RANZCP member wellbeing: Findings from our 2020 survey

 
RANZCP member wellbeing: Findings from our 2020 survey
RANZCP member
wellbeing:
Findings from our
2020 survey
RANZCP member wellbeing: Findings from our 2020 survey
Introduction
    The health and wellbeing of all RANZCP members remains a central focus for
    our College.
    The Membership Engagement Committee is supported by the Member
    Wellbeing Subcommittee in working towards this goal.
    As part of a College-wide focus in 2020 on member wellbeing and support,
    the Subcommittee undertook a large-scale quantitative and qualitative survey to
    better understand and identify member health and wellbeing issues of concern,
    and to help inform future College activities and programs.
    Through the survey we have been able to:
    • identify key issues of immediate member concern
    • obtain direct data from members to help inform the Member Wellbeing
      Subcommittee’s future wellbeing work plan and operational activities
    • track responses since the College’s last major wellbeing survey, and generate
      a benchmark wellbeing dataset of the College membership that is capable of
      being replicated and relied upon for future wellbeing studies
    • gather feedback on the College’s wellbeing response to COVID-19 and the
      projects and services it has delivered
    • plan any future collection of additional qualitative data – for example
      through local (Branch/NZ) focus groups, and/or open forums of members
      interested in discussing wellbeing issues.
    We were delighted by the survey response in a time of great uncertainty and
    very evident work load pressures and thank all members for their participation.
    We look forward to progressing this important work together.

    Dr Prue McEvoy
    Chair, Member Wellbeing Subcommittee

    August 2021

2   The Royal Australian and New Zealand College of Psychiatrists
RANZCP member wellbeing: Findings from our 2020 survey
About this survey
The survey attracted 1202 responses                       general themes were identified and
from members (a response rate of                          then broadly clustered. Select quotes
18.5%). Respondents were broadly                          that represent common responses are
representative of the College                             incorporated with the data collected.
membership, across gender, location
                                                          The College last conducted a similar
and member type.
                                                          survey into member wellbeing in
The survey was open between 28                            November 2014.1 This study received
September – 4 November 2020,                              1056 responses from members
with 6482 College members asked                           at a rate of 20.35%. Comparison
to share their views, reflections and                     data from the 2014 welfare study is
perceptions on their health and                           provided in this report.
wellbeing. The survey cohort included
                                                          Percentages expressed in this report
all Fellows (excluding retired), Trainees,
                                                          are representative of the total
Affiliate Members and non-member
                                                          response within that question only
SIMGs. Members based overseas were
                                                          and are not to be taken as a portion
not asked to complete the survey.
                                                          of the total number of the 1202
In analysing free text responses                          overall survey respondents.
(questions 9, 11, 13 – 16, 25 and 27),

1.   The final report to this survey is the Membership Engagement Committee study into the welfare of psychiatrists and trainees (March 2016).

                                                                                                        RANZCP member wellbeing: Findings from our 2020 survey   3
Who responded?
    Country of primary practice
    Australia                                                                                 New Zealand
      1019 84.78%                                                                              183 15.22%

    NT                                                                                        QLD
    1.18%                                                                                     19%
    WA                                                                                        NSW
    6.89%                                                                                     30.02%
    SA                                                                                        ACT

    9.15%                                                                                     2.46%

    VIC

    28.54%                                                            TAS                              NZ
                                                                      2.76%                            15.22%

    Member type

                         Fellow                                     Trainee (Associate)   The survey was not
                   65.30%                                              25.67%             provided to retired
                           781                                              307           Fellows, however
                                                                                          2.68% respondents
                                                                                          (32) indicated they are
                                                                                          retired Fellows who
                                                                                          had not previously
                                                                         (Retired)        notified the College of
                                                                                          their retirement.
      Affiliate member or overseas                                    Fellow (retired)
            trained psychiatrist
                                                                        2.68%
                      6.35%                                                 32
                            76

4   The Royal Australian and New Zealand College of Psychiatrists
Practice setting

    Public practice
                                                       41.95%
                                                       357
    Private practice
                                                   34.43%
                                                   293
    Both public and                           23.62%
    private practice                          201

                        Trainees - stage of training

         Stage one
                                   10.75%
                                   33
         Stage two
                                                         32.90%
                                                         101
         Stage three
                                                               45.28%
                                                               139
    Break in training
                                   11.07%
                                   34

     0 to 4 years            20 years                                                 Other/
                              or more                                             non-binary
     12.46%                              Prefer not
     106                  48.65%         to say                                      0.76%
                                414      1.85%                                                     9
                                         22
5 to 9           Time
years          working in                                   Gender
12.22%         psychiatry                                   identity
104
                                                                                              Male
  10 to 19 years                        Female                                    44.12%
  26.67%                                53.28%                                                525
  227                                   634

