Overwhelmed, passionate or workaholic?

Workaholic—a portmanteau word of work and alcoholic—literally associates a person’s relationship with their work with alcohol addiction. It is sometimes defined as an uncontrollable need to work constantly, characterized by excessive and persistent work activity with harmful consequences.Physicians, because of their long hours and devotion to their profession, have long been tagged as at-risk individuals. In a 1976 article on the various addictions of clinicians published in the Canadian Family Physician, Dr. Vincent Merville ranked workaholism as the first of doctors’ “socially respectable addictions.” The psychiatrist wrote at the time that his peers were unaware of their ergomania: “Because the physician works for a ‘noble cause,’ he considers that addiction to his work is ‘noble’ in itself. It also brings him success and a good reputation.”Since then, numerous studies conducted around the world have sought to quantify the phenomenon. They all tend to show that healthcare professionals are more addicted to their jobs than most workers. Among physicians and medical residents, its prevalence ranges from 14% to 48% according to the literature, while within the working population, it is around 4% to 10%.Such discrepancies are explained by the lack of a formal definition of workaholism, which is not recognized by the World Health Organization or among the addictive behaviours in the DSM-5. There is also no consensus on the diagnostic criteria to distinguish a suffering workaholic from a fulfilled workaholic. Finally, as a recent editorial in the British Medical Journal on the subject points out, “the motivations and reasons for working long hours in the healthcare sector are very different from those of people who are truly addicted to work.”Read: Dr. Ted Jablonski: Addicted to medicineAssumed dependenceDr. Benoît Heppell is a fine example of a fulfilled workaholic. The general practitioner works 50 to 60 hours per week, 12 to 22 hours more than the average Quebecer. He accepts his workaholism. “I’m addicted for pleasure. I like it, I’m passionate. Like it or not, my work defines me,” said the clinician, who admits that if he didn’t have other obligations at the end of his days, he could often do more. “The more you do, the better you are,” justified Dr. Heppell, judging that “exposure is fundamental, especially at the beginning of your career.”His colleague, Dr. René Wittmer, works just as hard, and he too has trouble switching off. “I really enjoy (practicing). Medicine stimulates me. I’m not burned out, and I’m very happy with my patients,” said the family physician, who is also involved in teaching and serves as president of the Choosing Wisely Quebec campaign. His professional commitment stems “mainly from passion, but also from a sense of responsibility. We have to be available for our patients,” explained the practitioner, who says he has never experienced the symptoms of addiction. The proof, he says: “I look forward to being on vacation, and when I’m there, I don’t want to open my computer.”A salaried pharmacist, both in-branch and at a family medicine group (FMG), Anne-Émilie Dionne works about 50 hours a week. Like Dr. Heppel, she admitted to being addicted to her job and finds her schedule normal. “I love my job, I love my profession. And what I do, I do by choice. I’m constantly looking to improve myself, to update myself, to better help people,” she said and added she feels very valued by a job that stimulates her intellectually. “Not having children, I have room in my life and time to invest,” acknowledged the 30-year-old, who has difficulty turning down new projects. “Passion always prevails!”A question of habitBefore her interview with Profession Santé (a sister magazine to the Medical Post), Dr. Mélissa Généreux had never thought of herself as a workaholic. Instead, she considered her need to work to be due to being overwhelmed with work. Upon reflection, it’s “a bit of both,” the public health specialist agreed. “I’m so used to being overwhelmed that I don’t know what to do if I have free time, and when I do, I start to feel bad, empty,” said the clinician. If she agreed to work so much (55 to 60 hours per week), it’s because she feels valued and useful. There’s also an element of habit, added Dr. Généreux. In residency, “we’re used to working a lot of hours, with on-call duties on evenings and weekends. I told myself that it was a necessary step, that when I’m the boss, I’ll break out of that mold. But we quickly fall into the spiral. There are so many opportunities and needs.”This medical culture, which consists of working hard, without counting the hours, certainly influences the relationship with work for clinicians, agreed Dr. Lyne Couture, for whom this is not the only explanation. “Basically in medicine, we have anxious and high-performing people. If they had gone into law or engineering, it would be the same,” said the family physician who calls herself “addicted to performance, whether at work or elsewhere,” as in her role as president of the Association of General Practitioners in Laurentides-Lanaudière.The other element to consider, according to her, is the situation of the health system and its issues of accessibility and labour shortages. “It’s difficult to cut back. It’s a matter of our public responsibility, of our moral contract, as the government, the Quebec College of Physicians, the media, and part of the population so aptly remind us,” observed Dr. Couture with a good dose of bitterness, who “is starting to find it all overwhelming. I intend to free up a little more time within the next two years,” she announced.Not really a choiceThis feeling of being forced to work hard is shared by a hospital pharmacist who wishes to remain anonymous. “I feel like if we want to publish articles or give presentations, we don’t really have a choice but to work a lot outside of our hospital hours. If we limit ourselves to the 40 paid hours per week, we can’t manage to do everything,” saud the professional, who can, depending on circumstances and emergencies, work up to 10 additional hours at home. He says this workload is “self-inflicted,” and he makes sure it doesn’t interfere with his family life: “If I have too much work, it interferes with my sleep.”His colleague Raphaël Gagnon-Paradis has been a pharmacist-owner for three years. He, too, has no choice but to work hard. His weekly minimum is 50 hours, “but it can be much more,” said the professional, admitting that at times, his obligations take precedence over his passion for work. “What I’m passionate about is providing my teams with an efficient environment and medication flow, suitable work tools, and structuring my laboratory. That’s why I became the owner.” But due to the shortage of pharmacists and technicians, he often goes behind the counter to help his employees or cover shifts during unfavorable hours. As a result, Gagnon-Paradis finds himself “overwhelmed by something that’s difficult to manage. If I were less overwhelmed, I wouldn’t be any less happy,” he admitted, adding that he sometimes manages to put the pharmacy aside. “But those breaks can’t be very long.”While it’s difficult to draw the line between commitment and overinvestment, passion and dependence, it’s important to know how to set limits, recommend the doctors consulted by Profession Santé . “Vocation shouldn’t push us to accept the unacceptable,” addsed Dr. Wittmer. “Since the demand is endless, it’s easy to burn out. We need to ask ourselves what’s sustainable so we don’t lose our health.” The risk is ending up with burnout or developing other addictions (alcohol, drugs, medication, etc.).For his part, Dr. Heppell remains attentive to his personal signals. “Sometimes, I get fed up. If I feel obligated to work, that’s when I’m not feeling well. My empathy is low, I’m on the verge of nausea. It’s time to put up barriers and take a vacation so as not to be overwhelmed.” And you, what is your approach to staying passionate about your work? —with files from Anaïs BouitchaThis item was originally in French on the Medical Post’s sister website, Profession Santé.

Overwhelmed, passionate or workaholic?

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