Re: Physician health

With up to 75% of physicians reporting burnout,[1] it is now more important than ever to understand the evidence on physician wellness. The Canadian Association of Interns and Residents (CAIR) supports efforts like those of Ms Tyzuk [Physician health: A review of lifestyle behaviors and preventive health care among physicians, BCMJ 2012;54:419-423] to highlight the importance of physician wellness interventions.

However, her conclusion that “…  cutbacks to resident hours means that health care facilities will have to find ways to cover the extra hours traditionally worked by residents, either by hiring additional staff or by increasing the workload of more senior physicians” is an over-generalization of the article by Fletcher and colleagues.[2] In this article, the majority of the new schedules were simply rearrangements of existing schedules; in fact, only 8 of the 54 studies reported hiring any additional staff.

Such misinterpretations necessitate clarification because there are already too many myths impeding improvement of physician fatigue management. For example, the idea that residents are advocating for “cutbacks” to work fewer hours is also a myth. Rather, Canadian residents are calling for a reduction in the number of consecutive duty hours.[3] This distinction is important because models exist (such as in Quebec[4]) where residents no longer work over 16 consecutive hours, yet still work virtually the same total number of hours. With such models, coverage for “extra hours” is not required.

CAIR wholeheartedly joins Ms Tyzuk in calling for physicians to “embrace changes that promote optimal physician wellness as an avenue to improved patient care.” We owe it to our colleagues and our patients to adequately understand the evidence, and to eliminate the myths that impede such positive changes.

—Simon Moore, MD, CCFP
President, Canadian Association of Internes and Residents
—Mathieu Dufour, MD, FRCPC
Vice-President, Canadian Association of Internes and Residents

References

1.    Wallace JE, Lemaire JB, Ghali WA. Physician wellness: A missing quality indicator. Lancet 2009;374(9702):1714-1721.
2.    Fletcher KE, Davis SQ, Underwood W, et al. Systematic review: Effects of resident work hours on patient safety. Ann Intern Med 2004;141:851-857.
3.    Canadian Association of Internes and Residents. Canadian Patient and Physician Safety and Wellbeing: Resident Duty Hours. Accessed 5 December 2012. www.cair.ca/u/elibrary/CAIR_EN_compressed%20final%20Apr%204.pdf.
4.    Fédération des médicins residents du Quebec. Maximum 16-hour call duty in an establishment… A reorganization backed by convincing scientific data. Accessed 5 December 2012. www.fmrq.qc.ca/PDF/horairesDeGarde/The16HoursCallInAFewWords.pdf.