Doctor burnout, defined as a work-related syndrome involving emotional exhaustion, depersonalization, and a sense of reduced personal accomplishment, is a global phenomenon. Across the Pond, our medical colleagues, like in so many other countries, are suffering significant burnout, despite working in radically different healthcare systems. UK doctor burnout has been impacted by the pandemic, too. This article explores the UK situation with particular reference to doctors working in the UK’s National Health Service (NHS).
Founded in 1946 by a visionary health secretary who had the foresight to “fill the doctors’ mouths with gold” in order to employ them, the NHS provides taxpayer-funded healthcare to every citizen independent of their ability to pay. Like Canada, but with worse weather. No one loses their house because of a hospital bill in the UK.
Broadly, the NHS produces some of the best outcomes for the lowest cost, in stark contrast to many private payor systems. A 2017 study revealed that the UK spent the least per capita on healthcare compared with all other high income countries studied. The UK had the lowest rates of unmet need and among the lowest numbers of doctors and nurses per capita, despite having average levels of hospital admissions.
It is also a hub of medical innovation and research. As much as I am a huge fan of the NHS, I am not going to spend too much time reminding readers just how brilliant it is. Despite the excellent value-for-money delivered, UK doctor burnout rates are comparable to the US and other high income countries.
There are important similarities and differences between the US and UK healthcare systems which, I believe, impact upon physician burnout.
Some 80% of doctors in a British Medical Association (BMA) 2019 survey were at high or very high risk of burnout, with junior doctors most at risk, followed by general practitioner partners.
During the Pandemic, BMA research which found 95 per cent of doctors said they went into work afraid of making a mistake, and 90 per cent saying the lack of staffing was the biggest contributor to not being able to provide proper care.
The BMA also run doctor tracker surveys of thousands of doctors. These have found that 40 per cent have experienced higher levels of stress and burnout, almost 60 per cent are severely fatigued, and 40 per cent have not taken an adequate break since March.
A landmark BMA survey responded to by 2,357 GPs highlights the profound strain pressures in general practice are placing on the wellbeing of doctors and the care of patients. Just one in 20 respondents said their workload was manageable. The survey also revealed that, using mean average figures, GPs are working more than 130 per cent of their contracted hours in their primary roles.
And nearly nine out of 10 reported that their workload was excessive and either prevents or significantly prevents the provision of quality and safe care.
Nearly 7500 doctors from around the world took part in the survey during 2020, including 402 from the UK (fifty-three percent were male, 45% female).
Sixty-five percent of UK doctors said feelings of job-related burnout had become more intense (note that this is a change in intensity rather than prevalence). For the rest, 35% did not experience burnout, there was no change for 26%, and it was less intense for 10%.
More than half of UK doctors were considering career changes after their COVID-19 experiences. These included:
Rather than whole system reform to remove perverse incentives and insurance company denials, the NHS simply needs appropriate funding as an essential service for the people. Instead of increasing taxes, savings could be made elsewhere. No government is without wastage.
In 2017, the UK spent £2,989 per person on healthcare. of the G7 group of large, developed economies, UK healthcare spending per person was the second-lowest, with the highest spenders being France (£3,737), Germany (£4,432) and the United States (£7,736).
As a percentage of GDP, UK healthcare spending fell from 9.8% in 2013 to 9.6% in 2017, while healthcare spending as a percentage of GDP rose for four of the remaining six G7 countries.
Unsurprisingly, burnout levels are lower in countries where the healthcare system is better resourced.
This article has explored UK doctor burnout prevalence and the impact of COVID-19. We have argued that the UK NHS is under-resourced as a proportion of GDP compared to other high-income countries spending on health.
While resourcing is not everything, I am certain that funding enough staff to deliver healthcare services will go a long way to reducing doctor burnout in the UK.