Younger MDs reject boomers' workaholism

Sarah Boesveld, Ottawa Citizen

Baby-boomer doctors are working too many hours and are burning out hard and fast, according to an Ottawa psychiatrist.

Dr. Derek Puddester, who spoke over the weekend in Winnipeg to the annual meeting of the Royal College of Physicians and Surgeons, says tired doctors make mistakes, lowering the quality of health care.

At the same time, a new generation of doctors already wants a better work-life balance, Dr. Puddester said – but unless the number increases, many people simply won’t have doctors.

Health Canada estimates that, by 2010, Canada will be short 5,800 doctors. But because of the burn-out and new doctors demanding shorter working hours, that number might reach 10,400, Dr. Puddester told the college.

“They’re the workhorses,” he said of boomer doctors in an interview Tuesday. “They just suck it up, have always worked hard and will always work hard,” he said. And while a strong work ethic is admirable, the 80-hour work weeks some boomer doctors put in won’t make them more efficient.

According to a 2003 study by the Canadian Medical Association, 45.7 per cent of doctors were experiencing severe burnout.

More physicians, especially emergency room doctors and surgeons between the ages of 35 and 54, peaking in their mid-40s, experienced burnout more often than their younger counterparts. The Ontario Medical Association reported that 85 per cent of physicians in the province feel they are overworked. The average physician in Ontario works 50 hours a week.

The University of Ottawa psychiatrist and an increasing number of Canadian medical professionals call it dangerous.

Dr. Brian Day, president of the Canadian Medical Association and baby boomer himself, says that, as an intern in the 1970s, he didn’t leave the hospital for six months. Today, there are restrictions on the hours residents and interns work, but not for a physician with his own practice, he said. Work quality can suffer as a result.

“If you work excessive hours, that fatigue can lead to errors,” he said.

And if other professions have restricted hours, so should physicians, said Dr. Puddester.

He said Canada is the same country that limits the number of hours that long-haul truck drivers can be on the road. He asks whether people that are “cutting into our bodies and affecting our minds” shouldn’t also face restrictions on hours worked.

Fewer working hours for physicians will make health care services more sustainable, he said. As director of the University of Ottawa’s Faculty Wellness Program, an initiative started in 2000 that aims to promote healthy lifestyles for physicians, Dr. Puddester has touted the benefits of a work-life balance.

Doctors have to learn how to say no and draw strict boundaries on their professional and personal lives and the government needs to pay attention when planning to block the future doctor shortage.

“We actually think that having doctors working reasonable hours is going to translate into better care for their patients,” he said, speaking on his cellphone from an Ottawa public pool where he was watching his son take a swimming lesson.

The increased number of female doctors in recent years plays a role too, Dr. Puddester said. Last year, 18 per cent more women than men graduated from Canada’s medical schools. However, when women enter their 30s, they may be more inclined to start a family, which will put patient care on hiatus, he said. Women also tend to better balance their career and home lives.

It’s not like they have a choice, says Dr. Janice Willett, president of the Ontario Medical Association. Women are still expected to rear children and keep house and also work hectic hours, she says. “With that kind of scenario, it’s likely we’re going to burn out our new graduates if we don’t find a way to make the workplace an acceptable place,” she said.

The problem is systemic, she says. Dr. Willett largely blames Ontario’s doctor shortage on the 1992 cuts to medical school spots. “The answer is to have enough people and allow them to work in a system that’s not so competitive on funding,” she said.

And while the McGuinty government has opened more medical school spots, Dr. Willett says doctors are waiting for the “bubble” of physicians expected to be in practice in seven to 10 years. “It’s up to us to create an environment they’re going to want to practise in,” she said.

The retirement crunch is expected to make the doctor shortage worse, causing a shortfall in doctors willing to work on-call hours. When Ontario’s estimated 1,500 specialist physicians over 65 retire, the province won’t see new doctors rushing to fill those shoes, she said.

“I can tell you that if we don’t look at something that’s a little bit more sustainable than that 70-hour work week, the length of practice of those doctors is not going to be great,” she said. “We need to make sure we respect that doctors need to have a family life and a stable life, in fact, to be a healthy practitioner. It is the wave of the future.”

Dr. Puddester agrees, calling himself the perfect example of finding a work-life balance.

“If I don’t say no, who’s going to take my kid to the pool and how am I going to stay sustainable for the long term? I love my work. I don’t think there’s any better job than the job I have. Keeping things balanced keeps me in tune with it.”
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