Guest blog by Chris Attoe, Occupational Health Psychologist at Centre for Sustainable Working Life, Birkbeck, University of London and Head of Research & Development, Maudsley Learning, South London & Maudsley NHS Foundation Trust
Supporting health workers to return to work after a break or absence is essential for high quality patient care and workforce sustainability. Most doctors will take a break from clinical work at some point in their career for a variety of reasons. A supported return helps us to feel valued while ensuring that services have the staff numbers required to support patients and population health needs.
However, returning doctors can face a range of barriers and challenges on their journey back. In recent years the NHS, Health Education England, professional bodies and others have tried to improve the support provided to returners. Nonetheless, there is a lack of evidence on how best to support returning clinicians, meaning that we are not working from an evidence base like we do when caring for patients.
What do we know about doctors returning to work?
Firstly, it’s important to remember what we know about doctors’ experiences of work in general. Doctors are more likely than many workers to experience burnout, psychological distress, and other health-related challenges. Meanwhile, doctors may face health-related stigma and barriers to accessing confidential support. However, doctors that do receive support often respond well. While the health status and outcomes of doctors may be well-researched, our understanding behind the reasons for this from an occupational health perspective remain limited and focus on illness and treatment rather than prevention and health promotion.
This is true in relation to returning to work after and absence. We know that doctors may take an absence from clinical work for a variety of reasons including parental leave, carer duties, further education or research, personal health, among others. We even have some idea of the barriers and challenges that they may face on returning to clinical work and accessing support. These range from individual considerations, such as identity or confidence, through to social considerations, such as relationships with colleagues and peers, and organisational considerations, including availability of support and flexibility.
However, there is very limited research into the experiences of returning doctors, their needs upon return, and how these can be effectively met. We have recently completed a systematic review (under review for publication) that collated the limited evidence base and yielded some findings relating to the considerations outlined above (see Table 1 below). This is an important step towards understanding doctors’ needs when returning to work, from an individual, social, and organisational/systemic perspective.
Table 1. Summary of systematic review findings – the needs, resources, and recommendations identified for returners and those involved in providing support.
| Personal | Social | Organisational | |
|---|---|---|---|
| Needs |
Work-life balance Emotional regulation Self-perception & identity Engagement with RTW |
Relationships Professional culture Stigma |
Flexibility & job control Work design OH services Organisational culture |
| Resources |
Empathy Self-awareness Awareness of RTW |
Peer support Mentor/supervisor Social network |
Flexibility Prior job satisfaction Paid leave |
| Recommendations |
Training provision Childcare facility & flexibility |
Stigma reduction Consistent supervisor |
Clear policy & information Tailored OH services Increased flexibility Improved staffing |
The challenges relating to returning to work predate and will continue beyond the pandemic. Consequently, we need doctors and OH professionals to participate in our current study in one or more of these ways: 1) completing a 10-minute survey on their views; 2) taking part in a 45-minute interview; 3) joining workshops to co-produce a new tool to support returners.
This study will be followed by a translational study to assess the feasibility and acceptability of the new needs assessment tool. If you are interested in taking part in this study contact Chris Attoe (chris.attoe@slam.nhs.uk). You can also read about a study near completion that assesses the needs of clinicians who returned or were redeployed during the COVID-19 pandemic.