By Hayley Harlock, MSW
The COVID-19 pandemic has had an immense impact on the well-being of Canada’s physicians, who have made significant and ongoing sacrifices to keep our communities healthy, safe and informed. Physician families have made similar sacrifices, and they are feeling parallel impacts. It has long been known that medical training and practice affects not only the life of the physician but also the lives of their partner and children, but the pandemic has highlighted these impacts and provided opportunities for physician families to begin having important conversations with stakeholders on what the impacts are and how their experience can be improved. The repercussions of the pandemic for physicians and their families will be felt long after the case counts are under control and the restrictions are lifted. I hope that support for physician families will become commonplace.
Before the pandemic, nearly one in three Canadian physicians who participated in the 2017 Canadian Medical Association (CMA) National Physician Health Survey reported experiencing burnout. The percentage was significantly higher for resident physicians (38%) than practising physicians (29%). The CMA has identified physician burnout as “one of the most significant challenges facing the health care system. It threatens the well-being of clinicians, residents and medical students, which can affect the quality of care given to patients. Healthy physicians mean healthy patients.”
In addition to burnout, physicians experience high levels of depression and suicidal ideation compared with the general population. Within the physician population, the percentages are highest for resident physicians, who had 95% higher odds of screening positive for depression and 72% higher odds of contemplating suicide compared with more senior physicians.
To my knowledge, studies have not yet been conducted on how family members of physicians screen, but I am confident there is a correlation. In fact, the 2017 National Physician Health Survey noted that one of the primary reasons physicians seek mental health help is related to personal stressors including family. The experiences of physicians through training and practice do not occur in isolation.
Family members of physicians
Although it is rarely discussed, there is a strong connection between the experiences of physicians and those of their families. The CaRMS match, geographic relocation, the long and expensive training years, call schedules, middle-of-the-night pages and atypical workplace stressors affect families too. These experiences can lead to exhaustion, compassion fatigue, burnout and depression.
In March 2020, the demands on physicians intensified, and so did the demands on their families. There were stories about physicians living in tents in their garages or in hotels to keep their spouses and children safe from infection. Those who moved for medical training or practice were unable to visit their families because of COVID-19 travel restrictions, which were often more intense at the hospital level than at the provincial/territorial or federal level. As well, physicians were redeployed to hotspots in other cities or regions to help on the front lines, leaving their families behind.
Physician burnout, and the impact it has on individual physicians, their patients and the health care system, has been discussed and researched, and services have been made available to support physicians. However, only 15% of the 2017 National Physician Health Survey respondents reported seeking help, even though 81% were aware that services existed. One of the most common barriers to physicians accessing services was shame about seeking help.
There is currently no system that can adequately address the diverse, individual needs of physicians the way their families can. Health care systems and medicine as an institution have lacked inclusion, equity and diversity for many years. The unique ability of physician families to anticipate and address the needs of the physician(s) in their family unit is one of the many benefits of including and supporting physician families at all stages of training, practice and into retirement. Physicians, their families, their patients and our health care system would all benefit from this.
This presents an opportunity to change how we help physicians. If only 15% of physicians are seeking help for their mental health, and one of the top reasons they seek help is related to family support, let’s make a change. The American Medical Association has acknowledged that the “effects of burnout on physician families'' have not been studied or supported and that there is room to improve this.
The impact of the pandemic on families, and the change it has brought
The COVID-19 pandemic has been disruptive in many ways and has led to unprecedented change. Physicians and other health care workers are increasingly publicly advocating for changes to be made to improve the medical system. They have been calling for paid sick leave to be provided to physicians and for the systemic barriers that exist in health care to be acknowledged, they are highlighting the impact the current health care system has on their families. When Dr. Michael Warner, a prominent intensive care unit physician in Toronto, was recently asked about burnout, he responded, “I definitely know how it’s affected my family. Without the support of my wife, everything would have fallen apart. She has kept our family together. The partners and the families of health care workers bear the brunt of this.”
Earlier this year, Dr. Jillian Horton released a book describing her experiences in medicine called We Are All Perfectly Fine. In this book she calls on the system to improve the culture of medicine by establishing and maintaining a more humane way to train future physicians and heal those who have been harmed. Our physicians deserve better, and so do their families.
Physicians’ partners are unrecognized allies in the health care system, who take on this role instinctively, out of necessity and without any formal training or support. We know that physicians can’t care for others if they’re struggling to care for themselves. In January 2021, Medscape released the results of a study on physician burnout. Many of the physicians surveyed in the study reported that burnout had a negative impact on their personal relationships. Burnout affects not only physicians, but physician families too.
What are we doing and what else can we do?
As the spouse of a vascular surgeon who struggled in silence for many years, I founded an organization for partners of medical students and physicians called The Flipside Life (TFSL). I connect and support partners through weekly confidential peer connection calls, events and social media. All partners of medical students and physicians are welcome, there is no cost to attend, and no sign-up is required. The scope of the engagement from the physician partner community has confirmed my theory that this group has needed formalized support for a long time. Through TFSL, I work with physicians’ partners every day, and I have seen a significant increase in the number of members of our community seeking support since the onset of the pandemic. Physicians’ partners have a lot in common, namely a desire to improve life on the flipside of the white coat.
Many of the physician health programs offered through various provincial and territorial medical associations also provide support services to physicians and their families.
The physical and emotional toll experienced by physicians and their families during the pandemic will be endured for years to come. Institutions, associations and other stakeholders that work with physicians must seek opportunities to make changes to support physician families, starting with formally acknowledging, including and supporting physician families from the first day of medical school onward. Some Canadian medical schools are leading the change by including physician families in the training journey. They have demonstrated their commitment to physician family wellness by including partners in orientation activities and other supportive and educational events. It’s deliberate, inclusive and meaningful actions like these that will help change the culture of medicine and support physician family health and wellness.
Our health care system depends on healthy doctors, and the health of physicians begins at home.
Results from the latest 2021 National Physician Health Survey and more recent physician health and wellness data are available here.
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