When Dr Hannah Szewczyk looks back at her medical career, she doesn't recall ever feeling burnt out. But she says it may have happened without her realising.
"It's tricky because I think [burnout is] also normalised in medicine a little bit," she tells ABC RN's This Working Life.
The chair of the Australian Medical Association's Council of Doctors in Training says burnout is very common in the healthcare profession, and it was something that was highlighted during the COVID-19 pandemic.
Dr Szewczyk says there are many reasons for this, including long hours.
"But there's also other things that contribute. A lot of doctors in training and junior doctors don't always feel valued by their workplaces. They feel like they're just another cog in the production line," she says.
"It's also just a very high-stress job. There's a lot of pressure … there's a lot of life and death in the hospital. There's also that risk of moral injury. And I think all of that contributes to burnout."
Burnout is clearly having a significant impact on this sector. Last year, a study of almost 8,000 healthcare workers reported that one in 10 had thoughts of suicide or self-harm during the second wave of the COVID-19 pandemic.
'It's really, really overdue'
Medical workers are not the only ones facing serious mental health risks in the workplace. It's also been reported that a shortage of teachers is causing burnout within the sector, while other industries, such as hospitality, may have unhealthy workplace expectations.
Some employers are trying to address the issues by considering initiatives like the four-day work week or more flexibility and job security for workers.
But a solution may now be available. And it's one that places a worker's psychological health under the responsibility of employers.
In June 2022, government agency Safe Work Australia updated its workhealth and safety (WHS) regulations to include some specific regulations to manage psychological risks at a workplace. These are also known as psychosocial hazards.
In August 2022, the agency released a new code of practice that tackles these risks.
This code names potential psychosocial hazards, ranging from the demands of a job as well as flexibility and autonomy to workplace interactions and the physical environment of a workplace itself.
Safe Work Australia puts forward WHS regulations and codes of practice to be adopted across the country's jurisdictions. And so far, the Commonwealth, New South Wales, Queensland, Tasmania and Western Australia have adopted regulations on managing psychosocial risks, with regulations in the Northern Territory planned to start in July.
"It's really, really overdue, so I'm glad to see this. I'm hoping that if we can improve the wellbeing of these doctors through this code, that there'll be more retention," Dr Szewczyk says.
Ian Neil SC, an employment and industrial law barrister, says the introduction of this new code is significant.
"[This code of practice is] regarded essentially as evidence of what is known about a hazard or a risk – or risk assessment or risk control. And a demonstration of what's reasonably practicable to address those hazards and risks," he says.
'That won't be good enough'
Neil believes that, with this new code, mental health hazards will be taken as seriously as other workplace hazards have been in the past.
"The focus for a very long time has been on physical hazards, physical risks, physical injuries and, no doubt, that's because they're the most obvious ones," he says.
"But for a long time now, there has been a recognition that work, like every other human environment, generates risks to people's psychological health [and welfare]."
"It won't any longer … be available for anyone involved in a process to say, 'Well, stress, anxiety, worry, and so on is just an inherent and inevitable part of any significant change, and there's nothing we can do about that.
"That won't be good enough."
Stress response
Researchers have often considered how work can harm our mental health.
For example, in 2015, a study of 240 health care workers reported that burnout was associated with mental health, stating that higher levels of exhaustion were linked with higher levels of depression.
And in 2020, US researchers studied the effect of job insecurity on almost 5,000 young people during the COVID-19 pandemic. They found increased anxiety and depression symptoms in those with insecure work.
Dr Ruchi Sinha is an associate professor of organisational behaviour at the University of South Australia. She says expected things like bullying, lack of communication and lack of recognition can cause mental harm. But stress is another significant mental health risk, she says, and it can arise from issues like lack of job clarity and poor organisation.
"Prolonged severe presence of these hazards creates stress. That stress can have both cardiovascular and musculoskeletal [impacts], so having pains in your neck bones, joints. And having blood pressure and cardiological issues comes from extensively long chronic stress," she says.
"Similarly, your feeling of exhaustion, burnout, anxiety, depression: These are psychological reactions to stress."
Chronic stress has been also linked with physical conditions such as diabetes and cancer.
There are clear ways to solve the problems. For example, research has found that removing mental health hazards can improve workplaces through increased productivity and reduced cost.
And Dr Sinha says a positive work environment can also help to buffer stress responses.
"When you have good, trusting, mutual respect and shared leadership with your peers, that provides a resource to manage the stresses of work," she says.
The code does sound an alarm for employers, she says.
"I think this regulation adds that layer of [employer] obligations. If you don't look after your employees in terms of burnout, and then rising level of cynicism, or potentially have interventions to prevent suicide and other stress disorders, then you are liable in some form or way for enabling poor mental health."
How does it work?
While the benefits of this new code are clear, there are questions about how it will be implemented and how employees will respond to it.
Neil predicts that regulatory authorities will "give real attention to these kinds of injuries" thanks to the new code of practice.
"All jurisdictions, Commonwealth and State, have inspectorates whose purpose is to investigate and take steps to ensure compliance with work health and safety legislation and obligations under that legislation."
Neil says compliance issues can be brought to the attention of regulators, including by whistleblowers. Workplaces will also be obliged to report on any potential risks.
However Dr Sinha is concerned about how this code will translate into everyday language and behaviour.
And she's worried about how many employees will speak up about concerns.
"[For example,] there's a lot of research to show that there are employee assistance programs [that] there are initiatives that work, but the actual take up – whether people opt for the services – is gendered and is driven by a lot of self and social stigmas."
Dr Sinha says those who report hazards may be split according to gender. She says some men may feel like they need to appear to be "strong, self-sufficient, action oriented, being in control of their life". But after "any stress response where they feel that they're not in control", they can feel uncertain, helpless and in need of support.
"Those [responses] go against their stereotypes. And we find that self-stigma is not that someone's telling them overtly that they can't do it. They themselves have that stigma about behaving in non-ideal gendered ways," she says
Dr Sinha says for women, there are similar reactions to workplace events such as microaggressions, and with issues around childcare, IVF and menopause.
"These are topics that we know are part of gendered stress responses. [Women] don't speak up about it because then they'd be seen as making trouble. And they'd see that they are feminine topics, and therefore they're not to be discussed [at work]."
The stigma of mental illness can also prevent some from speaking out or seeking workplace support.
Dr Sinha says, in order to create a safe environment that encourages dialogue, organisations must promote inclusion, including offering role models.
"You could have all of these written in policy documents but not a single person role-modelling those behaviours in reality," she says.
"Climate is what determines what is acceptable and unacceptable at the workplace. And now making psychological harm unacceptable is where the opportunity lies."
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