                                                 RANZCP member wellbeing: Findings from our 2020 survey   5
Career stage                                                            No
                                                                            15.58%
    reflections                                                             180
    Members were asked if they are doing the type of
                                                                                           Are you doing
    work they would like to be doing at this stage of their
    careers.
                                                                                         the type of work
                                                                                       you would like to be
    Private practice psychiatrists tended to be more positive                           doing at this stage
    about doing the type of work that they would like to be                               of your career?
    doing at this stage in their careers at 90.1%, compared                                                                   Yes
    to public practice psychiatrists with 83.71% answering                                                       84.42%
    positively. Those working in a combination were slightly
    higher at 85.5%.                                                                                                      975

                                                                                    “I would like to be working in the area
         Members were also asked what they would like                                that I am interested in however have
         to be different:                                                            been allocated elsewhere based on
                                                                                     service needs rather than my own
           To be working in a different                                              career progression”
                                                               33.33%
           subspecialty/area
           To have a reduced workload or
                                                               14.68%
           less hours, or less on call hours                                     “Less work pressure, less paperwork, more
           Would like to complete/finish                                          human interaction”
           training requirements for                           10.73%
           Fellowship
           Would like more support                                  7.90%   “Less stress and more support
           Would like to do more research or                                 for psychiatrists who have been
                                                                    6.21%
           academic work                                                     working over 10 years to help
           Would like to be in a supervisory,                                them avoid burnout”
           training, teaching or management                         5.64%
           position
           Would like to be doing a different
                                                                    4.51%              “Doing some work in the public and
           mix of public and private work                                               private, am missing the variety of
           Would like to do less admin                              3.95%               teaching, collegiality, teamwork
                                                                                        and involvement in management.
           Would like more resources                                3.38%               Working privately only, can be
           Would like to leave psychiatry                           1.69%               at times like working in a factory
                                                                                        alongside an assembly line”
           Want more time with patients                             1.69%
           Currently not working but want
                                                                    1.69%
           to be                                                                  “More clinical freedom without
                                                                                   administrative restrictions”

6   The Royal Australian and New Zealand College of Psychiatrists
Highest rated stressors
There was a high perceived workload for all psychiatrists (both public and private) and trainees in 2020 – this was
rated as the highest stressor for respondents in the last 12 months.
The 2020 survey did not enquire if COVID alone was the sole causative factor for increased workload issues,
however a safe assumption can likely be made as its impacts did change and elevate service needs for many Fellows
and trainees.
Similarly, the survey did not enquire if COVID-attributable workplace stressors or feelings of dissatisfaction were
higher in the last 12 months, and future studies may wish to consider this.

          The top four categories of responses received were:

                              Too much work
                                                                                                     Emotional
                              to do in limited
                                                                                                     exhaustion
                                   time
                               49.56%                                                             44.99%
                                    564                                                                  512

                                 COVID-19                                                            Paperwork
                                 pandemic
                                                                                                   41.92%
                               42.97%                                                                    477
                                    489

                                                                            RANZCP member wellbeing: Findings from our 2020 survey   7
The published literature on doctors’ health identifies                   Responses from psychiatrists working in private practice
    several categories of significant stressors for doctors.                 identified the following biggest stressors in the last 12
                                                                             months they experienced.
    Members were asked to select up to 10 answers that
    they felt were the biggest stressors in their working
    lives over the last 12 months.                                           STRESSOR                                   RESPONSES

                                                                             Paperwork                                       46.34%
     STRESSOR                                                  RESPONSES
                                                                             COVID-19 pandemic                               45.64%
     Too much work to do in limited time                            49.56%
                                                                             Patients who are difficult to manage            44.60%
     Emotional exhaustion                                           44.99%
                                                                             Emotional exhaustion                            40.77%
     COVID-19 pandemic                                              42.97%
                                                                             CPD requirements                                39.37%
     Paperwork                                                      41.92%
                                                                             Too much work to do in limited time             37.63%
     Patients who are difficult to manage                           37.43%
                                                                             Intrusion of work on family life                34.49%
     Negative organisational culture                                35.68%
                                                                             Time pressure to see patients                   31.71%
     Intrusion of work on family life                               35.59%
                                                                             Personal life stress                            27.53%
     Time pressure to see patients                                  34.53%

