Domhnall MacAuley: Stress, morale, and compassion fatigue

Domhnall Macauley Another part time middle aged GP. Another almost apologetic explanation. Another slightly embarrassed colleague. Why is it that so many GPs in their prime seem to be going part time, retiring, or changing direction? This was a generation who selected general practice as their first choice career. They aspired, not to a specialist training, but to a place on one of the most sought after general practice training schemes in the 1980s. There were hundreds of applications to some schemes, and even the least desirable had a ratio of applications to places of 5:1. What happened to these committed high quality doctors?

Something changed. Sadly, these are the very doctors I would most like to be my own general practitioner—caring, conscientious, and committed. Perhaps it’s because they care so much that they are spent, worn out, exhausted. Theirs was a commitment to personal and continuing care, but although nine sessions a week may be good for continuity, it can only lead to exhaustion and compassion fatigue. Crumpled and middle aged, their caring dream a little tarnished. Some may have problems, occasionally they turn to alcohol or self medicate. Mostly it’s silent attrition. A recent paper in BMJ Open caught my eye and, perhaps, partly explains why. The study of more than 500 GPs in Essex found that 46% had emotional exhaustion and 42% had feelings of depersonalisation. Male GPs were at greater risk. (

Is there a solution? I hear colleagues complain about the young doctors of today. They work their set hours and no more, clocking off at finishing time. And the public have little sympathy for doctors—just look at the Daily Mail’s reaction to these recent research findings ( ). The vocational component in general practice seems to have gone. But, perhaps that was part of the problem. Could vocational training and the values we embraced in the 1980s have created an expectation that was unsustainable? Did we create the monster that devoured us? As patients we all wish for a doctor committed to their work and to our individual care, rather than a clock watching shift worker. But, as a profession, we need to think about getting the right balance. In terms of long term sustainability, and retaining the best doctors with both knowledge and experience, we may need to think differently. Young doctors, often criticised, seem to value their work life balance more than our generation. They could be right.

Domnnall Macaulay is primary care editor, BMJ