By Aleisha Orr
One in seven GPs experience it and WA junior doctors report it at moderate-to-high levels – what is causing burnout among doctors and how can it be fixed?
It takes a lot to shake Dr Angela Alessandri. She’d previously gone through breast cancer and losing her sister, but after the most stressful year in her clinical paediatric haematology and oncology career, she finally decided she could not continue with her workload as it was.
The chest pains she had a week prior when walking away from a parent of one of her patients who was screaming at her had still not subsided when she met with the hospital’s management.
She told them she was not functioning as she should be and was not willing to continue in her head of department role at that same capacity.
As she waited at the lift afterwards, a senior colleagues said: “I have to say you don’t look like you’re a woman on the edge.”
Dr Alessandri told Medical Forum that she replied: “What you don’t understand is, I will look like this in my coffin, just because I look like this doesn’t mean I’m well.”
Many doctors may be able to relate, she was burnt out.
This may have been more than a decade ago in a Perth hospital that no longer exists, but burnout continues to be an issue for physicians in Western Australia.
Burnout, recognised by the World Health Organisation in the 1990s and classified an “occupational phenomenon” in 2019, manifests in energy depletion, increased mental distance from one’s job, and reduced professional efficacy.
It results from chronic workplace stress that has not been successfully managed.
Almost 61% of Australian workers were estimated to have experienced burnout, and doctors have been found to be particularly vulnerable.
According to a 2024 RACGP survey, one in seven GPs experienced burnout and a survey of 1100 junior doctors in WA’s hospitals last year found what it described as moderate-to-high levels of burnout.
The highest levels were recorded among women and newborn health (83%) and child and adolescent mental health (80%) services, however even in hospitals with more moderate rates one in five practitioners reported experiencing it.
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Recent research from Ahpra also found burnout and feeling undervalued were contributing to health practitioners leaving their profession – with one in 10 either considering quitting within a year or unsure about their future.
Long hours and high stress are common when it comes to working as a doctor.
In Dr Alessandri’s case, she was on call 24/7 apart from two of three weekends and she had what she describes as her most difficult set of families.
Doctors Health Advisory Service WA (DHASWA) assistant director Sarah Newman says many factors impact stress levels of practitioners.
“Not being able to get your leave, having your roster turn up with only two-weeks’ notice and not being able to plan your life, and then there’s stress of unpaid overtime,” she told Medical Forum.
“The hours and structures make it difficult in terms of self-care and to do things we all know we should do, even the basics like eating, having breaks to drink, or go to the toilet.”
Dr Newman said those who most often become doctors are perfectionists with a great deal of resilience, but this often means they push on until almost breaking point.
“We hold ourselves to very high account in the quality of our work,” she said.
“In medicine we highly stigmatise ourselves for having issues with ‘coping’ and especially for mental health issues.”
A Beyond Blue survey from 2013 highlighted the stigmatising attitudes within the industry around the competence of doctors with mental health conditions, and their opportunities for career progression.
The results may be from 12 years ago, but it was a landmark study with relevance in the current landscape.
About 40% of doctors surveyed felt medical professionals with a history of mental health issues were perceived as less competent and 48% felt those doctors were less likely to be appointed roles.
Weighed down by workplace pressures
Dr Newman said in a way burnout “is the antithesis of being professionally fulfilled” and can lead to a lack of professional efficacy.
She explained that while most come to medicine wanting to help people, poorly managed workplace stress often makes them lose that drive.
“You might feel inefficient or weighed down a lot by administration and then you don’t feel you are able to connect with the patients, and not being able to connect can bring feelings of cynicism, and present as sarcasm and resentment against these people for presenting for healthcare.”
Dr Newman said such feelings are not conducive with providing a good standard of care.
“We know there’s more medical errors, there’s more patient deaths when doctors are not well, and when they’re not able to look after themselves.”
AMA (WA) President Dr Michael Page said burnout can be directly traced back to the inadequacies of the health system.
“Whilst we absolutely support hospitals doing what they can to treat the symptoms of burnout, the root cause needs to be addressed,” he said.
Dr Alessandri says this was the case in 2014, when her burnout peaked.
“We were really struggling to cover the workload,” she said.
When Dr Alessandri eventually raised her concerns about the level of pressure staff in her department were under and received media attention, she recalled how her working environment became unwelcoming.
“People who I knew pretty well were ignoring me in the corridor,” she added.
Workplace culture has also been found to be an issue, with a third of medical trainees reported having witnessed bullying, harassment, discrimination, sexual harassment, or racism in 2024.
RELATED: Doctors experience bullying, discrimination and burnout at WA hospitals
The impact is even higher on international medical graduates (IMG). This year’s AMA (WA) Hospital Health Check report found IMGs were more likely to experience bullying, discrimination or harassment.
A total of 23% of IMG respondents reported experiencing discrimination compared to 12% of other doctors, and 29% of IMGs said they had witnessed discrimination compared to 22% of other doctors.
Driving doctors away
Dr Ashwita Siri Vanga, DHASWA’s international medical graduate (IMO) wellbeing representative, left the State after being repeatedly overlooked for roles she said she was more than qualified for.
She remembers seeking support via her employee assistance program after experiencing racism at work.