     Unrealistic community expectations                             29.61%

     Personal life stress                                           27.42%      The same question was asked in the 2014 study
                                                                                with respondents asked to rank 1 – 10 their
     Excessive overtime or long work
                                                                    27.24%      highest rated stressors in the last 12 months.
     hours
                                                                                The 2020 survey allowed respondents to select
     Training and assessment requirements                           24.87%
                                                                                all options that applied, and results were not
     Low morale                                                     24.78%      ranked in the same way as the 2014 survey.
     Electronic medical records being
                                                                    22.85%                                          WEIGHTED
     added to ‘paperwork’                                                        ANSWER CHOICES
                                                                                                                       SCORE
     Earning enough money                                           17.84%       Too much work to do in
                                                                                                                            8.08
                                                                                 limited time
     CPD requirements                                               17.66%
                                                                                 Paperwork                                  6.87
     Stigma towards psychiatry as a
                                                                    16.52%
     profession                                                                  Patients who are difficult to
                                                                                                                            6.68
                                                                                 manage
     Patient suicide                                                16.26%
                                                                                 Intrusion of work on family
     Threat of litigation                                           15.38%                                                  6.21
                                                                                 life
     Safety and violence (including                                              Time pressure to see patients              6.17
                                                                    15.29%
     occupational violence)
                                                                                 Threat of litigation                       5.15
     Political issues                                               13.71%
                                                                                 Earning enough money                       5.10
     Existential angst                                              11.78%
                                                                                 Unrealistic community
     Negative media comments                                        8.08%                                                   4.87
                                                                                 expectations
     The cost of practice overheads                                 8.00%        The cost of practice
                                                                                                                            2.98
                                                                                 overheads
     Prospect of re-certification                                   7.12%
                                                                                 Negative media comments                    2.92
     Gender bias                                                    6.59%

     Racism                                                         5.71%

     Threats/stalking                                               4.31%

8   The Royal Australian and New Zealand College of Psychiatrists
Additional significant stressors recently experienced
Members were also asked to list any additional significant stressors that they had experienced recently, identifying
the following:

      Workplace stressors                                                                             (69) 16.01%

                Workload                                                   (51) 11.83%

                  Bullying                                           (46) 10.67%

      Exams and training                                        (41) 9.51%

         Under-resourced
                                                         (35) 8.12%
              workplace

                    Illness                        (30) 6.96%

Issues with management
                                               (27) 6.26%
           or supervision

                 Isolation                 (23) 5.33%

                              0%      2%        4%        6%        8%        10%           12%           14%           16%

  Members were also                        “Interpersonal difficulties/team                  “College exams
  asked to list any                         dynamics”                                         especially the written
  additional significant                                                                      style essay exams”
  stressors that they
  had experienced                      “COVID has increased work
  recently, identifying                 significantly and the patients                “Bullying behaviour
  the following:                        are more distressed”                           amongst managers and
                                                                                       peers”

                                                                           RANZCP member wellbeing: Findings from our 2020 survey   9
Trainee stressors
     Trainee responses (comprising 25.67% or 307                            changes to exams, or uncertainty surrounding exam
     respondents) focused on the compounding impact                         changes, to highlight general dissatisfaction with a
     of changes to College training assessments and                         range of assessment elements, from the assessment/
     examinations as a point of stress, with the essay                      training requirements model, the essay format, to
     exam highlighted (this was also the case for SIMG                      communication by the College about the changes.
     respondents). Relevantly, 45.28% (139) respondents
                                                                            It is worth noting the timing of the 2020 survey in
     were stage three trainees, the largest trainee survey
                                                                            relation to the College’s assessments last year.
     cohort.
                                                                            In October 2020, the Essay Exam and MCQ assessment
     Training hurdles and examinations were rated stressful
                                                                            were both taking place, with the OSCE held later in
     ‘most’ or ‘all of the time’ for trainees.
                                                                            November but with a reduced number of trainees
     The more detailed responses made references to                         participating. In November 2014 only the OSCE took place.

        Trainee stressors were considered in the 2014 study with the question ‘how stressful are
        the following for you at this stage of your career?’

                                    Not at all                 Moderately      Extremely               Not
                                    stressful                   stressful       stressful           applicable

               Training
                hurdles
                                  26.94%                        23.11%        10.84%               39.10%                Total
                                       246                       211               99                  357                913

       Examinations               26.92%                       12.20%          15.82%              45.05%                Total
                                       245                           111          144                  410                910
          Prospect of
         revalidation
                                  31.05%                       36.17%           7.52%              25.27%                Total
                                       285                           332           69                  232                918

        These results can be compared with the 2020 survey question ‘As a current trainee, how
        stressful are the following for you at this stage of your career?’

