Psychiatrist burnout: Why COVID-weary doctors are taking a mental health break

Toronto psychiatrist Dr. Yusra Ahmad’s infectious laugh belies the stress she feels.

Single mother and domestic violence survivor worries about her 12-year-old daughter’s virtual learning.

“It’s hard,” she says. “Online school is definitely bad for her. And it’s hard for me to have her at home and juggle with my patients.”

Ahmad had to leave in-person work at Toronto General Hospital when her daughter’s education moved online in 2020, and she is relieved that classrooms will reopen on Monday, but will be closely watching public health guidelines.

She now sees patients online, many of whom are struggling with the same pandemic stress, loneliness, and anxiety that she suffers from. In addition to her practice, Ahmad advocates against gender-based, racial, and religious violence that she understands from personal experience. To deal with all this, he has reduced the workload of his patients to preserve his own mental health.

“I found it too much,” says Ahmad. “Our work can sometimes get a little close to home.”

As the demand for mental health care fired in canadaThe pandemic has fueled a frontline crisis that few are talking about: the burnout of psychiatrists, with “extraordinary” rates of burnout in an overtaxed profession, Ahmad says.

General public concerns about family members becoming ill or losing jobs, isolation, and uncertainty about the future are contributing to the growing demand for mental health services.

It’s a rhythm that’s hard for psychiatrists to follow, says Dr. Bev Young, a perinatal psychiatrist in Toronto. The mother of two says she burned out after working nonstop the first year of the pandemic as a clinical director at a downtown hospital.

“It was too stressful to work in an academic center,” says Young.

Psychiatrists at her hospital went to great lengths to provide “resilience training” to staff treating critical COVID cases and launch programs like her “Pregnant and Scared” classes where pregnant and new mother patients wrestled with pandemic fears and the stress of caring for children. home from daycare or in virtual classrooms.

“And now it’s happening again,” Young worries. “What the- – – k are you going to do?”

New patients on the hospital’s long waiting list, old patients calling her back, and current patients needed her more than ever. He battled insomnia and finally, last July, went to work part-time.

“I said, ‘Something has to change. I can’t take this anymore.’”

She feels guilty that she can’t help more people, but says it was difficult advising anxious and depressed patients to stop using Zoom and exercise when “here I was sitting on my butt.”

Young is not alone.

Dr. Renata Villela, president of the Ontario Psychiatric Association says that a third of the professionals were already dissatisfied with their work-life balance in 2019, according to a study by the Canadian Medical Association. The pandemic has made things worse, with many choosing to leave patient care to take care of themselves. Some are cutting back on caseloads, while others are finding alternative sources of income, such as consulting and life coaching. Still others are retiring early.

“I can’t stand working with trauma patients anymore,” says a 48-year-old psychiatrist who doesn’t want to be identified to protect her patients’ feelings. He is planning to retire from patient care in the next few months. “I’m fried. I need to find a job that is less emotionally draining.”

These departures are leaving Ontario with a severe shortage of psychiatrists, Villela says. The number per capita was already declining before the pandemic, according to the Canadian Medical Association. And with half of all Canadian practitioners over the age of 55, that shortage is likely to accelerate.

Telehealth (treatment by video) has helped reduce the deficit by allowing psychiatrists to see more patients at odd hours of the day and to reach patients who can’t keep appointments in person, Villela says. “But for some, telehealth comes at a cost to their own mental health.”

Online patient care is more mentally and physically taxing than in-person care, she says.

“It’s a different feeling for psychiatrists,” says Villela. “They suffer from fatigue and eyestrain.” Working from home also erodes the boundaries between work and personal life.

Dr. Nikhita Singhal, a psychiatry resident at the University of Toronto, is used to the blurred lines between work and personal life. It was her own struggles with mental health that brought her to the field.

“I saw that the system was broken and I wanted to come in and help change things.”

As a resident, Singhal has worked with different patient populations at three hospitals during the pandemic. It was the rise in adolescent eating disorders and suicide attempts that she treated at Toronto’s Hospital for Sick Children that affected her most profoundly.

Singhal herself entered SickKids with an eating disorder when she was just eight years old and says it’s “really difficult” to see so many teenagers suffering from a highly stigmatized illness with very few mental health professionals to help.

Singhal laments the lack of resources and funding for mental health compared to the “millions of people dealing with cancer and heart disease.”

Organization for Economic Co-operation and Development Research (OECD) Y carleton university supports their concern, showing that Canada spends only half the proportion of its health spending on mental health compared to the OECD average.

“We just don’t have enough psychiatrists,” says Young. research from the Institute of Clinical and Evaluative Sciences shows that nearly a third of psychiatrists averaged fewer than two new patients each month, limiting access to mental health care for the most vulnerable. “Everything is reactive now. We don’t have enough psychiatrists to even do the current maintenance.”

Psychiatry has also suffered from a long-standing stigma that has discouraged doctors from specializing in the field. “Our own colleagues don’t see us as real doctors,” says Ahmad.

To increase the number of psychiatrists, a 2018 report by the Ontario Psychiatric Association recommended improving exposure to psychiatry in medical school, increasing the number of trained psychiatrists in Ontario, and paying psychiatrists more.

But experts say recruiting more psychiatrists won’t be enough to stop Canada’s mental health crisis.

Dr. Paul Kurdyak, a research leader at CAMH and the Institute for Clinical Evaluation Sciences, says family physicians should provide more mental health care. In the same way that primary care physicians play an important role in heart disease and cardiologists become involved in more complex cases, family physicians should be the main providers of mental health care, with psychiatrists supporting when necessary. necessary.

Kurdyak believes that team-based models of care, which include psychiatrists, family doctors and other health professionals, are the best way to enable more patients to receive mental health care.

But systemic changes will take time, he says. We currently have no way to align the expertise of psychiatrists with the patients who need them, says Kurdyak. And just over 60 per cent of Canadian family doctors feel they are “well prepared” to care for patients with mild to moderate mental illness, according to one study. 2019 Commonwealth Fund Survey.

“We have a long way to go in mental health care in Canada,” says Kurdyak. “It is very important and I am very concerned, especially for our youth.”

Kurdyak and Villela are concerned about the pressure on psychiatrists and have particular empathy for doctors with young children at home from school and daycare. Psychiatrists must stop “thinking that it is bad to stop caring for other people and take care of themselves,” says Villela.

Young sets an example. He loves his profession again now that he works part time. “I hope that my daughters have the same professional satisfaction that I have,” she says.

For Ahmad, the stress continues.

She juggles concern for her patients who are isolated, the well-being of her daughter in virtual school, and her advocacy work.

“I’m in the eye of the storm,” he says.

“That’s why I have my own therapist.”