newsGP – What characteristics are most associated with GP burnout? – RACGP

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Dr Filip Vukasin
Filip Vukasin
According to new research, risk factors include being aged 40–60, working long hours and not having a spouse.
A Flinders University study has investigated the association between locus of control (LoC) and work-related behavioural, societal and personal factors, in the process identifying characteristics that are more likely to lead to burnout.
 
Published in the Journal of Psychiatric Research, it studied data provided by 3664 GPs who participated in a longitudinal annual survey of doctors nationally and found certain factors are predictors for a lower LoC, including:

  • being aged between 40–60
  • working long hours
  • poor balance of professional and personal commitments
  • poor support network
  • being overseas trained
  • not having a spouse.

LoC is a social cognition that relates to the level of self-control people have over their personal environment that influences their life.
 
Lead author Dr Vivian Isaac, Senior Lecturer Rural Mental Health at Flingers University told newsGP that LoC is important.
 
‘We know that feeling in control of one’s life can help mitigate occupational stress,’ he said.
 
‘Studies have shown that individuals with a high LoC are more resilient, cope better under stressful conditions, have higher job satisfaction and in the case of healthcare workers, cope better with shift work.’
 
While burnout research typically emphasises negative emotions such as depression or anxiety, Dr Isaac said his team wanted to focus on building capacities.
 
‘There is growing interest in understanding psychological factors that can been seen as resources for coping when under stress. LoC has been shown to reduce burnout,’ he said.
 
‘However, it hasn’t been previously studied among Australian doctors.’
 
The research points to the ‘sandwich generation’ – those aged 40–60 who may be managing both young children and elderly parents – as being more likely to have a lower LoC compared to people outside of this age bracket.
 
‘It’s an interesting finding,’ Dr Isaac said.
 
‘Myself in the age group, and having doctor friends in the age group, I have witnessed the challenges [of] managing multiple responsibilities.
 
‘However, more qualitative research is needed to throw more light on this issue.’
 
The team also found some GPs work as many as 70 hours per week, with regional doctors likely to log even more if servicing small communities.
 
‘These long hours contribute to fatigue, reduced wellbeing, and poor mental health, which alongside maintaining patient and colleague relationships and workforce shortages is increasingly leading to burnout and depression,’ Dr Isaac said.
 
It is a cohort all too familiar to RACGP Rural Chair Associate Professor Michael Clements.
 
‘The pressures our rural and remote doctors face are significant,’ he told newsGP.
 
‘There is often a shortage of doctors and pressure to cover after-hours shifts even if you’re not on call. We know our remote doctors can sometimes work 24/7 for weeks at a time.
 
‘If you’re working and living in a community and there’s a death, you can feel like you can’t take a day off. Also, in a small team it’s hard to take time off. I’ve seen pregnant doctors feeling bad for taking maternity leave.
 
‘If rural doctors feel a victim of long hours or resent the hours or resent colleagues taking time off and so on, then they can burn out.’
 
Dr James Ibrahim, Chair of RACGP Specific Interests Social Prescribing, told newsGP LoC has a large part to play in health – in particular the extent to which people understand their medical conditions, the control they have over their health management, and how much their choices impact on outcomes.
 
He points to the Patient Activation Measure (PAM) as a tool that can assess a patient’s knowledge, skill and confidence in managing their healthcare.
 
‘Low PAM scores need a traditional link model with high intensity input,’ he said.
 
‘Those with moderate scores might need a hybrid model where a GP or nurse can be a link offering touchpoints and assistance intermittently, but not so much one on one.
 
‘Those with high PAM scores would usually just need the tools to navigate options themselves, sometimes just signposting and then they go and do it themselves.’
 
Dr Ibrahim says when working on the individual level, GP–patients may be easier to engage with as many have a history of being driven high achievers.
 
‘There is often a history of competitive sports, music, performance or art that lots of doctors have excelled in, and it may have been part of their identity that they have let go of over time,’ he said.
 
He recommends social prescribing for mild-to-moderate anxiety and depression and low LoC as a way of re-establishing a patient’s agency.
 
‘I have about 30–40 things that are specific to my local area, like a fishing club, Men’s Shed, and surf lifesaving clubs,’ he said.
 
‘There’s a great gym close by with a good culture that has a social calendar, or parkruns where you can volunteer and don’t have to compete, or wildlife support and rescue teams and a dog shelter.
 
‘More broad ones include Mister Perfect, Ask Izzy and My Community Directory, but I think it’s more successful when the patient comes up with it themselves.’
 
Regarding systemic solutions for managing low LoC, Associate Professor Clements says workforce solutions need to be tailored.
 
‘There needs to be financial reward, so system-wise this needs to be sufficient. Fatigue management and planned leave is necessary to stop rural doctors feeling trapped – and they are right, they are trapped sometimes,’ he said.
 
‘We can look at a town and roster to predict what is necessary for the demands.
 
‘Rural doctors associations are important in connecting remote and isolated doctors with meetings and check ins. Each state has one and they run conferences yearly and families can come as well and there is a collegiality to it.’
 
Dr Isaac said on the social side of things, work–life balance is key.
 
‘We found over half of all GPs surveyed were dissatisfied with their social network, which was then negatively affecting their sense of control,’ he said.
 
‘This clearly highlights that the work–life imbalance has tended to become normalised for GPs and they struggle with work overload, which has a negative impact on their ability to do their job.’
 
According to the 2022 Health of the Nation report, 73% of GPs reported having experienced feelings of burnout over the past 12 months. Dr Isaac hopes his research can have a positive impact on them and remote GPs who are more likely than metro GPs to retire in the next 10 years.
 
‘I believe improved supportive structures and programs will improve recruitment and retentions for GPs,’ he said. ‘Especially in rural and remote locations.’
 
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