                                     None of                     Some of         Most of             All of the
                                     the time                    the time       the time               time

               Training
                hurdles
                                    4.67%                     45.33%          29.33%               20.67%                Total
                                         14                    136                 88                   62                300

       Examinations                 7.69%                      30.10%          31.11%              29.10%                Total
                                         23                          90            99                   87                299

10   The Royal Australian and New Zealand College of Psychiatrists
Work–life balance
                                                                “It has been mostly balanced with
Despite workload being the strongest stressor identified,        occasional periods of poor balance
respondents’ subjective feelings of appropriate work–life        until the pandemic hit this year, when
balance were generally reported positively.                      the needs in the community increased
‘Mostly balanced with occasional periods of poor balance’        so much and as a psychiatrist I felt
was the strongest response to this question with 27.96%          I had to take on more work. Then I
(324 responses) followed by ‘mostly balanced’ with               felt it has become poorly balanced
21.14% (245 responses). The negative categories of               sometimes”
‘sometimes poorly balanced’ (18.55%), ‘often poorly
balanced’ (16.31%) and the most severe option of ‘usually
poorly balanced’ (9.66%) did trend down the sliding scale,
                                                                “Not possible to have work–life
which was somewhat reassuring.
                                                                 balance when you are a doctor and
 Mostly balanced with occasional                                 also have children”
                                                   27.96%
 periods of poor balance
 Mostly balanced                                   21.14%
                                                                “Have cut back on work hours due to
 Sometimes poorly balanced                         18.55%
                                                                 impending burnout – thus mostly
 Often poorly balanced                             16.31%        balanced now”
 Usually poorly balanced                             9.66%

 Other                                               4.66%      “Working from home has blurred
 Never                                               1.73%       things this year. Also, things have felt
                                                                “more urgent” to colleagues this year
Respondents’ subjective perception of their own work–life        and intruded into my personal time.”
balance aligned closely with the next question about what
they subjectively thought a loved one or family member
would say about their work–life balance, with 25.8%             “Members of my family have suffered
(299 responses) selecting ‘mostly balanced with occasional       due to my absence from the home;
periods of poor balance’.                                        the direct result of the hours I have
The general trend of public and private psychiatrists’ own       had to work both in the workplace
self-assessment of work–life balance was relatively similarly    and at home which included most
represented.                                                     weekends”

                                                                      RANZCP member wellbeing: Findings from our 2020 survey   11
Members were also asked to assess what would a loved                     Members identified the following activities that
     one, such as a family member, friend or partner, say                     they regularly use as a means of relaxation/way
     about their work–life balance:                                           to unwind:

                                                                                              Top response
      Mostly balanced with occasional
                                                                     25.80%
      periods of poor balance
      Sometimes poorly balanced                                      22.26%

      Often poorly balanced                                          17.77%

      Mostly balanced                                                16.22%

      Usually poorly balanced                                        13.46%         Catching up with friends/
      Other                                                          2.67%              family/children
      Never                                                          1.81%
                                                                                            72.65%
                                                                              Catching up with friends/
                                                                                                                      72.65%
           “Have had very limited ability to do the                           family/children
            above in 2020 as a result of excessive                            Physical activity                       68.85%
            workload and on-calls, limited
                                                                              TV/movies/streamed content/
            available activities due to COVID and                             internet/social media/video             66.35%
            training requirements including formal                            games
            education course requirements”
                                                                              Reading                                 56.00%
                                                                              Travel/holidays/weekends
                                                                                                                      55.48%
                                                                              away
                                                                              Listening to music                      48.06%

                                                                              Gardening                               37.79%

                                                                              Arts and theatre                        27.09%
                                                                              Meditation/yoga/being in a
                                                                              quiet space for a period after          26.75%
                                                                              work/formal relaxation
                                                                              Other                                   15.70%
                                                                              Don't have the opportunity to
                                                                                                                        8.63%
                                                                              regularly relax or unwind

12   The Royal Australian and New Zealand College of Psychiatrists
Factors that assist in getting support
Having helpful colleagues was rated highest when            Members identified the following factors as generally
seeking support to maintain wellbeing when seeking          the most helpful when seeking support to maintain
support to maintain wellbeing (for all member groups)       their wellbeing:
with 81.08% (947 respondents), followed by peer
review with 57.53% (672 respondents) and then               Helpful colleagues                                      81.08%
supervision at 41.61% (486 respondents).
                                                            Peer review                                             57.53%
Beyond colleagues and peers, family and friends rated
highly as a helpful factor with 42.5% followed by           Supervision                                             41.61%
personal therapy/psychotherapy at 14.98% from the
                                                            Clear lines of clinical responsibility                  31.34%
204 clustered free text responses.
Aligning with this, ‘catching up with friends/family/       Mentoring                                               19.61%
children’ was also the most selected option regularly       Networking opportunities                                19.01%
used by members as a means of relaxation or to unwind
at 72.65% (842 respondents), followed by more               Other                                                   17.47%
individual activities and options like physical activity,
                                                            Congress or other conferences                           17.21%
movies, television or reading to follow.
                                                            Directors of Training                                     9.25%
Not having an opportunity was in the minority at only
8.63%, but it was still a concerning amount as 100
respondents selected this option.

