The health and wellbeing of junior doctors: insights from a national survey

Alexandra L Markwell and Zoe Wainer
Med J Aust 2009; 191 (8): 441-444. || doi: 10.5694/j.1326-5377.2009.tb02880.x
Published online: 19 October 2009

The health status of doctors is better than average; like other higher socioeconomic groups, they are less likely than the general population to suffer lifestyle-related illnesses, such as heart and smoking-related disease.1-3 However, they are at greater risk of mental illness and stress-related problems and are more susceptible to the “3 Ds” — depression (including suicide), drink and drugs.4,5

Junior doctors (interns through to completion of training) are a subgroup of the medical profession who may be at greater risk of poorer health. They face specific pressures related to their professional stage and development, including coping with the demands of each new clinical placement, furthering their medical career, and maintaining social and personal networks. Junior doctors do not prioritise their own health care and feel pressured not to miss shifts because of ill health.6 They can be unwilling to admit illness or accept that they are not coping with the demands of their career. This can lead to a failure to recognise, acknowledge and act on the early warning signs of illness.

Recent data on the attitudes of junior doctors to work–life balance suggest that they now are less willing to accept the personal costs traditionally associated with a career in medicine. In response, recent initiatives have endeavoured to improve the support available to junior doctors.7 Medical colleges are providing wellbeing programs for trainees and Fellows, and medical schools increasingly include self-care programs in their curricula.8

Despite these innovations, the Australian Medical Association (AMA) Council of Doctors in Training remains concerned about the state of junior doctors’ health, and in 2008 undertook a survey to raise awareness and record baseline data on the health and wellbeing of junior doctors in Australia and New Zealand.

Survey results

This survey confirms that junior doctors have a high level of career satisfaction; however, it is of concern that 38% of respondents indicated that they were not prepared for life as a doctor, and 17% would not choose medicine as a career if they had their time again. This is consistent with 2006 British Medical Association data, which established that 15% of medical graduates had a low desire to practise medicine.11 The coping strategies nominated by most junior doctors were appropriate, although they relied heavily on the ability to maintain relationships, which could leave junior doctors vulnerable if they became isolated through heavy work and study demands.

The ProQOL prevalence figures for burnout, job satisfaction and compassion fatigue are consistent with those reported in other studies, and comparable with an earlier study using a different instrument.4,12-14

That 71% of respondents were concerned about their own health, and 63% were concerned about the health of a colleague, confirms that junior doctors are aware of their health care needs and require access to independent medical care. That said, the survey found that fewer junior doctors (66%) have their own GP compared with the general population (80%).15 The rates of self-medication and prescription probably reflect that junior doctors have difficulty accessing independent medical care, and that the culture of medicine promotes self-care. No formal data are available on the use of doctors’ health advisory services by junior doctors, so the rate of 5% provides a baseline for future reference.

Junior doctors appear unable to access annual leave in full. This is of concern as taking leave may help protect them against the long-term effects of fatigue. Junior doctors also take relatively small amounts of sick leave and carers’ leave. It is conceivable that this may change as the average age of medical graduates increases, and so too does their need to care for children or elderly parents.

Although adults require between 7 and 9 hours of quality sleep in a 24-hour period, most junior doctors were sleeping 7 hours per night or less.16 Likewise, the Australian National Physical Activity Guidelines recommend that adults do 30 minutes of moderate-intensity physical activity on most days; only about a quarter of survey respondents were able to follow this recommendation.17 As most junior doctors were working up to 60 hours per week (as well as studying), it is not surprising that exercise and sleep are given a low priority.

To address the concerns raised by this survey, the AMA Council of Doctors in Training has put forward a series of recommendations (Box 4) and resolutions (Box 5), which were endorsed by the Federal Council of the AMA in March 2009.18 A poster campaign designed to raise awareness was also launched in October 2008. The full report of the survey is available on the AMA website at <>.


This survey provides a snapshot of the health and wellbeing of junior doctors and an indication of how they are able to balance their personal and professional lives. The results indicate that most junior doctors have a rewarding and satisfying career in medicine, but at a cost to their physical and emotional health. The data also confirm that the medical culture of self-reliance persists, and inappropriate self-care practices develop early in doctors’ careers.

On the basis of this survey, it is clear that the AMA has an ongoing role in

Supporting junior doctors during this challenging phase of their careers is vital to ensure a healthy and sustainable medical workforce.

4 Recommendations from the Australian Medical Association (AMA) Council of Doctors in Training18*

Junior doctors should:

To support junior doctors — hospitals, medical colleges, medical boards and government should:

* Adapted from the AMA position statement, The health and wellbeing of medical students and practitioners — 2006.18

 The AMA publication, National code of practice. Hours of work, shiftwork and rostering for hospital doctors, provides guidance on safe rostering practice.19

  • Alexandra L Markwell1
  • Zoe Wainer2

  • Australian Medical Association Council of Doctors in Training, Canberra, ACT.


The survey was funded by the AMA and undertaken with the assistance and support of the AMA Federal Secretariat. We thank the doctors in training who completed the survey, and acknowledge the ongoing support and inspiration of the Council of Doctors in Training. We also thank Professor Tony Brown for his editorial input in the development of this article.

Competing interests:

Alexandra Markwell, as a former board member of the Federal AMA, has received an allowance and travel assistance to attend meetings on behalf of the AMA. Work on this survey was undertaken on behalf of the AMA. She has received travel assistance from the Medical Council of Tasmania to present at their conference, and from Queensland Health to present the survey results at the International Doctors’ Health Conference in London, 2008.

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