Hospital doctors in Ireland and the struggle for work–life balance

Abstract

Ireland has a high rate of doctor emigration. Challenging working conditions and poor work–life balance, particularly in the hospital sector, are often cited as a driver. The aim of this study was to obtain insight into hospital doctors’ experiences of work and of work–life balance. In late 2019, a stratified random sample of hospital doctors participated in an anonymous online survey, distributed via the national Medical Register (overall response rate 20%; n = 1070). This article presents a qualitative analysis of free-text questions relating to working conditions (n = 469) and work–life balance (n = 314). Results show that respondent hospital doctors, at all levels of seniority, were struggling to achieve balance between work and life, with work–life imbalance and work overload being the key issues arising. Work–life imbalance has become normalized within Irish hospital medicine. Drawing on insights from respondent hospital doctors, this study reflects on the sustainability of this way of working for the individual doctors, the medical workforce and the Irish health system. If health workforce planning is about getting the right staff with the right skills in the right place at the right time to deliver care, work–life balance is about maintaining doctor wellbeing and encouraging their retention.

“We All Really Need to just Take a Breath”: Composite Narratives of Hospital Doctors’ Well-Being during the COVID-19 Pandemic

“…Some were drawn to coping mechanisms that negatively affected their physical health, like alcohol and overeating, as has been documented among doctors during COVID-19 lockdowns [ 53 ]. Others were drawn to use work as a coping mechanism and undertake additional work, like Sean and Bridget, which may cause or reinforce poor work–life balance [ 15 ] which may damage doctors’ longer-term well-being and accelerate burnout [ 6 ]. While workplace well-being supports are largely focused on supporting doctors in their physical, social and emotional experiences in the workplace, they also need to consider doctors’ total life space, and help doctors acknowledge and address how isolation or family pressures outside the workplace might be affecting them.…”

“…Linked to this strain, for many years prior to COVID-19, Ireland’s doctors’ well-being was already reported to be poor, with high levels of emotional exhaustion, burnout and poor work–life balance. For example, Hayes et al found that one-third of hospital doctors in Ireland were suffering from burnout [ 14 ], and Humphries et al found that 73% of hospital doctors in Ireland had a strained work–life balance and high levels of work-family conflict [ 15 ]. In both cases these findings compared unfavorably to findings in studies of doctors in other countries [ 16 , 17 , 18 ].…”

“…Informal supports in workers’ personal lives, such as friends and family, have been shown to protect against burnout and reinforce resilience and coping [ 31 , 35 ]. However, poor work–life balance and work–life conflict, which is widespread among hospital doctors in Ireland [ 14 , 15 ], often mean that doctors have insufficient time outside work to access these informal supports, thereby creating further stress [ 33 ]. Colleagues and collegiality may provide some informal protections against stress [ 31 , 36 , 37 ], although perhaps not if these colleagues are suffering the same stress themselves.…”

COVID-19 and doctor emigration: the case of Ireland

“…To encourage their retention (and to encourage further return migration) will require an equivalent level of commitment from the Irish health system. Pre-pandemic, the authors noted that doctor retention would require providing hospital doctors with improved working conditions [ 9 ] and a better work life balance [ 22 ], correcting the disparity in consultant pay, ensuring the availability of posts [ 15 ] and challenging the culture of medical migration [ 15 ]. Although the pandemic has altered much, it has not changed the fact that doctor retention will not be achieved without resolving these underlying drivers of doctor emigration.…”

“…The availability of better working conditions in several key destination countries such as Australia [ 9 ] was a significant driver of this emigration. Doctors emigrated from Ireland to escape the challenges they encountered in the Irish health system, either in terms of poor working conditions [ 7 , 9 ], poor work life balance [ 22 ], or uncertain career progression. This resonates with what Hirschman described as a ‘victory of... mobility over politics’ [ 23 ].…”