                                            Top 3 factors

     Helpful colleagues                           Peer review                                Supervision

        81.08%                                  57.53%                                      41.61%
    947 respondents                         672 respondents                          486 respondents

                                                                          RANZCP member wellbeing: Findings from our 2020 survey   13
For members who selected ‘other’ when identifying
      what factors are generally most helpful when seeking
      support to maintain their wellbeing:

                                               42.5%                         “Family and friends, most of whom
                                                                              are also medical professionals
                                         identified that support from
                                                                              who understand the stressors
                                         family and friends was most
                                               helpful for them.
                                                                              related to medical work”

                                             14.98%                                   “Ongoing personal therapy, leave,
                                                                                       outside interests, family and
                                                                                       maintaining a good work-life
                                          indicated personal therapy/
                                            psychotherapy was most                     balance”
                                                helpful for them.

                                                                            “Separating work and leisure time

                                                5.81%
                                                                             more consciously – a little more
                                                                             difficult when working from home
                                            had other hobbies and            and no/few opportunities to go out
                                          interests outside work that        to do things”
                                          was most helpful for them.

                                                                        Private practice psychiatrists identified these factors as
     The 2014 survey compared quite similarly when
                                                                        being most helpful to them when seeking support to
     members were asked about what work-related
                                                                        maintain their wellbeing in response to the 2020 survey:
     factors they recognised as key supports or enablers
     of maintaining their wellbeing at work:
                                                                        Peer review                                        79.02%
      Helpful colleagues                                         94%    Helpful colleagues                                 78.67%
      Peer review                                           75.25%      Supervision                                        29.02%
      Clear lines of responsibility                         70.88%      Congress or other conferences                      23.43%
      Supervision                                           61.07%      Other                                              19.93%
      Mentoring                                             43.18%      Networking opportunities                           18.53%
      Congress/other conferences                            37.95%      Mentoring                                           9.44%
      Networking opportunities                              36.86%      Clear lines of responsibility                       8.74%

14   The Royal Australian and New Zealand College of Psychiatrists
Health concerns
55.23% of respondents (639) indicated that they had      The data on whether public or private psychiatrists had
experienced health concerns in the last 12 months, and   experienced any health concerns in the last 12 months
of that group 46.8% indicated that this required them    was similarly represented. Public psychiatrists were
to take time off.                                        more likely to take time off for their health concerns
                                                         (49.75%) over private psychiatrists (40.26%).
Although this question did not pinpoint the nature or
seriousness of health concerns, responses to how much    A higher percentage of private psychiatrists said that it
time members needed to take off were generally at the    was ‘very difficult’ (19.57%) or ‘difficult’ (34.16%) to
lesser-end of the scale, with 40.46% (123 respondents)   take time off when compared to public psychiatrists,
needing to take up to one week off, and a further        who reported that it was ‘very difficult’ (8.52%) or
20.72% (63 respondents) needing to take one to two       ‘difficult’ (30.68%) to take time off. Similarly, a larger
weeks off. 13.81% (42 respondents) needed to take        proportion of public psychiatrists noted that it was
more than four weeks off. COVID-19 infections of         ‘easy’ (31.25%) to take time off, when compared with
members and associated time off was not surveyed.        private psychiatrists (23.13%).

      Members were asked if, in the last 12                   Of that group that answered ‘yes’, they
      months, they experienced any health                   were further asked if their health concerns
       concerns, responding as follows:                      required them to take any time off work:

                                                Yes      Currently                                                     Yes
                                     55.23%              taking time                                   46.80%
                                              639        off work                                                   300
                        Health
                                                         6.08%
                      concerns                           39                       Time off
                    in the last 12                                                  work
                       months

 No                                                       No
 44.77%                                                   47.11%
 518                                                      302

Members who experienced health concerns in the last        The 2014 survey enquired about members’ health
12 months took the following amount of time off:           in a different way.
                                                           Respondents were asked if they had any current
CLUSTERED TIME PERIOD                   PERCENTAGE         health problems (physical or mental) that
Took up to one week off                       40.46%       significantly limit their role as a psychiatrist.
                                                           8.42% (77) responded ‘yes’, with 91.58% (838)
Took one to two weeks off                     20.72%
                                                           responding ‘no’.
Took three to four weeks off                  21.05%       Respondents were further asked if they had
                                                           such problems in the past, with 21.69% (198)
Took more than four weeks off                 13.81%
                                                           responding ‘yes’ and 78.31% (715) responding
                                                           ‘no’.

