Doctors in charge of the most complex health procedures in Canada cannot have a second wind

Unlike the United States, with its many large private clinics and hospitals that offer complex treatments, much of the high-tech care in Canada is only available at academic health science centers, which are partnerships between teaching hospitals and medical schools, says Stephen Archer, chair of the department of medicine at Queen’s University.Getty Images/iStockphoto

They are the medical professionals who perform some of the most complex procedures in the country. They train our future doctors. They advance medical research. And they are exhausted.

Many academic doctors were already experiencing a state of emotional, mental or physical exhaustion before the pandemic. But as Canadian surveys in recent years have shown, Burnout among this population of health professionals exploded during the first waves of COVID-19[feminine]. And some fear it will have lasting consequences for health care in this country.

“As part of the hallmarks of burnout, you stop caring about yourself and performance deteriorates and you’re just not engaged,” said Stephanie Garner, clinical assistant professor in the division of rheumatology at the University. University of Calgary. This can diminish the quality of training that medical residents receive and lead to medical errors, she explained: “It will have repercussions for years.

The effect on academic health science centers across the country could also be particularly detrimental.

Unlike the United States, with its many large private clinics and hospitals that offer complex treatments, a lot of high-tech care in Canada — including advanced surgeries such as heart transplants — is only available through academic health science centers, which are partnerships between teaching hospitals and medical schools, said Stephen Archer, head of the Department of Medicine at Queen’s University.

“So every hospital is important, home care is important, family medicine is important. But academic health science centers kind of hold the keys to all the high-tech medicine that we do, as a whole,” Dr. Archer said. “And so if they break down or get drunk, so does the system.”

In addition to clinical care, the teaching and research that academic doctors undertake, including research to find new treatments and cures, can suffer when exhausted, said Edward Spilg, geriatrician, assistant professor and holder of the Research Chair in Physician Wellness at the Department of the University of Ottawa. of Medicine.

“Clinical practice helps patients today, but education and research are what help patients tomorrow,” Dr. Spilg said.

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In a study published in the Canadian Journal of General Internal Medicine in June, Dr. Garner and colleagues at McMaster University found three out of four academic physicians and non-physician faculty members at the school The Department of Medicine reported burnout in a survey in early 2021. Women and early-career people were disproportionately burnt out.

The findings echo those of another study, published in the journal BMJ Open in May 2021, which found that 68% of doctors surveyed at the University of British Columbia at two teaching hospitals were exhausted. More than 20% said they were considering leaving the profession or had left a position. As in the McMaster study, more women were exhausted than men.

As an early-career faculty member and mother of three young children, Dr. Garner said she could relate. Trying to juggle teaching, research, clinical care and personal life was difficult enough before the pandemic. But trying to guide patients through an unpredictable, unreliable and sometimes inaccessible healthcare system — due to COVID-19 clinic closures and surgical delays — made the job all the more difficult, she said. . So have school closures, lack of child care, isolation, and fear of bringing COVID-19 home.

In previous waves, in-person opportunities to collaborate and seek advice from colleagues on complex cases, which are essential for a positive work environment, have also disappeared, as health visits moved online, said Dr. Garner.

Now that the country has emerged from the acute phase of the pandemic, some of these challenges and pressures have eased. But in other ways, things only got worse, Dr Archer said. Patient volumes are high, compounded by an extraordinary increase in the number of sick children in this respiratory virus season. Nursing staff are burnt out and demoralized, and academic doctors, who are often asked to comment in the news media on how to keep people safe, are increasingly subject to public abuse, it said. -he declares. All this contributes to the moral distress of doctors, he added, noting that mental health is now the number one cause of work stoppage in his service.

Another problem is that as academic doctors struggled to meet the overwhelming needs of clinical practice, their teaching and research often took a back seat. And as some labs have been closed and non-COVID-19 clinical trials halted, many setbacks have experienced setbacks that are not easy to recover from.

Sonia Anand, lead author of the McMaster study and a professor of medicine and epidemiology at McMaster, said she fears these setbacks and high rates of burnout among women and early-career faculty will lead them to abandon their research and educational aspirations.

This is particularly concerning because even though many women are entering academic medicine, few end up in leadership positions, a problem that has persisted for decades and is known as the “leaky pipeline,” said Nadia Khan, lead author of the UBC study and professor of general internal medicine. If burnout causes more women to drop out of academia, it could exacerbate gender gaps and lead to less diverse research, she said.

Too often, the solutions offered come in the form of personal advice, like getting more sleep, but they don’t actually solve the problem, Dr Khan said. The biggest problems are rather organizational and systemic, such as a deluge of administrative tasks and a high volume of patients, which prevent doctors from devoting time to patient care.

“They’re harder to treat, but without treating them we really can’t get to the heart of burnout,” she said.

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