’s not just about putting a patient asleep but also taking care of all the bodily functions,” he explained.
Coetzee continued: “It’s routine for instance to give a patient a drug that paralyses the patient in order for the surgeon to access that bodily are, so we have to take over their breathing. But things happen during surgery, they get reflux responses and you have to be monitoring this all the time and be prepared to act if there’s crisis. So you have to be aware of what is happening to your patient from minute to minute, if a cardiac arrest happens you have to be on your feet, thinking clearly, its high pressure.”
Background: Burnout among doctors negatively affects health systems and, ultimately, patient care.
Aim: To determine the prevalence of burnout among doctors working in the district health system in the Overberg and Cape Winelands districts of the Western Cape Province and to compare the findings with those of previous South African studies.
Setting: Rural district hospitals.
Methods: During 2013, a validated questionnaire (Maslach Burnout Inventory) was sent to 42 doctors working in the district health system within the referral area of the Worcester Hospital, consisting of the Overberg health district and the eastern half of the Cape Winelands.
Results: Response rate was 85.7%. Clinically significant burnout was found among 81% of respondents. High levels of burnout on all three subscales were present in 31% of participants. Burnout rates were similar to those of a previous study conducted among doctors working in the Cape Town Metropolitan Municipality primary health care facilities. Scores for emotional exhaustion (EE) and depersonalisation (DP) were greater than those of a national survey; however, the score for personal accomplishment (PA) was greater. EE and PA scores were similar to that of a study of junior doctors working in the Red Cross Children’s Hospital; however, EE was smaller.
Conclusion: This study demonstrates high burnout rates among doctors working at district level hospitals, similar to the prevalence thereof in the Cape Town Metropolitan primary health care facilities. Health services planning should include strategies to address and prevent burnout of which adequate staffing and improved work environment are of prime importance.
Andrew R Liebenberg, Johan F Coetzee, Hofmeyr H Conradie