Am I Suffering from Burnout as a Doctor in Training?

Introduction

As doctors, we are trained to notice subtle clues in our patients to identify a diagnosis. However, we are notoriously bad at treating ourselves with the same sensitivity and respect. 

Unsurprisingly, the 2021 NHS Staff Survey measured all-time high levels of burnout among NHS staff. It showed 33.1% of NHS doctors suffered from severe burnout and many more struggled with mild-moderate symptoms, which may explain why record numbers of junior doctors are taking time out of training. 

🩺 Here is a personal story of Amelia, a junior doctor who now works as part of the Messly Team:

‘My personal experiences with burnout started slowly in F1 and peaked in F2 while working in respiratory high care during the worst of the pandemic in 2020. I could just about manage working and sleeping, but I lacked the energy to do anything else, while always feeling that I wasn’t doing enough. I didn’t have the energy to batch-prepare wholesome meals like my colleagues, to meet up after work for drinks or dinner, to read interesting medical journals, to do research and audits, or to study for exams. I was having migraines daily, being sick at work, and suffering with such bad abdominal discomfort that I was referred for a CT, a colonoscopy and a cystoscopy. I honestly thought I might be dying.’

In this article, you will learn:

❓What is ‘burnout’ and how it’s different from stress and depression.
🏨 Which elements of the locum lifestyle might be contributing to your burnout.
📆 How to manage burnout and the next steps to take.

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😴 What is Burnout?

Burnout is profound mental and physical exhaustion caused by chronic exposure to intense stress. 

It is not a physical or mental health condition, but an occupational phenomenon. It is usually due to workload and work environment but can also be caused by other stressors such as caregiving and relationships. 

The World Health Organization defines burnout as ‘energy depletion or exhaustion, increased mental distance from your job, negativism or cynicism, and reduced professional efficacy. 

How is Burnout Different from Stress or Depression?

Stress is the feeling that there is too much to do, too much to think about, too much to change, and too much to choose from. Stress is about being overstimulated and overwhelmed.

Burnout is the feeling that there is not enough time, not enough brain space to think, not enough people to provide support, and not enough energy to make it through the day. Burnout is feeling empty and depleted. 

The difference between burnout and depression can be subtle and hard to determine. The main difference is the broadness of symptoms. Burnout may cause a lack of confidence in our professional ability, and make us feel like we are failing work, whereas depression may cause a general lack of confidence and like we are failing at life. Burnout can present as compassion fatigue or apathy towards work whereas depression can cause global anhedonia and apathy towards our lives and those in it. 

🤧 What are the Symptoms of Burnout?

Alongside severe exhaustion, cynicism, detachment, and a sense of hopelessness and inadequacy, you may also feel more irritable, apathetic, and unable to concentrate. You may start relying on food, alcohol or illicit substances to cope. 

Physical symptoms that are common are:

👉 Poor sleep or insomnia
👉 Headaches or migraines
👉 Stomach aches
👉 More frequent viral illnesses or the reduced ability to recover from viral-type illnesses 

If you think you might be suffering from burnout, try this quiz: https://sensa.health/burnout/

🚨 Why is it Important to Acknowledge Burnout?

Here are three excellent reasons why recognising and managing burnout is essential:

👉 Your Wellbeing:
You deserve to put yourself and your welfare first, even when it is contrary to your fundamental beliefs as a doctor. If you are not managing, then everything else in your life may suffer as a result, including your work and your patients. It is in the best interests of everyone that you are safe, healthy, and thriving. 

👉 Patient Care:
It is your duty to deliver safe and effective patient care, which includes recognising factors that could be negatively impacting your ability to do so.

👉 NHS Resources:
‍Burnout can lead to long periods off work resulting the NHS losing a valuable resource; you.

🤔 How to Manage Burnout:

One of the first questions that people suffering from burnout may ask themselves is; ‘Should I quit my job?’ While this might sometimes be the answer, it’s generally not the right solution. It certainly isn't the only solution.

