A national survey of obstetricians and gynaecologists has revealed high levels of burnout in the sector since the COVID-19 pandemic.
Burnout, recognised by the World Health Organisation as a syndrome resulting from chronic workplace stress, is characterised by feelings of energy depletion or exhaustion; increased mental distance or negativism about one's job; and reduced professional effectiveness. It often can manifest as a lack of empathy and compassion as well as unprofessional behaviour.
One-fifth of professionals responded to the survey conducted in 2022. Of the 1114 doctors who completed it, 72% met the criteria for burnout, compared to a baseline figure of 36% before the pandemic in 2019. A total of 9% reported having suicidal thoughts, up from 3% previously. The highest levels of burnout were seen in the category of younger resident doctors, at 80%.
Researchers at Imperial College London say their study indicates that many NHS professionals in these areas may be experiencing mental health problems, with significant implications for both the clinicians themselves and for patient care. They are calling for urgent action by healthcare organisations.
The study's publication follows several high-profile enquiries into maternity care failings in the UK, as well as a recent review announced by UK Government Health Secretary Wes Streeting into England's maternity and neonatal care units.
Professor Tom Bourne, Chair in Gynaecology at Imperial College London, who led the study, said: "As well as having a severe impact on the clinicians themselves, we know that burnout is detrimental to patient care, with evidence that it carries double the risk of patient safety incidents and is associated with poor professional behaviour. Doctors with burnout are more likely to be named in medical negligence cases, report more medical errors and have lower patient satisfaction ratings."
He noted: "Among the many factors involved, recent investigations into poor care at maternity units have talked about cultures where staff lack compassion and empathy – and these are key burnout characteristics. Our study should be a warning to healthcare organisations and policy makers to urgently consider implementing strategies to mitigate the serious impacts of burnout on clinicians and their patients."
In a national survey of practising members of the Royal College of Obstetrics and Gynaecology, the Maslach Burnout Inventory Survey for Medical Personnel was used to evaluate burnout in 3102 doctors in 2019 (3102 responses) and 2022 (1114 responses), allowing comparison before and after the main waves of the Covid pandemic. Other aspects of doctor wellbeing were also measured including suicidal thoughts, insomnia, and depression.
The results found that 72% of doctors met the criteria for burnout in 2022, compared to 36% before the pandemic. The highest levels of burnout were seen in younger resident doctors, with four out of every five (80%) meeting the criteria for burnout. A total of 39% of doctors reported defensive medical practice, compared to 13% pre-pandemic. Worse doctor wellbeing was commonly reported after the pandemic, with overall 62% of doctors reporting anxiety, 31% depression and 9% having suicidal thoughts, compared to respectively 33%, 14% and 3% pre-pandemic.
Compared to those not experiencing burnout, doctors with burnout were 7 times more likely to have suicidal thoughts, 5 times more likely to report depression, and around 4 times more likely to report anxiety, anger and irritability, sleep problems and insomnia.
The authors acknowledge the limitations of the study which include a lower response rate to the post-pandemic survey, although comparable or higher to other national surveys of this kind; and possible selection bias – for example, those less affected by burnout may have been less likely to respond to the survey. Conversely, those suffering the most from burnout may also have failed to respond.
Findings are consistent with a 2023 General Medical Council training survey in which 72% of UK obstetrics and gynaecology trainees and 52% of obstetrics and gynaecology trainers were at moderate/high risk of burnout, based on seven questions from the Copenhagen burnout inventory.
Professor Bourne, who is also a consultant gynaecologist at the Imperial College Healthcare NHS Trust, said: "Burnout should be a major concern for healthcare organisations. The contributing factors aren't only overwork, but also a lack of autonomy and control."
"Having a supportive culture can be helpful. It is not just an individual responsibility to increase one's resilience; organisations should be looking at initiatives such as improving the ability of doctors to influence the culture and fairness of organisations, to introduce minimum standards of basic facilities, improve work schedules and rotas, develop supportive teams, tackle workload intensity and ensure effective training and supervision to support their clinicians in what is clearly a very pressured sector of the NHS."
Dr Alison Wright, President-Elect of the Royal College of Obstetricians and Gynaecologists, and consultant in Obstetrics & Gynaecology, said: "This paper's finding of such high rates of burnout amongst doctors training in Obstetrics and Gynaecology deeply concerns me, especially given the detrimental impact that burnout can have on patient care. I see this as a call to action and look forward to working with government and other organisations, to do whatever we can to improve working conditions for frontline clinicians and residents, thereby supporting and enabling Obstetricians and Gynaecologists to provide the best possible care to women and families."
The work at Imperial was underpinned by infrastructure support from the NIHR Imperial Biomedical Research Centre, a translational research partnership between Imperial College Healthcare NHS Trust and Imperial College London.
'Burnout, wellbeing and defensive medical practice in obstetricians and gynaecologists in the UK before and after the COVID pandemic: A repeated cross-sectional survey study' by Parker, N.,
Bourne, T., et al. is published in Acta Obstetricia et Gynecologica Scandinavica. DOI: 10.1111/aogs.70006
