Year

2023

Degree Name

Doctor of Philosophy

Department

School of Medicine

Abstract

Background Balancing a career and a family is challenging due to the significant physical, mental, and emotional demands. This balance can be particularly troublesome when juggling simultaneous training towards a medical specialty fellowship and a young family. The timing for these training years often coincides with the years typically associated with reproductive and early family life. Burnout and stress have been shown to be rising within the medical workforce, especially among junior doctors and registrars. There is limited evidence on the impact of parenting to alleviate or exacerbate stress and burnout amongst these trainees, and how balancing challenging work demands with life events impacts on their experiences of stress and burnout.

Aim The thesis aimed to understand the experiences of stress and burnout in General Practice registrars, with a focus on the impact of parenting. The thesis was conceptualised with the aid of Abendroth and den Dulk’s (2011) work-life balance framework. The framework facilitated investigation at multiple levels of potential impacts on stress and burnout, starting at a national policy/systems-based level, and moving sequentially to examine individual experiences at the workplace and personal level.

Methods This thesis used mixed methods research with an explanatory sequential design approach. An initial systematic review was conducted to determine what was already known in the literature regarding the topic area. This review was repeated prior to the thesis compilation in 2023 to encompass recent updates to the literature. This was followed by a policy review of maternity leave policies in Australian medical speciality training programs, across both hospital and community-based speciality training programs. A quantitative study was undertaken employing a cross sectional online survey design. The survey instrument utilised the Maslach Burnout Inventory and data was analysed using bivariate and multivariate regression models. Finally, a qualitative analysis was completed to explore the experience of stress and burnout in General Practice registrars and the factors that may exacerbate or protect the registrars from stress and burnout, with a focus on the experiences of two groups of registrars, those that have children, and those that do not.

Results It was identified that there is a paucity of Australian literature looking at the impact of stress and burnout on training doctors, and notable gaps in evidence around the impact of parenting on the experiences of stress and burnout. Current maternity and paternity leave policies across specialty training programs in Australia do not allow parents to undertake a variety of flexible work options around pregnancy, paternity leave and return to work. Specifically, in General Practice training there is an inequity in comparison to other speciality training programs as there is no paid leave entitlements. Additionally, stress and burnout were found to be very common across General Practice training with over 75% of registrars in the quantitative component of this thesis experiencing moderate to high levels of burnout, with all the interviewed registrars in the qualitative arm experiencing episodes of stress and burnout in their General Practice registrar training terms. Factors that contribute to stress and burnout included time pressures, financial pressures, isolation, lack of support from both the workplace and personal networks, and worry and guilt across both professional and personal roles. Protective mechanisms for stress and burnout included supportive national policies that encourage work life balance, support from within the workplace, at a policy and local level, support at an individual level within the home, balance across work and life commitments, and access to localised supports, including other avenues such as having a personal psychologist or a General Practitioner (GP).

Conclusion This study contributed to the existing literature, and to the best of the candidate’s knowledge, it is the first comprehensive investigation in the context of community-based medicine, focussing on burnout and the impact of parenting. This research confirmed the high rates of burnout in this population and explored themes across those participants’ experiences that contributed to, and alleviated, their stress and burnout. This thesis has highlighted the following key and practical opportunities that can be made to reduce the occurrence of stress and burnout in the General Practice registrar population. At a national level, specific policy recommendations have been identified. The first recommendation pertains to designing and implementing a program of flexible and paid maternity and paternity leave for all registrars. The second recommendation is to encourage all medical professionals to have their own GP and formal or informal debriefing networks. The third recommendation is a targeted approach to attract and retain registrars into the General Practice registrar training program. Based on these findings, the following research directions have been recommended to improve relevant policies. These include further research into equitable funding of leave entitlements including maternity and paternity leave. Additional, research to further investigate the effects of different support systems, for example, family, peers, and professional counselling, in mitigating burnout. There is also a need to undertake research to enable a greater understanding on the limitations around the recruitment and retention of General Practice registrars, and further investigations into burnout mitigation, specifically surrounding workplace flexibility and job satisfaction.

FoR codes (2008)

1199 OTHER MEDICAL AND HEALTH SCIENCES

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Unless otherwise indicated, the views expressed in this thesis are those of the author and do not necessarily represent the views of the University of Wollongong.