“The person on the line was not comfortable talking to me, they said ‘I am a white Caucasian male… I don’t know much about your cultural background or what happens in your life, and I don’t think I’m the right person, but I’m still happy to continue and have another session’.”
She adds that IMOs were often more reluctant than the average doctor to seek support.
“They don’t want to complain and isolate themselves further.”
While burnout may not be considered a medical condition, GPs can provide support for it, including to their peers. However, many doctors are often reticent to see a GP.
The Beyond Blue study also found 59% of doctors felt being a patient themselves causes embarrassment.
Dr Newman estimates about 50% of Australian doctors have a regular GP compared to almost 80% of the general population.
While doctors in WA can self-prescribe, Dr Newman said they should have a GP for matters “requiring an objective assessment”.
Dr Newman says doctors often fear being reported.
A spokesperson for the Medical Board of Australia confirmed mandatory reporting about health impairment does not apply in WA.
The spokesperson said the Board “supports doctors treating other doctors to prioritise the care of their patient” and that it was only in very rare cases that treating doctors may decide to make a voluntary notification about a doctor-patient if they were refusing care and putting patients at risk.
Surveys repeatedly show levels of stress are most severe in junior doctors and it can begin before a medical student graduates.
Changing the culture
Medical Students’ Association of Notre Dame (MSAND) vice president Yoveena Brian explained that rosters vary, but some senior students would be doing 40-hour weeks on top of their studies.
Ms Brian said role modelling and culture are important for those entering the profession.
“Students look to those ahead of them to understand what is normal and acceptable when it comes to managing stress,” she told Medical Forum.
“However, everyone is facing pressure from the system, as such, system level support is key.”
She admits the attitude of ‘just getting on with it’ still exists among students but is hopeful this is shifting.
“When asking current junior doctors about recommendations for internship, they often mention the amount of overtime, ease of taking leave/sick days and pastoral care/support as key points to consider.”
MSAND wellbeing chair Jay Caruso says there is growing awareness among students that “it is okay not to be okay”.
However, the structure of the course can reinforce the ‘pushing through’ mentality.
“When some clinical rotations are only two weeks long it can be hard to take time off, as it either means missing valuable hospital time or having to make up for it with longer days or weekends,” Mr Caruso said.
As well as some universities having clinical psychologists that medical students can access confidentially, many also have core curriculum components that seek to embed skills to prevent burnout.
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There is support available to practitioners through wellbeing officers in hospitals to address welfare concerns in staff and DHASWA provides a confidential 24/7 telephone advice line.
“Doctors usually call when they are at a crisis point where they can no longer manage themselves, and this can mean their health needs are urgent,” Dr Newman added.
Those responding have a variety of doctors representing different interest groups, who they can put callers in touch with.
“You’re talking to a colleague who understands the strains and stresses of being a doctor.”
DHASWA has a list of GPs and clinical psychologists willing to see doctors and medical students as a priority.
In 2024, 55% of callers expressed concerns about workplace stressors including medico-legal and Australian Health Practitioner Regulation Agency issues, work-life balance, bullying, harassment discrimination, or racism, physical health and the ability to access care.
With almost a fifth of WA’s medical specialists due to reach retirement age in a decade and lost productivity from burnout in doctors costing the national economy billions annually, the issue requires attention at all stages.
A brighter future
Dr Alessandri, who now works part-time as a clinical paediatric haematologist at Perth Children’s Hospital, said she is encouraged by the stronger focus on work-life balance from younger doctors.
Dr Helen Wilcox, head of UWA’s medical school, said while medicine may have once been dominated by ‘type-A’ personalities, universities were increasingly looking for diversity in their medical student cohorts.
“We find there may be students who are studying medicine who do have that more driven, high stress, perfectionist personality, but by spending time with other students that have a more measured approach to workload, that helps them regulate, and that’s the power of community.
“There’s a role for all personas, all approaches, those with the more perfectionistic approach, who place a sense of urgency in study, they’re often quite motivating for the students who have a steadier, lower paced approach. They balance each other.”
In an effort to provide supportive work settings, the national branch of Doctors Health Services has released the Every Doctor, Every Setting Framework.
It provides a comprehensive strategy to support the mental health and wellbeing of Australian doctors and medical students, and it focuses on practical implementation.
The plan outlines actionable items across primary, secondary, and tertiary prevention as well as mental health promotion and leadership.
National Doctors Health and Wellbeing Leadership Alliance Chair Professor Steve Robson said system-wide change is needed and the strategy will prompt this.
Supporting doctors beyond mental health
While the AMA (WA)’s most recent Hospital Health Check, released in May, shows a welcome reduction in burnout rates among junior doctors in WA hospitals, Dr Page told Medical Forum that burnout in doctors “won’t be addressed until the need to significantly expand our health infrastructure and medical training is taken seriously by governments”.
The report noted it was encouraging to see notable improvement across the majority of employers, which is likely linked to significant improvements in access to leave this year.
While the Women and Newborn Health Service again recorded the greatest level of burnout, it decreased by 13% since 2024, to 70%.
The WA Government’s Health Workforce Strategy in place until 2034 acknowledges that due to increased demands on health staff in the public system “introducing mechanisms to manage work-related stress is a priority”.
But as workforce pressures, doctor shortages, difficult shifts and increasing patient demand continues, so too does the risk of losing valuable doctors to burnout.
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