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Long hours putting pressure on mental health of doctors in training

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The AMA is calling for urgent action to support doctors in training, with new research showing that long working hours and fatigue are putting the future medical workforce at greater risk of poor mental health and suicide ideation.

Research published this week in the British Medical Journal’s BMJ Open shows that doctors in training who work more than 55 hours each week have double the risk of developing mental health problems and suicidal ideation.

AMA President, Dr Tony Bartone, said the research – based on data from the highly respected 2013 Beyond Blue National Mental Health Survey – highlights the ongoing need for governments and authorities to tackle long working hours for doctors in training.

“A healthy medical profession is vital to patient safety and quality of care, and the sustainability of the medical workforce,” Dr Bartone said.

“Significant evidence already exists to show that doctors are at greater risk of psychological distress and stress-related problems.

“This new research provides clear additional insight into how the workplace can affect the health and wellbeing of the medical profession.

“Long working hours, unpredictable rosters, overtime, being on-call, and night shifts are significant systemic barriers to the maintenance of physical and mental health and wellbeing.

“There is an established link between working more hours and having higher rates of anxiety, depression, and psychological distress.

“This should be a wake-up call for hospitals and health services to commit to a review of rostering practices to identify unsafe working hours and develop new evidence-based safe working hours policies and practices. The evidence is clear and irrefutable.

“Such a review must include an investigation into the significant amount of unpaid overtime to determine the full hours that doctors in training are working.

“Public hospitals also need to look at how they can create mentally healthy workplaces. Not to do so is unacceptable. This is the 21st century. A safe workplace is a right and a necessity.

“On top of providing safer working hours, reforms must include strategies to address bullying and harassment, support for education and training, better access to leave, and the introduction of initiatives such as a Chief Wellness Officer.

“We owe it to our doctors in training to do everything possible to ensure safe and healthy workplaces.”

The 2016 AMA Safe Hours Audit report showed that the previous trend towards safer working hours for doctors had stalled, with 53 per cent of doctors at significant risk of fatigue. This mirrored the results of the 2011 AMA Safe Hours Audit.

In the extreme, unbroken shifts of up to 76-hours were reported, as well as working weeks of up to 118 hours.

The impact of long working hours on doctors in training is compounded as they also must manage the competing demands of work, study and exams.

The AMA’s National Code of Practice – Hours of Work, Shiftwork and Rostering for Hospital Doctors (the Code) was revised in 2016. It provides practical guidance on how to manage fatigue and eliminate or minimise the risks associated with shiftwork and extended working hours. The AMA recommends that this should be adopted as the minimum standard by all States and Territories.

The BMJ Open research paper is available at https://bmjopen.bmj.com/content/10/1/e033525