COMMENTARY

“We’re not better now”: Canada’s health care providers need well-being supports, stat

Andrea Lum, MD, and Laura Foxcroft, MD

Now, more than ever, robust well-being supports are needed for Canada’s health care providers — especially as we prepare to exit the Omicron wave and build back a battered health care system. For two years since the World Health Organization declared a global pandemic, health care workers have been on the front lines burning the candle at both ends.

But the issue of burnout was already brewing well before the virus crisis brought hospitals to their knees. We went into the pandemic with a very high burnout rate, with evidence showing it affected a staggering half of practising physicians.

We’re not better now. Our providers are exhausted, clinically, academically, and emotionally. More physicians are experiencing moral injury, compounded by a growing lack of institutional trust and, more recently, vitriol directed toward doctors, nurses, and health care professionals.

A recent study¹ showed that, among Ontario physicians, the annual rate of outpatient visits for mental health and substance use increased by 27% during the first year of the pandemic. The report also found physicians self-report high levels of symptoms of anxiety and depression, with surveys suggesting these symptoms have been worsened by the COVID-19 crisis.

As contractors — not hospital employees — doctors often aren’t included in many organizational, hospital-based support networks, resources, or employee assistance programs. The figures are a stark sign of the need for greater mental health resources for physicians and highlight the need for programs that support physician well-being.

As we look toward an end to the pandemic, and a new normal for many, the health care system is faced with a daunting task: clinical backlogs, patients with long COVID, and a shrinking workforce of health care experts, to name a few.

Amid the COVID-19 crisis, the Ontario Medical Association issued a report2 outlining five system-level solutions to physician burnout. Among ensuring fair and equitable compensation, increasing work-life balance, and streamlining administrative work, providing institutional supports for physician wellness was listed as a key priority. The OMA also calls for implementing proven, individual-level well-being interventions for physicians.

Western University’s Schulich School of Medicine & Dentistry in London, Ontario, is answering that call with the implementation of the Peers for Peers program to better support our clinical faculty members’ mental health. The first program of its kind in Canada, Peers for Peers provides one-on-one support for clinical faculty, allowing us to provide guidance in moments of need. Well-being leads offer emotional support and resources, recognizing that it is important for professionals to access supports they need but at a distance from their leaders or employers.

Think of it like roadside assistance — if your car breaks down at the side of the road, we’re there to help. We can tow you back home, safe and sound, but there’s more that needs to be examined to determine why the car broke down in the first place. Was there a problem with the engine? Were you driving down the wrong road?

Peers for Peers allows clinical faculty members in challenging situations to get the support they need, and to be guided to resources. It’s these kinds of quick interventions that are needed to prevent trauma and for people to look after their own emotional well-being.

Our well-being program provides fast, accessible support, but we are not the permanent infrastructure or systemic solutions required for long-term change. There are no maximum hours physicians can work in a week. Our medical culture is often to continue working and serving our patients, sometimes without paying attention to our own wellness, resulting in burnout. That needs to change.

Proactive efforts to streamline physician training — targeting budding doctors to certain fields, whether it be primary or speciality care, based on population needs to better serve our various communities — is also essential.

And we must acknowledge that the hardest hit population of health care workers throughout the pandemic is women. We must provide extra resources to this group, who often bear the brunt of childcare and family needs, which have been greatly disrupted by COVID-19.

But well-being initiatives are still a place to start, and programs targeted for providers must become more common nationally.

We have developed a Peers for Peers training curriculum accredited by the Royal College of Physicians and Surgeons of Canada and the College of Family Physicians of Canada that covers a range of topics, from empathetic listening to recognizing peers in distress to implicit bias.

There has been uptake across Ontario, with both the Northern Ontario School of Medicine in Sudbury and the Richmond Physicians Society adopting the program’s framework. Growing interest in the program across Canada also tells us why such well-being initiatives are important and needed so urgently.

Because the program is customizable to the unique needs of various health care groups, educational institutions, and communities, it becomes intensely local. That grassroots aspect is apparent, and we’re starting to see the culture shift here in London’s health care network to one where physicians and providers prioritize their mental health.

It has been a challenging two years for our southwestern Ontario community and Canada at large. Against the backdrop of a global pandemic, we’ve gone through unprecedented social, political, and racial reckonings, we collectively began to reconcile the trauma of Canada’s residential school system, and we’ve experienced alarming climate events from coast to coast. That’s on top of the emergencies and crises doctors combat in our local communities daily.

Through all of this, care providers have continued to fight to improve the health — and mental health — of Canadians. Now, it’s time we heal the healers.

References

1.Myran DT, Cantor N, Rhodes E, Pugliese M, Hensel J, Taljaard M, et al. Physician health care visits for mental health and substance use during the COVID-19 pandemic in Ontario, Canada. JAMA  Netw Open 2022;5(1):e2143160. https://doi.org/10.1001/jamanetworkopen.2021.43160

2.Gajjar J, Pullen N, Laxer D, Wright J. Healing the healers: system-level solutions to physician burnout. Toronto: Ontario Medical Association; 2021. Available: https://tinyurl.com/2yaxuk2w

Authors

Andrea Lum, MD, is vice dean of Clinical Faculty Affairs at the Schulich School of Medicine & Dentistry, Western University.

Laura Foxcroft, MD, is assistant dean of Faculty Wellbeing at the Schulich School of Medicine & Dentistry, Western University.

Correspondence to:

andrea.lum@schulich.uwo.ca