                                                                        RANZCP member wellbeing: Findings from our 2020 survey   15
Taking time off from work
     Members indicated they are planning on taking the
     following amount of time off:

      CLUSTERED TIME PERIOD                                   PERCENTAGE

      Plan on taking 1 week off                                      10.81%

      Plan on taking 2-3 weeks off                                   18.91%

      Plan on taking 1 month off                                      8.01%

      Plan on taking more than 2 months off                          27.02%

      Reduced caseload or hours                                       8.01%

     Respondents generally experienced that it was harder to take time off from work when they are unwell than it was
     easy, with 30.93% (347 respondents) indicating it was ‘difficult’ to take time off, and 13.10% (147 respondents)
     saying it was ‘very difficult’ to take time off.
     Members were asked to rate how difficult or easy it was for them to take time off work:

                                Ease of taking time off for personal health

                           Very easy                (80) 7.13%

                                  Easy                                                              (287) 25.58%
            It varies/depends on
                                                                                             (261) 23.26%
                   circumstances
                             Difficult                                                                              (347) 30.93%

                       Very difficult                                (147) 13.10%

                                            0%            5%          10%      15%          20%          25%          30%          35%

     Members then identified the following barriers to taking time off work:

      Lack of appropriate backfill                                   51.52%
                                                                                The same barriers to taking time off featured heavily
      Fear of letting the team down                                  48.22%     in the 2014 survey, albeit with a smaller sample size
      Attitude of 'soldier on'                                       44.03%     of respondents to this qualitative question.
      No slack in the system e.g. short staffed                      36.27%     The highest-ranked category of responses (104)
                                                                                identified a ‘general difficulty/letting the team down/
      Guilt                                                          35.56%
                                                                                soldiering on/short staffed/stigma’ in their responses.
      Challenges of private practice                                 28.97%
                                                                                The study found that:
      Self-stigma                                                    15.69%
                                                                                ‘…the key theme in many of the responses was
      Lack of supportive work environment                            10.96%     the difficulties associated with taking time
      Perceived stigma                                               10.25%     off, particularly in relation to ‘letting the team
      No barriers                                                     9.27%
                                                                                down’ and the amount of work which will need
                                                                                to be completed upon their return to work.’
      Lack of supportive supervisor                                   5.26%

16   The Royal Australian and New Zealand College of Psychiatrists
Barriers to help seeking
When asked to identify the main barriers to seeking          trust, privacy’ (5.29%, 61 respondents), ‘concern
assistance in relation to their wellbeing, ‘time’ was        over AHPRA and mandatory reporting’ (2.25%, 26
the largest reported clustered theme (32.12%, 370            respondents) as well as ‘distrust or lack of faith in the
respondents). However, balanced against this it was          system’ (1.04%,12 respondents).
also positive to see that ‘no barriers’ was second only to
                                                             The highest-rated response to members’ self-perceived
‘time’ (18.22%, 210 respondents).
                                                             difficulty in talking with another medical practitioner
Negative perceptions, or fear of stigmatisation for          about their own health concerns was that it was neither
being unwell or for seeking help for health concerns         difficult nor easy to do, with 37.41% of respondents
was also apparent but was not observed as a dominant         selecting this as the dominant response. ‘Easy’ and
trend (13.19%, 152 respondents), however it was              ‘very easy’ combined to be higher at 36.12% (416
an underlying concern for a number of free text              respondents) compared to ‘difficult’ or ‘very difficult’
responses that highlighted other factors as well. For        combining at 26.47% percent (305 respondents).
example, there were associated categories that could
                                                             Public psychiatrists generally found it more difficult to
be identified within this theme which included ‘shame
                                                             talk to another medical practitioner about their own
or guilt about seeking help’ (1.12%, 13 respondents) or
                                                             health concerns. They found it ‘very difficult’ (7.95%)
‘reluctance to be a patient’ (1.73%, 20 respondents).
                                                             or ‘difficult’ (19.32%), which was above private
The clustered categories addressing issues of                practitioners who said it was ‘very difficult’ (4.27%) or
institutional, workplace or regulatory trust and             ‘difficult’ (15.66%) to a lesser extent. ‘Neither easy nor
support did feature, but were not highly selected by         difficult’ was the most prevalent response for public
respondents. These included ‘issues of confidentiality,      (40.63%) and private (37.37%) practice psychiatrists.

              Largest reported barrier                                    Balanced against this and
               for seeking assistance:                                      second to ‘time’ was:

                                   Time                                                           No barriers

                            32.12%                                                            18.22%
                                 370                                                                 210
             “Time off in working                              “None, I manage my health and
              hours to see a doctor”                            well-being very conscientiously as
                                                                obligation to myself and my patients. If
                                                                I am not in reasonable shape, how can
                                                                I be of value to my patients?”

