“Hospitals are overwhelmed. Physician burnout is rampant. I’m working to change that”
After I was diagnosed with stage-four thyroid cancer, my colleagues covered my shifts and even helped me financially. Now, it’s my turn to support them
James Maskalyk is an emergency physician at St. Michael’s Hospital and the executive editor of the Canadian Medical Association Journal. Recently, Maskalyk was appointed wellness director of nine Toronto hospitals affiliated with the University of Toronto. Here, he talks about the burnout problem among emergency physicians across the city and how he plans to help create a healthier and happier medical culture.
—As told to Sakeina Syed
I’ve worked as an emergency physician for more than 18 years. When I put on my scrubs and ID badge, people often tell me their whole life stories. Many of the patients who come through our ER are marginalized in various ways, whether they’re newcomers, unhoused, or people who have experienced abuse. Every day I go to work, I have to prove myself worthy of their trust.
Lately, though, it’s been difficult for physicians to do our jobs properly because of the chaotic state of emergency rooms. We’re dealing with compounding crises: in addition to ongoing surges of Covid-19 and other viruses, hospitals are overcrowded and understaffed, ERs are closing across the country, and there’s a dire shortage of primary care physicians. Meanwhile, because of other systemic failures—such as the province’s shortage of affordable housing and long-term care homes—people are also coming into the ER for their unmet social needs.
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For health care workers, these conditions are untenable. Since the beginning of the pandemic, we’ve seen an epidemic of burnout. According to a survey conducted by the Canadian Medical Association in November 2021, 53 per cent of physicians have experienced high levels of burnout—a stark increase from the 30 per cent who reported that they were struggling in 2017. The CMA also found an alarming rise in reports of depression and suicidal ideation among doctors. It’s no wonder that health care professionals are leaving the field en masse, either temporarily or permanently, across the country.
Even for doctors, the first symptoms of burnout can be difficult to recognize. A patient might come up to us and ask for a glass of water. Instead of responding positively, we might get frustrated and say, “I’m kind of busy right now. Can you come back later?” In more severe cases, burnout can lead to depersonalization and a loss of interest in our work, leaving us feeling disconnected from our patients, almost seeing them as objects. For far too long, physicians haven’t been given the time or space to discuss the emotional challenges we experience at work. Doctors are expected to ask how we can help others, but there’s very little opportunity to talk about how we need help.
I know having supportive colleagues can make all the difference in times of crisis. At the beginning of 2020, my mother passed away, and I was overwhelmed with grief. As a distraction, I threw myself into the emergency response to the first wave of the pandemic. At times, I felt so numb that I barely registered the extent to which I was putting my own life at risk. Then, in May 2020, I felt a swollen lymph node in my neck; soon afterward, I was diagnosed with stage-four thyroid cancer.
When I was forced to give up all of my shifts and begin treatment, my colleagues covered for me. Some of them even helped support me financially while I was taking time off work. Their generosity helped make my recovery possible. Now, I truly understand what it feels like to be held by a community of people who care about me. It’s difficult to stay well in isolation—we need to look after one another.
Earlier this year, I was appointed to the position of wellness director of nine hospitals affiliated with the University of Toronto. In my new role, I’ll help create a culture of well-being for emergency physicians while continuing my own medical practice in the ER. Even small changes to our daily routines can make a dramatic difference—whether it’s making sure there are quiet rooms available for doctors to rest, cry, or speak to their children, or ensuring that doctors have a regular mindfulness practice, such as therapy or meditation.
We’ve also developed community-building practices at St. Mike’s that I’m hoping to replicate across various hospitals. Right now, most ERs don’t have protocols in place to help physicians process the emotional impact of patient deaths or other traumatic experiences. I use a technique called “the pause” to counteract fallout from those events. For example, right after a patient passes away, I encourage health care practitioners to take the time to gather and pay tribute to the person who has died. We might say something like: “I want to recognize this person as someone who had a life, family and dreams. And I’d like to acknowledge the people in this room who tried to help them even though they may not have known anything about them.”
Similarly, I plan to implement critical incident debriefing across ERs. After a tough event, like a medical misstep, doctors will come together on the same day as the incident to discuss their experiences. About a week later, we’ll follow up with a formal debriefing led by a trained facilitator. A lot of feelings come up in these processing sessions. They help prevent our traumatic experiences from interfering with our lives and relationships outside of work. Regular moments of reflection also allow us to find the meaning in the work we’re doing—to feel the sense of purpose that can go missing when we’re burnt out.
Still, it’s crucial that these shifts in hospital culture are accompanied by policy changes to address the conditions leading to our burnout. The province needs to take measures to reduce strain on emergency rooms: increase the hours that non-emergency hospital wings are operating, redirect ER patients to more specialized care, and better fund social services so fewer people end up in the hospital in the first place. These changes will keep the public healthier and ease the burden on physicians, allowing us to rediscover the parts of our job that are rewarding, transformative and healing.