Health – Burnout rife among stressed GPs

Patient complexity has increased because GPs are seeing more patients presenting with mental health issues, and, because more people are now elderly, many have more complex needs.

Two recent surveys from The Royal New Zealand College of General Practitioners have signalled real concern about an increase in GP burnout, the number of GPs intending to retire, and the sustainability of the sector.

The College runs its Workforce Survey biennially and when preliminary results of the latest survey showed an increase in burnout among its members (31 percent in 2020 compared to 22 percent in 2016), they acted. A second survey specifically covering burnout, and completed by 1495 GPs across New Zealand, clarified the causes into three main areas:

  1. Patient complexity has increased because GPs are seeing more patients presenting with mental health issues, and, because more people are now elderly, many have more complex needs. Mental health issues in New Zealand are significant (and very important) and primarily addressed in the community, mostly through a person’s GP. In 2019 the College found that 30 percent of GP consults have a mental health component.
  2. The 15-minute appointment model – a model that is 30 years old and outdated, doesn’t work for patients with complex mental health conditions. However, the 15-minute appointment model is the framework for how GPs are funded so this needs urgent Government intervention to change.
  3. The paperwork is a relentless mountain – paperwork and tasks like email need to be completed outside consultation time. That includes referrals, tests, and screening results. GPs are spending an additional two hours a day on patient follow up work.

These issues are intensified when there are not enough GPs to do the work required. Some GPs are leaving the profession because of burnout, and it’s increasingly hard to get overseas-trained doctors into the country because Immigration New Zealand’s visa exemption period for essential workers, like doctors, are so short-term.

College President Dr Samantha Murton says, “Our membership of 5500 GPs and rural hospital doctors provide 96 percent of New Zealand’s frontline care but they’re increasingly struggling with how to do that, while also keeping themselves well.

“The issues of the general practice sector are complicated, but they’re not impossible, which is why we’re speaking out – to advocate for immediate as well as longer-term action that will make a measurable difference to the health of New Zealanders, and the wellbeing of our GP community.

“GPs are highly-trained specialists and they’re highly empathetic people who want to do the best for their patients; they deserve to be able to do that without sacrificing their wellbeing,” she says.

“It takes at least 11 years to train as a specialist GP and I know of people who are walking away because they can’t continue to practice effectively and that’s staggering but also incredibly concerning for the future of New Zealand’s community health care,” Dr Murton says.

“General practice is a diverse, rewarding career that makes a visible impact on people and their communities, but it needs to be a job that people can do safely.”

Despite the difficulties of the profession, more than half of GPs (54 percent) and 80 percent of rural hospital doctors rated themselves as likely to recommend a career in their field.

ENDS

Read the burnout survey results https://www.surveymonkey.com/results/SM-D283ZPPK9/

About the surveys

– There were two surveys: The College’s Workforce Survey 2020 (which had a 62 percent response rate (3117 members) is yet to be released I full and showed an increase in burnout, which signalled the need for a more detailed survey.

– The College’s burnout survey was a subsequent, specific survey about burnout and was answered by 1,511 members.

Retirement intentions

– Nearly one-third (31 percent) of survey respondents were intending to retire from the GP workforce in the next five years and nearly half (49 percent) in the next 10 years.

– If we exclude registrars (doctors training to become specialist GPs), these percentages rise to 36 percent intending to retire in the next five years and 58 percent in the next 10 years. There is little difference in retirement intentions between rural and urban GPs.

Burnout

– Nearly one-third (31 percent) of GP respondents rated themselves high on the burnout scale.

– More than one-fifth of respondents (21 percent) working in rural hospital medicine rated themselves as being burnt out to some degree.

– Respondents reporting high burnout were more likely to be aged between 40 to 64 years, a practice owner or partner, and working full-time.

The College’s burnout survey showed the big issues to be:

– Increasing complexity of patient presentations (92 percent said this had a big or overwhelming effect)

– Barriers to timely patient hospital/other specialist referrals (78 percent said this had a big or overwhelming effect)

– Number of patient consults a day (71 percent said this had a big or overwhelming effect)

– 53 percent of respondents said they spend more than 90 mins a day on ‘inbox’ tasks and 85 percent spend more than 60 minutes a day.

– Significant numbers of patient consults run significantly over time for which you are not paid (86 percent said this had a big or overwhelming effect)

– 55 percent of respondents said they do three or more consults a day at a reduced fee or no fee.