‘I am struggling’ – how workload, hours and stress were overwhelming OH even before coronavirus

Occupational health practitioners were stressed, overworked and exhausted even before the coronavirus pandemic, a SOM survey has concluded. Nic Paton looks at what is going wrong for the profession in terms of work demands and hours when it comes to appointment, time and report-writing management. 

Amid fears that occupational health could be overwhelmed during this half of the year by the scale, complexity and sheer multitude of the health, wellbeing and practical operational challenges facing it as we move through the coronavirus pandemic, the pressures, stress and demands being put on practitioners are well and truly in the spotlight.

These pressures were brought into sharp relief by a recent survey carried out by SOM (the Society of Occupational Medicine), which concluded that, even before the pandemic, practitioners were feeling under almost constant deadline pressure, were often having to complete work out of hours, were stressed and lacking in work-life balance, and often felt under-valued or exhausted, or both.

Looking in more detail at the findings, the survey of approximately 140 SOM members (therefore encompassing both occupational health and occupational medicine practitioners) started off by asking respondents how much time on average they were given for an initial OH referral appointment.

More than half (57%) said they got a full hour, with a quarter (25%) getting 45 minutes. The rest were evenly spread, with 3% each saying they got 30 minutes, 75 minutes, and an hour-and-a-half respectively. As to whether people with satisfied with this time allocation, the split was broadly two-thirds satisfied (61%) to one-third not (33%).

‘Making up’ in personal time

However, despite this positivity overall, when the survey dug a little deeper it was clear many respondents felt under growing time and workload pressure, and were often “making up” in their personal time.

As one put it: “Cases are becoming more complex and my view would be a standard appointment is 90 minutes and any mental health case is allocated additional time – two hours.”

“Usually cases are multiple co-morbidities/complex and often need 40 minutes to carry out the consult and 20 minutes is just not enough time to complete clinical paperwork and write a good quality report. I usually end up writing reports in my own time, which is not good for work-life balance,” said another.

This pressure to take work home or work out of hours was also highlighted by another respondent. “It is impossible to undertake a remote telephone consultation and write the report within the time allocated. I am expected to undertake eight consultations a day over 7.5 hours. On Friday I worked until midnight. I frequently work until 20.00. No paid overtime.”

When asked whether the time allocated for the referral also included time for report writing, nearly three quarter (73%) agreed yes it did. However, for those who answered “no”, more than half (52%) said they were not given any allocated time during the day for report writing. A tenth (11%) were allowed 30 minutes and 4% each were given an hour to an hour-and-a-half respectively. This parsimony also taking its toll, as one respondent pointed out.

“I always work one to two hours each day outside of my work hours to complete the work required and this is not due to poor time-management skills, it’s the complexity of the cases and time to assess the employee that is challenging in the timescales given.”

Another highlighted how they were normally given just 15-20 minutes to write, check and publish their report and complete any onward referrals, for example to physiotherapy or counselling, adding: “It is unachievable, particularly when having very high audit criteria for reports (and rightly so), but when doing seven/eight cases in a day the pressure is too much and causes stress.”

Around half (54%) were provided further time for administration, but, for many again, their allocations were (as one said) “completely inadequate”, with most only getting 30 minutes to an hour (both 38%) at most.

One respondent explained, they got just 30 minutes a day to prepare for cases, finish reports, make onward referrals, complete referral forms, undertake general administration and answer emails, adding there was “never enough time to complete everything that is required.”

When it came to health surveillance work, three-quarters of hour to an hour was average for about a quarter of respondents (24% and 23% respectively), although 18% got half an hour and 3% were allocated just 15 minutes.

The most common tasks undertaken in this context were taking blood pressure and heart rate (70%), measuring height and weight (80%), BMI (63%), blood sugar (10%), urine analysis (40%), vision assessments (70%), review of health questionnaires (80%), musculoskeletal assessment (50%), HAVS (up to tier 2) (43%), skin checks (60%), audiometry (73%), and spirometry (83%).

Again, the consensus was broadly dissatisfied with the amount of time allocated for this work (69% dissatisfied to 24% satisfied). A common complaint was there was often little, if any, leeway given for, if example, repeat checks had to be carried out because of a concern being flagged or someone presenting with a more complex issue. Or, as one respondent also simply highlighted: “There seems to be a belief that it’s best to push as many through as possible and often people are late.”

Box-ticking and pushing people through

To conclude, the survey painted a picture of practitioners working under intense time and cost pressure and, to an extent, often under pressure just to be ticking boxes and pushing people through.

The knock-on effect was not just the impact this was having on the quality of care and intervention practitioners felt they were able to deliver, but also practitioners’ own health and wellbeing.

As one respondent put it: “We need to practice what we preach to clients and make workloads manageable, with a focus on job satisfaction and quality service rather than churning out numbers to continually exceed/increase profits at the expense of dedicated staff.”

“Our own health and safety is at risk from not having time to take a postural break or use the bathroom. No time for support after a tough case and no time to support colleagues,” added another.

Or, as one rather plaintively concluded: “Exhausted and overworked. I am 67 almost 68 so struggling.”