Firm findings on doctors’ wellbeing

Our focus this month is on doctors’ wellbeing. Medicine remains a profession that brings respect, affluence and job security, perhaps less of each than in the past but these privileges remain nonetheless. In some circumstances, however, privileges aren’t sufficient to deliver happiness and wellbeing. Anecdotes and surveys of morale tell us that the current environment in the NHS is one of those circumstances. Unhappiness of doctors is featured in medical journals and newspapers, and on television and websites. This phenomenon is something to do with the ease with which people are able to find an outlet for their frustrations but that isn’t the entire explanation.

Fay Smith et al. surveyed medical graduates from the 1970s, now senior doctors, and asked them about their wellbeing.¹ Forty-four percent of doctors believed that their job had an adverse effect on their health and wellbeing. Forty-three percent did not believe that the NHS is a good employer when doctors become ill themselves. These sentiments were stronger among women and general practitioners.

But it isn’t just the quantitative data from this study that will interest readers. A sample of comments from respondents echo words that you might hear regularly in conversations with doctors. A male general practitioner complaining of burnout in the years leading up to the survey, says: ‘I felt unable to provide the service I felt my patients deserved despite lengthening my hours and reducing my income’. A female psychiatrist explains: ‘I was very unhappy with the changes that occurred during my final years in medicine. In my view, neither staff nor patients were well served by the trust I worked for’.

Straightforward logic leads from happier staff to better patient care, except it seems hard to translate into reality. One solution might be mentoring. A review by Gemma Wilson et al. finds an association between mentoring and better relationships, better physical and psychological health, and better work.² Perhaps it’s a helpful coincidence that this article is published at the time when doctors are calling for a return to the ‘firm’ system? While team dynamics in a firm weren’t necessarily mentoring, firms did provide peer support and guidance, both of which seem harder to find in today’s NHS. Often, too, and perhaps this is why they are remembered with fondness, firms felt like a privilege.