36% of doctors suffer from burnout, while 58% want to emigrate to work abroad. At the same time, most doctors, 80%, fear litigation and malpractice, which leads them to practice defensive medicine, a sociological study shows.
8 out of 10 doctors fear malpractice – Photo Shutterstock
“The burnout rate is 34-36 percent. We must see that burnout is not simple fatigue, it can be a disease with depression, suicidal tendencies and we have colleagues who have actually done it. Then there is the direct impact on the quality of the medical act. A doctor in burnout no longer has the same ability to relate to the patient“, said Daniel Coriu, president of the College of Doctors from Romania.
And that is precisely why 58% of young doctors want to work abroad. “The second direction was the intention of external migration. The entire population of doctors in Romania, regardless of age, social status, well, women make up 25 percent, men 30 percent. We are talking about people who work in Romania, in the medical system, they intend to leave. For those under 35, the intention is 58 percent“, said Coriu.
Physician migration is influenced by several factors, including economic disparities and working conditions, training and professional development opportunities, quality of life, and political and regulatory factors. It is essential that health leaders find solutions to address these challenges and promote more equitable and sustainable health policies, epidemiologist Emilian Popovici points out in an article.
“The third direction was the fear of litigious conflict and malpractice. Almost 80 percent have this problem with the fear of malpractice and then they will practice a defensive medicine. All these three directions must give us something to think about. (…) We came up with a new malpractice law, it is blocked. Very high interest is not. If the politicians want to leave things like this… Regarding the intention of external migration, know that income is not a problem as it was ten years ago, salaries have increased, the main reason relates to working conditions“, said Daniel Coriu.
The Romanian College of Physicians emphasizes that the current malpractice law does not provide adequate protection for either patients or doctors, so it calls for the development of a new law on the malpractice policy and clarification of the criminal liability of doctors. That's why solutions are being sought to improve the quality of the medical act and the doctor-patient relationship, as well as for compensation mechanisms for victims of medical mistakes.
“You always have to justify absolutely everything you do”
Dr. Marius Zaharia, president of the Commission for Resident Doctors of the Romanian College of Physicians, explained to “truth” which are the main causes of the high burnout rate among doctors.
“The small number of people, because it is not only about the doctors, but also about the medical personnel who remained quite small in number; shortages in hospitals, not enough budget is allocated for all the necessary purchases; very high workload, very, very many patients. Bureaucracy is another very stressful factor, from my point of view. All the time, at every move, you have to justify absolutely everything you do. Somehow, the system was built from the perspective that we need to be controlled as if we want to harm people. It seems to me a very wrong perspective. The system doesn't trust us and needs to control us. Because we should justify why we choose to operate, why we choose to give treatments, not why we choose not to do certain things. And from here, all this defensive attitude towards patients, which leads to more bureaucracy, to over-investigation many times, without any other justification than: that's what the protocol says”says the resident doctor.
The time and energy lost affects the quality of the medical act. There is also a lack of a law to establish days off for doctors. “It should be legislated that I am not legally allowed to work the day after the shift“, adds Dr. Marius Zaharia.
Malpractice – the bau-bau of doctors
As the College of Doctors claims, patient representatives also advocated for the implementation of mediation methods and alternative procedures, instead of resorting to criminal processes in cases of malpractice.
“It would be much easier if every hospital had mediation departments. For example, in France, only 3% of patient complaints or malpractice cases go beyond the hospital gate. It is not a cover-up, there is simply this mediation, it starts from the premise that doctors are also human and can make mistakes. This conflict is mediated at the level of these departments, after which, if unsuccessful, it is moved on. Then cutting out some of the red tape would help. Clearly, a new malpractice law must be made, but no focal action will change the course of things if there is not this synergy on the part of the institutions and the population”, explains the president of the Commission for Resident Doctors of CMR.
Why are doctors afraid of malpractice and litigation? “The percentage is so high because people, first of all, have completely unrealistic expectations when they come to the doctor. They see health as a right for which they do not have to do something active, to maintain it, only the doctor has an obligation to solve his health problems, considering many times that they have no obligation to protect themselves in active mode. Does not exist primary prevention, to say. If we were a little more educated, if we took a little more care of our health, there would be a smaller volume of patients and the doctors would not be so overworked“, says the doctor Marius Zaharia.
