Burnout in intensive care

The recent tragic suicides of young doctors have highlighted concerns regarding the welfare of trainees in our profession. The Trainee Committee of the College of Intensive Care Medicine of Australian and New Zealand (CICM) met in Melbourne in March 2017, and the recent results of the survey1 into bullying and harassment, in addition to the deaths of several junior medical officers to suicide, provided for a solemn meeting.

The committee wants to highlight the factors that adversely affect intensive care medicine trainees:

• bullying, discrimination and sexual harassment;1

• staffing and intensity as, while patients’ needs are more complex, staffing has not increased with this intensity of practice;

• rapid response teams, which are often under-resourced, poorly trained and undersupported; and

• poor workforce planning and tenuous future job security, compelling junior doctors to pursue increased non-clinical commitments without an allocated time to do so.

A consequence of these factors is burnout, which disproportionately affects intensivists and is an increasingly significant risk in trainees.2 Changes in work practices, severity of illness, increased demand for limited resources and increasing intensive care unit size — problems that have recently been addressed by Corke3 — have all played a part in burnout rates.

The Trainee Committee welcomes the approach of the CICM to tackle these issues.4 The college is steadfast in its zero tolerance to bullying, discrimination and harassment, and remains committed to fair and equitable access to training. The college also values the need for a reasonable balance between provision of clinical services and time for professional development, and recognises the importance of work–life balance, including part-time training and the provision of parental and other forms of leave. However, the CICM has limited ability to enforce these needs at hospital level.

Finally, the CICM embraces rapid response teams, recognising the importance of an appropriately supported service, but hospitals need to respond to this need, and lack of planning and matching training with lifetime workforce demands have to be a priority for the government at all levels.

Our specialty will change significantly in the next decade or so. We chose intensive care because we enjoy the work we do and find the challenge it provides rewarding. We must ensure that the next generation of intensivists can meet this challenge too.