                                                                            RANZCP member wellbeing: Findings from our 2020 survey   17
Members identified the following main barriers to seeking assistance in relation to their wellbeing:

      Time                                                            32.12%
                                                                                         “Stigma of illness in the
      No barriers                                                     18.22%              medical profession”
      Perceived stigma                                                13.19%
      Issues of confidentiality/ trust/
                                                                       5.29%         “Confidentiality as I work in a small rural
      privacy
                                                                                      community where everyone knows everyone”
      Workload and understaffing                                       3.12%

      ‘Soldier on’ attitude                                            2.95%
                                                                                      “Short staffing – when I take time
      Denial or avoidance                                              2.77%
                                                                                       off, other people have to do my
      Access to services                                               2.77%           work in addition to theirs.”
      Self-minimising issues                                           2.43%

      Management/supervision                                           2.34%                “Availability of professionals to speak to”
      Concerns over AHPRA and mandatory
                                                                       2.25%
      reporting
      Reluctance to be a patient                                       1.73%
                                                                                              “Lack of supportive work environment”

      Shame or guilt about seeking help                                1.12%

      Personal GP                                                      1.12%                “Prospect of Medical Board intervention”

      Distrust or lack of faith in the system                          1.04%

       “I am a medical practitioner –                                 ‘Time’ was also the biggest barrier to seeking assistance in
        my role is to fix others’ health,                             relation to wellbeing in 2014.
        not waste time and resources                                  The top areas from the qualitative responses to that survey are as
        on my own. Wasting other                                      follows:
        doctors’ time to look after
        me takes them away from
        other patients, which is the
        only priority. I feel very guilty                            Lack of time                                  276/688            40%
        if I seek any health assistance                              Problems with the psychiatrists’ own
                                                                                                                   172/688            25%
        personally – if I can’t fix it                               attitude or psychological willingness
        myself, then it should be a                                  Problems with workplace including
        matter of toughing it out”                                   excessive work, shift work, inflexible
                                                                                                                   162/688           23.5%
                                                                     routines, management and or
                                                                     collegial behaviour
                                                                     Family obligations, of which a
                “Admitting I need help”                              significant minority referred to having         56/688          8.6%
                                                                     children
                                                                     Concerns about confidentiality or
                                                                                                                     46/688          6.7%
                                                                     privacy
                                                                     No barriers                                     43/688          6.25%

18   The Royal Australian and New Zealand College of Psychiatrists
Talking to another medical
practitioner
Members were asked how difficult it was for them to talk to another medical practitioner about their own health
concerns:

            Very easy          (92) 7.99%

                  Easy                                                 (324) 28.13%

 It varies/depends on
                                                                                                 (431) 37.41%
        circumstances

              Difficult                            (221) 19.18%

         Very difficult    (84) 7.29%

                          0%       5%       10%           15%     20%          25%           30%           35%            40%

                                             Not aware
                                             27.95%
Members were asked if they were
aware of any other doctors' health or
                                             322                             Awareness
                                                                              of local
other health/medical services in their                                        medical
local area that they could access to                                          support
address any health concerns.                                                  services                               Aware
                                                                                                           72.05%
                                                                                                                       830

  The 2020 survey results suggested an improvement          their own health concerns, there was a marked
  on general knowledge of doctors’ health/medical           negative decline since the 2014 survey.
  services available in members’ areas from the 2014
                                                            Of the 828 respondents to the 2014 survey question
  survey.
                                                            ‘how difficult is it to talk to your GP about your own
  Of the 905 respondents to that question in 2014,          health concerns?’, 23.43% responded ‘very easy’
  only 56% answered ‘yes’ with 44% answering ‘no’.          and 58.82% responded ‘easy’. Whereas ‘difficult’
  It should be noted that the question in 2014 was          16.43% and ‘very difficult’ 1.33% scored much
  slightly different, asking if members were aware of       lower. Again, there was a slight change in wording
  any other support services in their local area they       from the 2014 question from GP to ‘another medical
  could access to address their health concerns.            practitioner’ however this alone likely does not offset
                                                            this negative change.
  However, on the question of self-perceived difficulty
  in talking with another medical practitioner about

                                                                           RANZCP member wellbeing: Findings from our 2020 survey   19
Support from the College
     The College has offered members a range of services and supports during COVID-19. Members were asked which
     were most helpful to them during that time.

      Continuing professional development                                     Information from your local College
                                                                     34.65%                                            14.74%
      and webinars                                                            Branch/National Office
      Weekly updates from the RANZCP                                          None of the above                        11.84%
                                                                     32.46%
      President
                                                                              Clinical guidance and answers to
      Advocacy (e.g. Medicare items)                                 25.00%                                            10.61%
                                                                              Frequently Asked Questions
      Have not used these resources                                  22.37%   Practice support information             6.67%

      Information about training changes                             21.23%   RANZCP COVID-19 library                  6.14%
      Information about exam/assessment                                       Membership services and fees
                                                                     20.61%                                            2.98%
      changes                                                                 assistance
      Self-care, wellbeing services and peer                                  MEC open Zoom forums for members         2.89%
                                                                     14.82%
      support networks

     There were differences between public and private practice psychiatrists on which member services and supports
     were most valuable to them during COVID-19, with advocacy being strongly supported by private practice
     members (49.1%, 137 respondents).

