Mater Dei doctors have been less impacted by burnout as a result of the pandemic than their colleagues overseas, according to a study.

The survey, carried out to assess the impact of COVID-19 among the whole range of doctors in areas most affected by the pandemic, found the Department of Surgery to be the most badly impacted because elective theatre had to be stopped, negatively affecting the younger medics’ training.

The findings on burnout at MDH compare “very favourably” to the high rates of severity that emerged in international studies, said consultant cardiologist Caroline Magri, who researched the impact of COVID-19 on the doctors between last April and May.

This image of nurses supporting each other outside Mater Dei’s ITU went viral during the early days of the pandemic.

Basic Specialist Trainees – doctors a level up from the foundation year burdened with responsibility while still young and lacking experience – were found to be the worst affected by the pandemic primarily because they were frontliners.

But the impact on them was also due to being asked to work in other departments, including Public Health, to assist in contact tracing, as well as moving from surgery to casualty, for example, reducing their exposure to operations and hitting their training.

Higher grades unaffected

Foundation Year doctors were also affected, followed by Higher Specialists Trainees, the survey showed. But the burnout score was still low.

Higher grades were unaffected by the pandemic probably because they were more autonomous, in control and experienced, whereas the basic specialist trainees would be told what to do, explained Magri, a senior visiting lecturer at the University of Malta.

Her brainchild, the survey involved MDH doctors from foundation year all the way up to consultants and chairmen, working in the departments of Medicine, Surgery, Anaesthesia, A&E, Cardiology and Cardiothoracic Surgery. 

A total of 243 doctors completed a questionnaire for the survey, which was conducted with the assistance of hospital COO Steve Agius and Vincent Cassar, Head of the Department of Business & Enterprise Management at the university. 

“Interestingly, their overall psychological state was good,” Magri said.

COVID-19 did not have any major effect on doctors’ job satisfaction, it was found.

“Their overall psychological state was good”

“Exhaustion burnout” was mostly prevalent in the Department of Medicine, with the weekly working hours and the number of times the doctors ended up in quarantine and isolation also having a negative effect.

The survey found that the Department of Infectious Diseases was “highly engaged”. It was important to note the “camaraderie” that united this department, Magri said, adding that the healthcare workers here played a pivotal role from the onset of the pandemic. 

Teamwork among the managers and administrators also allowed the hospital’s capacity to be increased to meet the demands of the ever-growing number of positive COVID-19 cases, Magri highlighted.

Early lockdown helped

Lockdown during the early phases of the pandemic allowed the hospital management to get equipped with Personal Protective Equipment and hand hygiene to safeguard healthcare workers – unlike hospitals abroad that were hit hard and immediately by COVID-19.

The Maltese doctors “fared well” during the pandemic because of this “time lag” in which they could get prepared, Magri continued.

Italy, for example, was immediately inundated by cases, with doctors and nurses dying, but Malta experienced the surge later than the rest of Europe, and during the first lockdown, the hospital could top up their resources.

“At no point did we have no PPEs, or alcohol hand rub, unlike other countries,” Magri said in her analysis of the data.

“Things were not perfect, and when Public Health was drowning in patients, we had to help out. But that was only for a short period during the second semi-lockdown in March 2021.”

The fast vaccination of doctors by January 2021 also helped doctors feel empowered to control the disease.

Even though they were exposed to patients, they felt protected, and this helped mentally, Magri said of the reasons for achieving a low burnout score.

Doctors ‘offended’ by another study

Another study conducted around the same time contradicted these findings, concluding MDH junior doctors were prone to overtiredness, errors and a loss of empathy to the detriment of patients when on duty for 32-hour stretches.

The research by trainee psychiatrist Alexander Clayman on the effects of post-duty sleepiness on the health and function of 139 house officers revealed a negative impact on their mental and physical health as patients experienced poor empathy and accidental and non-accidental medical errors.

It quoted doctors saying they would be so burnt out they were glad when a patient passed away as it meant “just another name to cross off the list”.

Magri said doctors took exception to this study and felt offended and insulted, adding that anyone thinking in that way needed serious psychiatric help and had to immediately stop working until recovered.

She pointed out that Clayman’s study only assessed Foundation Year doctors, had a smaller sample and based its focus group on 10 of them, while this study could compare different grades and departments.

Magri assured, however, that her research was conducted at the same time and not carried out as a result of this study’s findings.