Time and again, providers are asked to go the extra mile – to maintain quality of care and bear the brunt of patient frustration in a grossly understaffed and under-resourced health system. But health workers are also human, and their commitment often comes at the cost of their own safety and well-being.
Results from the CMA’s 2021 National Physician Health Survey (NPHS), a study of more than 4,000 physicians and medical learners, showed high rates of burnout (53%), depression (48%) and low professional fulfillment (79%). And eight in 10 respondents reported experiences of intimidation, bullying or harassment in their workplace or training environment.
Negative wellness outcomes were particularly pervasive in disadvantaged groups such as women, residents, physicians practising in rural and remote areas, and physicians living with disabilities.
The impact of the pandemic is evident, exacerbating existing cracks in the health system and increasing incidents of abuse in care settings. But a professional culture resistant to change and increasing workloads and administrative duties also impact physicians’ physical, psychological and cultural safety.
Speaking up about wellness and safety concerns can be difficult as well. A 2020 survey of physicians at two Vancouver hospitals, conducted by the UBC Faculty of Medicine, found that at least one-quarter were “very hesitant” or “fearful” to come forward.
What we're actually doing is allowing the system to continue to take from each of us, without ever forcing the conversation about how else can we do this? Is everything that I am doing really necessary for a physician to do?— Dr. Jillian Horton, physician health and wellness expert
With only a patchwork of existing efforts to improve physician safety – and little accountability – some providers are leaving the system entirely. Nearly half (49%) of NPHS respondents indicated that they were considering reducing or modifying their clinical work hours within the next two years. One in five respondents to the UBC survey said they were considering quitting or had already quit the profession.
An exodus of trained professionals would have a devastating impact on an already struggling health system. Beyond turnover, unsafe working conditions and poor physician wellness can sometimes trickle into practice, increasing the potential for medical errors, decreasing productivity and lowering the overall quality of care.
The health of Canadians depends on a thriving health workforce.
When we see our care providers run visibly ragged and we hear the autopilot sound in their voice, we know this means that there will be less capacity for empathy and partnership. Our care providers deserve systemic support – as defined by them – and I know firsthand that this, in turn, increases quality of care – as defined by patients.— Jake Starratt-Farr, CMA Patient Voice Member
Our work on physician safety
As the voice of the profession, the CMA is in a unique position to convene health providers, governments and other stakeholders to work toward a shared understanding of the challenges and opportunities for physical, psychological and cultural safety within our health system.
That starts with a comprehensive understanding of physicians’ lived experience.
The CMA’s NPHS – launched in 2017 and conducted on a three- to four-year cycle – is a critical first step. Significantly, the study uses an equity lens to examine at-risk subgroups, which will help shape recommendations for system-level changes from medical school through retirement.
We’re also investigating approaches to safety both within and beyond the health sector.
Our partners on physician safety
The CMA brings physicians together with patients, policymakers and thought leaders to advance physical, psychological and cultural safety both in the profession and the health system through signature events like our Health Summit and the Canadian Conference on Physician Health.
In 2024, we are also jointly sponsoring the International Conference on Physician Health in Halifax alongside the American and British Medical Associations, showcasing a diversity of research and innovations to mitigate burnout and promote professional well-being.
We will also be working in allyship with First Nations, Inuit and Métis Peoples, and are committed to engaging with Indigenous physician groups to ensure voices and interests are integrated into our work.
How else is the CMA supporting health workers’ physical, psychological and cultural safety?
While violence and abuse against health care workers didn’t start with the pandemic, its escalation through COVID-19 underscored the need for swift and decisive action. In the fall of 2021, the CMA called for urgent federal legislation to protect health care workers, resulting in the passing of Bill C-3, an amendment to the Criminal Code making intimidation or bullying a health worker an offence punishable by up to 10 years in prison. The CMA continues to advocate for the enforcement of the law by agencies across the country.
The CMA also actively supports physicians through our Physician Wellness Hub, offering resources for both individual- and system-level change, like handling burnout, threats and harassment, and how to foster a safe learning environment.
What physicians can do to help
Collaboration with physicians and learners of all ages, stages and specialties, from rural and remote communities as well as big cities, is essential for a better way forward.