                                 CPD and webinars, as well as weekly updates from the
                                 RANZCP President featured strongly in both sets of data.

                                      PUBLIC                                                        PRIVATE

      CPD and webinars                                               38.90%   Advocacy (e.g. Medicare items)           49.10%

      Have not used these resources                                  29.39%   Weekly updates from the RANZCP
                                                                                                                       48.39%
                                                                              President
      Weekly updates from the RANZCP
                                                                     26.80%   CPD and webinars                         41.22%
      President
      Information about training changes                             19.02%   Information from local College
                                                                                                                       19.71%
                                                                              Branch/National Office
      Information from local College
                                                                     14.41%   Have not used these resources            17.56%
      Branch/National Office
      Self-care, wellbeing services and peer                                  Self-care, wellbeing services and peer
                                                                     13.26%                                            16.13%
      support networks                                                        support networks
      None of the above                                              12.68%   Clinical guidance and answers to
                                                                                                                       13.98%
                                                                              Frequently Asked Questions
      Advocacy (e.g. Medicare items)                                 10.37%
                                                                              Practice support information             12.54%
      RANZCP COVID-19 library                                        9.22%
                                                                              None of the above                        8.96%
      Clinical guidance and answers to
                                                                     6.34%    RANZCP COVID-19 library                  3.58%
      Frequently Asked Questions

20   The Royal Australian and New Zealand College of Psychiatrists
Members were also asked to share any thoughts about
how the College can better support the health and       “A formal review of the essay style
wellbeing of members.                                    examination – too difficult and
                                                         stressful. No correlation between
                                                         being a good clinician and passing
                 Top response                            the exam”

                                                                  “Current support seems well
                                                                   considered and appropriate”

                                                        “Generally, I think the College does share
                                                         a lot of info, promotes help seeking,
         Support for trainees/                           advertises how to access support. Self-
      examination changes issues                         stigma is the biggest barrier so some

               14.38%                                    focus on addressing that would be good
                                                         e.g. stories of colleagues who have
                                                         needed and sought help and the positive
Support for trainees/examination
                                                         outcome”
                                            14.38%
changes issues
Pleased with College and doing a
                                            11.31%
good job                                              “Advocate for meaningful systemic change
Engage in advocacy for reform                9.21%     in the health care sector”
Increase links/access to mentoring/
peer support/career advice/social            5.17%
media groups                                            “Have robust and obvious channels
Relaxation of CPD requirements/CME/                      to facilitate members and students
                                             4.73%
Clinical updates feedback                                finding peer and mentoring support”
Communications feedback to College
                                             3.07%
(positive and negative)
Enhance access to medical/mental                            “Work to decrease prejudice and
health services for doctors & work
                                             2.71%           promote our professional standing”
to reduce stigma and negative
perceptions of psychiatry
New ideas for webinars/workshops             2.36%
                                                      “Good, comprehensive and timely
Workplace changes such as: load/
hours/conditions
                                             2.28%     communication to Fellows and
                                                       trainees. In saying this, I think the
An improved or better response/                        communication has been pretty good”
                                             2.10%
services provided by the College

                                                              RANZCP member wellbeing: Findings from our 2020 survey   21
Next steps
     The Membership Engagement Committee and the Member Wellbeing
     Subcommittee are now progressing this report, including through the
     development of recommendations and an appropriate action plan for the
     RANZCP Board. As this work continues, we will continue advancing our work in
     this area by:

         Publishing this                                    Consulting with key College committees
          report, and                                      and stakeholder groups, seeking feedback
         sharing it with                                   on the results and the broader issues they
           members.                                         highlight, as well as ideas for the future.

                                                               Communicating further with members
                                                               who indicated via this survey that they
                                                               would like to be a part of a wider group
                                                                supporting projects and activities in
                                                                         member wellbeing.

22   The Royal Australian and New Zealand College of Psychiatrists
Inviting views from members       Encouraging members
  on practical measures the       to use and refer to our
College can implement in the        Member Wellbeing
   short to medium term.              Support Hub.

  Continuing to mainstream             Maintaining
 wellbeing discussions within      communication with
 the College (e.g. at Congress)      members about
     and leveraging public        wellbeing and self-care
campaigns to maintain general           strategies.
 visibility and awareness (e.g.
     Mental Health Week).

                                      RANZCP member wellbeing: Findings from our 2020 survey   23
Head Office
309 La Trobe Street
Melbourne VIC 3000
Australia

T +61 (0)3 9640 0646
F +61 (0)3 9642 5652

E membership@ranzcp.org
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