A Qualitative Study of Occupational Stress and Burnout among Emergency Physicians in Canada

ABSTRACT Title: A Qualitative Study of Occupational Stress and Burnout among EPs in Canada Researcher: Helena Krista Fleming Supervisors: Christina Brux Mburu, MPhil, Dr. Per Kristian Hilden (University of Oslo) Dr. Skye Barbic, Ph.D., OT (University of British Columbia) and Dr. David Barbic (Providence Health Care, Vancouver, Canada). Introduction: Research suggests that burnout is a commonly reported concern among emergency physicians in Canada. In addition, burnout is understood as having serious consequences for emergency physicians (EPs), the quality of patient care and the health system at large. Despite consistent data suggesting concerning levels of occupational stress and burnout in EPs over time and across settings, few qualitative studies of Canadian EP experiences are available. Study Objectives: The primary objective of this study is to generate insight into the experiences and perceptions of occupational stress and burnout among emergency physicians in Canada. The secondary objective is to consider how their perceptions and experiences of coping, interventions and health and wellbeing might reveal insight into not only occupational stress and burnout, but also ways of potentially supporting occupational wellbeing in this profession. Study Design and Method: This study employed a qualitative exploratory research design. I conducted semi-structured, in-depth interviews with fifteen EPs practicing in three urban centers in Canada. I systematically and comprehensively coded the data and used thematic analysis to identify categories and themes in the EPs accounts of their work experiences. The major themes that emerged related to occupational stress, burnout, protective resources, coping strategies, and engagement. These themes were then compared with previous research and analyzed with reference to the current scholarship about emergency physicians in Canada and contemporary theories of occupational stress and burnout. Findings: This study suggests that resource constraints, relationships, policy, and coping strategies contribute to occupational stress, while the volume of stressors, experience, age, perception and coping strategies appeared to mitigate the impact of these factors. Furthermore, factors typically considered protective were reported to either mitigate or contribute to occupational stress depending upon the circumstance. Factors identified as potentially influencing burnout were additional serious stressors, in excess of factors contributing to occupational stress; such as divorce, lawsuits, perceived errors, and the inefficacy, inaccessibility or removal of habitual coping strategies. Implications and Recommendations: Multiple factors may mitigate or exacerbate occupational stress. For instance, task-oriented and emotion-oriented coping strategies may either contribute to or reduce occupational stress, depending on the circumstances. The high grit and resiliency of EPs may increase stress and contribute to some EPs pushing beyond their capacity, which may contribute to burnout. On the other hand, self-awareness and self-regulation may have a positive influence on stress reduction and protect against burnout. The data suggests that cumulative stress is potentially unsustainable for some EPs when in addition to habitual work stress they are faced with additional serious personal or professional stressors and insufficient support