Burnout, well-being and defensive medical practice among obstetricians and gynaecologists in the UK: cross-sectional survey study

Abstract

ObjectivesTo determine the prevalence of burnout in doctors practising obstetrics and gynaecology, and assess the association with defensive medical practice and self-reported well-being.DesignNationwide online cross-sectional survey study; December 2017–March 2018.SettingHospitals in the UK.Participants5661 practising obstetrics and gynaecology consultants, specialty and associate specialist doctors and trainees registered with the Royal College of Obstetricians and Gynaecologists.Primary and secondary outcome measuresPrevalence of burnout using the Maslach Burnout Inventory and defensive medical practice (avoiding cases or procedures, overprescribing, over-referral) using a 12-item questionnaire. The odds ratios (OR) of burnout with defensive medical practice and self-reported well-being.Results3102/5661 doctors (55%) completed the survey. 3073/3102 (99%) met the inclusion criteria (1462 consultants, 1357 trainees and 254 specialty and associate specialist doctors). 1116/3073 (36%) doctors met the burnout criteria, with levels highest amongst trainees (580/1357 (43%)). 258/1116 (23%) doctors with burnout reported increased defensive practice compared with 142/1957 (7%) without (adjusted OR 4.35, 95% CI 3.46 to 5.49). ORs of burnout with well-being items varied between 1.38 and 6.37, and were highest for anxiety (3.59, 95% CI 3.07 to 4.21), depression (4.05, 95% CI 3.26 to 5.04) and suicidal thoughts (6.37, 95% CI 95% CI 3.95 to 10.7). In multivariable logistic regression, being of younger age, white or ‘other’ ethnicity, and graduating with a medical degree from the UK or Ireland had the strongest associations with burnout.ConclusionsHigh levels of burnout were observed in obstetricians and gynaecologists and particularly among trainees. Burnout was associated with both increased defensive medical practice and worse doctor well-being. These findings have implications for the well-being and retention of doctors as well as the quality of patient care, and may help to inform the content of future interventions aimed at preventing burnout and improving patient safety.

Work‐related post‐traumatic stress symptoms in obstetricians and gynaecologists: findings from INDIGO, a mixed‐methods study with a cross‐sectional survey and in‐depth interviews

“…The mental health of the medical work force affects the wellbeing of doctors and their families, and the care they can provide for patients. High levels of burnout have been reported among obstetricians and gynaecologists . Doctors can be exposed at work to events that they find traumatic, and obstetricians and gynaecologists may be particularly at risk.…”

Clinical negligence costs: taking action to safeguard NHS sustainability

“…Other problems include the poor state of buildings, lack of proper equipment, and challenges in information technology. These problems directly affect safety with additional pervasive effects on workplace morale, ability to provide compassionate and safe care, and burnout 1718…”

Implications for the future of Obstetrics and Gynaecology following the COVID‐19 pandemic: a commentary

“…32 Moreover, according to a recent study, 36% of all doctors working within O&G in the UK met the criteria for burnout using a validated tool. 33 When focusing on trainees alone, the level of burnout rose to 43%. 33 The existential threat posed by the global pandemic, coupled with the perils associated with treating COVID-19 patients and the need to reduce personal risk of disease, seem likely to exacerbate psychological strain among doctors worldwide, further impacting on wellbeing and retention in the specialty.…”

“…33 When focusing on trainees alone, the level of burnout rose to 43%. 33 The existential threat posed by the global pandemic, coupled with the perils associated with treating COVID-19 patients and the need to reduce personal risk of disease, seem likely to exacerbate psychological strain among doctors worldwide, further impacting on wellbeing and retention in the specialty. In a survey of Obstetric and Gynaecology junior doctors within the UK, 64.9% reported they had received adequate training on two-person donning and doffing of PPE but remained anxious regarding the safety of PPE provided.…”

“…Conversely, having pride and seeing value in one's work has been shown to help prevent burnout. 33 As such, it is possible the appreciation and gratitude demonstrated by the public throughout the crisis will enhance feelings of existence and self-worth among clinicians.…”