Two years with no reprieve: Canada's doctors are stressed, burned out—and the data confirms it

When COVID first hit Canada in early 2020, the country’s physicians–together with other healthcare workers–hit back hard with a focused collective energy, hunkering down to help distressed patients even as the scientific community’s understanding of this novel coronavirus continued to change day by day. Today, after almost two years of working and living in the midst of a pandemic, doctors are beyond tired. Various surveys over the past 12 months have confirmed high levels of burnout, anxiety and fatigue among the country’s physicians. A CMA survey released in March found doctors’ fatigue had increased by almost 70% over the last year. Another survey, released in August by the Ontario Medical Association, revealed almost three-quarters of Ontario doctors had experienced some level of burnout in 2021–an increase of almost 30% from the previous year. These surveys, combined with other indicators such as the increased use of support services, point to a growing mental health crisis among Canada’s doctors and to an urgent need to expand the country’s capacity to help physicians who are struggling with the psychological effects of the pandemic. “We know the impact on mental health has been increasing for physicians,” Dr. Caroline Gérin-Lajoie, executive vice president of physician wellness and medical culture at the CMA, told The Medical Post. “We’ve known for a while that burnout is on the rise among physicians, but since the pandemic we’ve seen reports of increased rates of burnout, anxiety, depression and other signs of mental health issues.” Watch: Video: 4 ways to take time off as a physician In its first national survey of physician health, which was released in 2018, the CMA reported 30% of physicians were feeling burned out. At the same time, however, more than 80% believed they were highly resilient. A new CMA physician health survey launched in October–with results expected to be shared in spring 2022–will likely find a profoundly changed mental health state among Canada’s physicians. “Even before the pandemic physicians were struggling with dissatisfaction with their working environment and with the medical culture–factors most related to their physicians’ wellness,” said Dr. Gérin-Lajoie. “So you can imagine how the pandemic, with all the stressors, has affected all of these key factors.” Beyond the surveys, another gauge of physicians’ worsening mental health during the pandemic is their increased use of support services. Read: The trouble with 'resiliency' Last year, the Alberta Medical Association’s physician and family support program saw an increase of about 30% from 2019 in calls related to anxiety, stress and depression. It’s even worse this year, said AMA president Dr. Vesta Michelle Warren. In recent months, calls to the help line have climbed to an average of 300 a month–about 40% higher than the average total calls per month in 2020. In Ontario, calls to the provincial medical association’s physician health program support line went up by 30% this year–a stark contrast from the start of 2020, when the intake line actually saw a decrease in calls. “When the pandemic hit there were actually less calls coming in,” said Dr. Joy Albuquerque, medical director at the Ontario Medical Association. “It was sort of that galvanizing time when everybody was just so focused with what was happening in the beginning–lots of energy, lots of focus.” During this time, many psychiatrists and therapists reached out to the OMA to offer their support, recalled Dr. Albuquerque. “They wanted to be there for physicians, so we had all these people available and ready for when the calls came, and initially there wasn’t any,” she said. Fast forward two years and the OMA–like its counterparts in other parts of country–must find ways to expand the capacity and coverage of its physician support program. This year, OMA Insurance doubled its mental health benefit for doctors and their families to $10,000 for outpatient treatment each year. The OMA also put out a call in September for mental health professionals to “just take one” referral of a physician or medical student who needs help. Read: Mental health services for physicians ramp up across country for COVID-19 “It is estimated that there will be a more than 40% increase in demand for mental health and addiction services for the general population due to the COVID-19 pandemic,” the OMA said in a press release to launch the “just take one” campaign. “We are seeing similar increases in our own physician population.” Dr. Albuquerque said the campaign was necessary because the country’s mental health professionals are running out of appointment slots in their calendars. “Everybody is maxxed out,” she said. “And yet, we still ended up with over 40 people who responded to our campaign, and some have agreed to take more than one referral.” Efforts to expand support for physicians’ mental health are also underway in Alberta, said Dr. Warren at the AMA. “We don’t see the need decreasing in the months to come,” she said. “In fact, we fear an increase.” At the CMA, a partnership with MD Management and Scotiabank led recently to a new wellness support line for physicians in Saskatchewan, Ontario, Nova Scotia, Newfoundland and Labrador, Yukon and Nunavut. Peer-to-peer support has also been invaluable, said Dr. Roslyn Schwartz, a Kingston, Ont.-based physician who volunteers as a facilitator at Doctors Lounge Online, a virtual drop-in group for doctors. Read: The surgeons are not OK! Dr. Schwartz, a family doctor who practices psychotherapy, said doctors find it helpful to talk to peers who share similar experiences and who speak the same jargon. “We spend quite a bit of time talking about COVID numbers, vaccines, how we’re coping in our practices and at home,” she said. “We support each other in ways that non-medical friends can’t.” Since she started hosting the lounge in August 2020, Dr. Schwartz noticed that doctors tended to drop in more when their practices experienced downtimes, such as when surgeries were on hold or when patients weren’t coming into clinics. “As the pace of medical practice has begun to pick, the balance has shifted and there are fewer people attending today than there was last year,” said Dr. Schwartz. “And yet there’s a greater need for support. But this is typical of the situation for doctors: when we need help the most, we usually don’t get it because we’re too busy looking after everyone else.” The value of peer-to-peer support has led to a new project at Doctors of B.C., which will soon be putting out a call to different communities for five sites to test a model designed to promote non-clinical, empathetic conversations between colleagues, according to Sharon Shore, a spokesperson for the association. In the first wave of the pilots, the program will train between 30 to 40 physicians, said Shore. The goal is to have 80 doctors trained within a year of launching the pilot. With Omicron driving up case counts across the country, and the potential for other variants to wreak even more havoc in the new year, doctors can use all the help they can get for their mental health, said Dr. Albuquerque at the OMA. “There’s no question that what we’re dealing with today isn’t just stress but constant, unremitting chronic stress,” she said. “There’s no reprieve in sight and it’s overwhelming people’s ability to cope.” Read: The environmental impact of the anxiety pandemic

Two years with no reprieve: Canada's doctors are stressed, burned out—and the data confirms it

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