🍎 Focus on the Fundamentals

Make sure that you are properly taking care of yourself. This might include:
✅ Get some proper sleep 
✅ Stay hydrated
✅ Eat wholesome meals
✅ Move your body and elevate your heart rate
✅ Step away from your stressors by putting that research project on hold, or going on holiday
✅ Avoid substances like cigarettes, alcohol and other drugs. 

These recommendations are based on the six pillars of health which are evidence-based recommendations for promoting physical and mental well-being (reference: https://www.sciencedirect.com/science/article/abs/pii/S2186495019300173, and reference https://bslm.org.uk/) 

Here is a free NHS resource for a personalised mind plan of evidence-based interventions to boost your mental well-being. https://www.nhs.uk/every-mind-matters/mental-wellbeing-tips/your-mind-plan-quiz/

💭 Communicate and Escalate

Don’t keep your struggles to yourself. Bringing others into the fold can help you find solutions you might not have been able to identify on your own. 

Try talking to:
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👉 Your Friends and Family:
They may have had similar struggles and could provide valuable insight and support. 
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👉 A peer group:
Joining a peer group to discuss the issues you’re facing and get the group’s perspective and support. If you haven’t joined a peer group or don’t know what this involves, check out this article on peer groups for locum doctors here.
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👉 Your Rota Co-ordinator / Medical HR / Your Agent:
Whoever is sending you shifts, let them know exactly what shifts might be right for you and what isn't. If you don't want to travel, then tell your agency to look for work more locally, and if you are moving departments too frequently then tell your rota coordinator that you want consistency over frequency. Once they know exactly what you want, they are more likely to message you when the right shifts are available. 
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👉 Your GP:
As an outsider, they may be able to offer more objective support and help manage any additional symptoms of anxiety or depression. 
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👉 Occupational Health:
If you need a referral from your line manager, then you may not be able to use OH for support as a locum. However, if you locum for the same trust regularly, then you may find that medical HR will still refer you if you ask them to. If OH accepts self-referrals then give that a go. Alternatively, your agency may have its own OH department or a company that they work with to speak to them about your options. 

‍🙏 Regain Control

You might feel like your options are limited as a trainee, but hopefully some positive changes will have occurred if you followed the above steps. 

🩺 If you continue to feel burned out and like leaving medicine is your only option, then first read what Amelia, Messly’s own junior doctor did:

‘The first Wednesday of August 2020, when I became an F3, pretty much all of my burnout symptoms went away overnight. The moment that I regained control over my work-life balance, autonomy in my scheduling and freedom in my decision making, I was cured. I felt energised again, excited again, and pain-free again. Like many of my colleagues, I took a few months off to travel and immersed myself in the hobbies that used to bring me joy, and then I returned to medicine in a way that comfortably aligned with my personal boundaries and goals. I have been working consistently, and happily ever since.’ 

There are so many ways to have a fulfilling career in medicine, if that is what you want. Read this article about medical careers as a non-trainee doctor. Before you decide that medicine is no longer for you, try flipping the narrative and putting yourself in a position of empowerment and control so that you can serve yourself, your patients, and the NHS better and for longer.

In Summary:

✨ Burnout is an occupational phenomenon, not a mental health condition. 
✨ Burnout is caused by chronic exposure to intense occupational stress, usually from work. 
✨ Burnout is similar to stress and depression in some ways but is its own thing. 
✨ It is important to recognise burnout for the sake of your own well-being, that of your patients, and the NHS as a whole. 
✨ There is lots that you can do to manage burnout without needing to leave medicine forever. 
✨ Focus on the fundamentals. 
✨ Communicate and escalate. 
✨ Regain control. 

If you are a locum doctor and you are worried about burnout, this article provides helpful coping mechanisms.

Your Ultimate Guide to Succeeding as a Locum Doctor

This article is part of a wider series of resources and guides that are designed to support you as a locum doctor, covering areas such as getting your first job, managing your finances, understanding your rights, and many more. Visit our Locum Doctor Hub for everything you need to know about locuming today.

Additionally, if you're considering an F3 year, you might also find it useful to look through the selection of resources we've put together in our F3 Resource Hub.”

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