With junior doctors in England this week taking part in a three-day walkout, research has highlighted how long hours, intense workloads, a lack of senior support and toxic interpersonal relationships – as well as pay – are leaving doctors feeling stressed, anxious and, in some cases, despondent and desperate.
Research from Leeds University has painted a grim picture of the ongoing intense mental and physical pressures being faced by doctors and other healthcare staff, irrespective of when or if any pay deal is agreed.
The research, carried out by doctoral researcher Sanjay Popat of Leeds University Business School, asked 58 junior doctors in their first and second years to keep an audio diary for two months. They made verbal entries of their experiences of stress on the days they experienced them.
They were also interviewed before and after this period. Overall, this meant 118 interviews were carried out along with 745 audio-diary entries, totalling just under 1.2 million words and 6,400 minutes of audio data.
NHS stress and wellbeing
“The data show overwhelmingly that junior doctors faced high levels of stress across the period of the study – 81% of the sample reported experiencing days that they would describe as ‘very’ or ‘extremely stressful’. This was true across specialities, ranging from accident and emergency, and geriatrics, to general practitioners,” the study argued.
The top four most cited sources of stress amongst junior doctors were high workload, understaffing, lack of senior support, and interpersonal relationships.
Key challenges included excessive administrative work, high volumes of patients and long working hours, with 339 references to high workload. “Doctors spoke about how this made them feel panic, despondence, and desperation – in one case, they said the workload for a junior doctor was worse in the UK than it was in their ‘third world’ home country!” Popat argued.
Junior doctors reported feeling unsupported by more senior colleagues, with 231 separate reports along these lines. They complained of often being left to make complex clinical decisions by themselves, which they did not feel capable of making.
As one respondent put it: “We had a patient who had high potassium that could have been dangerously high and caused a heart attack. And I tried to contact all my seniors for advice, but absolutely no one would call me back or if they did, they didn’t want to comment.”
Hostile and toxic interpersonal relationships were another significant source of stress. There were 202 mentions of confrontation and conflict in the audio diaries.
One respondent said: “So basically, today, I’ve been shouted at for basically just moving… I basically have to hold something for four hours, I moved, she’s not happy, I got shouted at for not moving the blade… We’re tiptoeing around her, and it’s just the environment is so hostile, it’s so awkward and hostile.
“And it was stressful because I had to deal with that from eight to five, from eight to seven… It was a very, very stressful day. I also have been sprayed in the face with blood and medication because she was a bit angry – she threw a bit of a tantrum and that went on my face. So yeah, I just had to suck it up and I just stood there for the next hour or so.”
Popat concluded that the findings “overall paint an alarming picture of the plight of today’s junior doctors”.
He added: “They highlight the harsh and unsustainable working conditions that junior doctors face in the UK, and show just how close many are to burnout early in their careers. While the study highlights a need to change structures, funding and working conditions that improve workload, staffing, and support systems, the findings also raise the question as to whether increasing pay alone is enough to alleviate the stress experienced by junior doctors.
“Our findings also show how there are both cyclical and cumulative consequences of experiencing these stressors. They affect how doctors rationalise new situations, and can create vicious cycles, perpetuating feelings of anxiety and despair,” he said.