Through doctors' eyes: A qualitative study of hospital doctor perspectives on their working conditions

Abstract

Background Hospital doctors face significant challenges in the current health care environment, working with staff shortages and cutbacks to health care expenditure, alongside increased demand for health care and increased public expectations. Objective This article analyses challenges faced by junior hospital doctors, providing insight into the experiences of these frontline staff in delivering health services in recessionary times. Design A qualitative methodology was chosen. Methods Semi‐structured in‐depth interviews were conducted with 20 doctors from urban Irish hospitals. Interviews were recorded via note taking. Full transcripts were analysed thematically using NVivo software. Results Dominant themes included the following: (1) unrealistic workloads: characterized by staff shortages, extended working hours, irregular and frequently interrupted breaks; (2) fatigue and its impact: the quality of care provided to patients while doctors were sleep‐deprived was questioned; however, little reflection was given to any impact this may have had on junior doctors own health; (3) undervalued and disillusioned: insufficient training, intensive workloads and a perceived lack of power to influence change resulted in a sense of detachment among junior doctors. They appeared immune to their surroundings. Conclusion Respondents ascribed little importance to the impact of current working conditions on their own health. They felt their roles were underappreciated and undervalued by policy makers and hospital management. Respondents were concerned with the lack of time and opportunity for training. This study highlighted several ‘red flags’, which need to be addressed in order to increase retention and sustain a motivated junior medical workforce. Statement of contribution What is already known on this subject? Loss of public funding in Ireland has led to large numbers of Irish trained doctors emigrating. Research indicates the likelihood of medical graduates returning depends on improvements to working conditions. Good working conditions are likely to encourage doctor retention yet little research has been conducted in this area. What does this study add? Intense workplace demands reduce confidence and productivity among doctors. Junior doctors were reluctant to reflect on the impact current working conditions had on their own health. Early warning signs of burnout appear to resonate with many of the issues raised by junior doctors in this study.

Continuing professional development and Irish hospital doctors: a survey of current use and future needs

“…6 Against the backdrop of a challenging economic environment, Ireland's health system has experienced significant budgetary pressure and this has produced a decrease in front-line staff morale and an increase in international migration. 7,8 Irish trainee doctors have referred to feeling undervalued by the system and have reported fatigue as well as heightened anxiety regarding clinical performance and decision-making skills. 8 These pressures are heightened by the recent shift in the role expectations of doctors, which has expanded beyond clinical knowledge and skills to include team management, administration and use of electronic records.…”

“…7,8 Irish trainee doctors have referred to feeling undervalued by the system and have reported fatigue as well as heightened anxiety regarding clinical performance and decision-making skills. 8 These pressures are heightened by the recent shift in the role expectations of doctors, which has expanded beyond clinical knowledge and skills to include team management, administration and use of electronic records. Providing educational opportunities in such areas has become an important focus for CPD.…”

Practise what you preach: health behaviours and stress among non-consultant hospital doctors

“…2 Non-consultant hospital doctors (NCHDs) experience particular stressors associated with working in hospital jobs and being at an early stage of their careers. 8 In Ireland, training requires NCHDs to frequently relocate. This, combined with health expenditure cutbacks, increased healthcare demand, non-compliance with the European Working Time Directive (EWTD) and increased public expectations, has led to difficult working conditions.…”

“…This, combined with health expenditure cutbacks, increased healthcare demand, non-compliance with the European Working Time Directive (EWTD) and increased public expectations, has led to difficult working conditions. 8 This study aimed to identify the factors driving NCHD health behaviours, assess the impact of workplace stress on NCHDs and evaluate initiatives which may improve the health behaviours of this new generation of doctors. It also assessed their standard of self-care and preferred sources of support.…”

Stress of Medical Practitioners in Private Healthcare Industry

“…The importance of this factor as a contributor to job stress among medical practitioners has been found by previous researchers such as Smith (2001), Happel et al (2013), Gray-Tofta and Anderson (2002), Aziz (2004), andMcGowan et al (2013). Excessive workload reduces productivity and leads to stress.…”