Am I Suffering from Burnout as a Locum Doctor?
Introduction
There are so many reasons why a doctor may choose to leave training to become a locum, but feeling burned out is one of the most common ones.
Unsurprisingly, the 2021 NHS Staff Survey measured all time high levels of burnout among NHS staff. It showed 33.1% of NHS doctors suffered from severe burnout and many more struggled with mild-moderate symptoms, which may explain why record numbers of junior doctors are taking time out of training.
It may have come as a shock, therefore, when the feelings of burnout didn’t go away after you started locuming. While being a locum comes with many advantages, there are also elements to locuming that can contribute to burnout.
🩺 Here is a personal story of Amelia, a junior doctor who now works as part of the Messly Team:
‘As a locum, you have to protect yourself more than you did as a trainee and that constant vigilance can be really exhausting. The stress of feeling like the outsider, out of my depth or my comfort zone can be overwhelming at times and can make locuming less enjoyable. I’ve been pushed into situations that made me uncomfortable such as being pressured to take shifts I didn’t want, being asked to work in far away places, in departments I didn’t agree to, or to do skills or tasks that I know I am not allowed to do. I was scared that saying no might affect my ability to get shifts again, but I also wanted to do the right thing.’
In this article, you will learn:
❓What is ‘burnout’ and how it’s different from stress and depression.
🏨 Which elements of the locum lifestyle might be contributing to your burnout.
📆 How to manage burnout and the next steps to take.
😴 What is Burnout?
Burnout is profound mental and physical exhaustion caused by chronic exposure to intense stress.
It is not a physical or mental health condition, but an occupational phenomenon. It is usually due to workload and work environment but can also be caused by other stressors such as caregiving and relationships.
The World Health Organization defines burnout as ‘energy depletion or exhaustion, increased mental distance from your job, negativism or cynicism, and reduced professional efficacy.
How is Burnout Different from Stress or Depression?
Stress is the feeling that there is too much to do, too much to think about, too much to change, and too much to choose from. Stress is about being overstimulated and overwhelmed.
Burnout is the feeling that there is not enough time, not enough brain space to think, not enough people to provide support, and not enough energy to make it through the day. Burnout is feeling empty and depleted.
The difference between burnout and depression can be subtle and hard to determine. The main difference is the broadness of symptoms. Burnout may cause a lack of confidence in our professional ability, and make us feel like we are failing work, whereas depression may cause a general lack of confidence and like we are failing at life. Burnout can present as compassion fatigue or apathy towards work whereas depression can cause global anhedonia and apathy towards our lives and those in it.
🤧 What are the Symptoms of Burnout?
Alongside severe exhaustion, cynicism, detachment, and a sense of hopelessness and inadequacy, you may also feel more irritable, apathetic, and unable to concentrate. You may start relying on food, alcohol or illicit substances to cope.
Physical symptoms that are common are:
👉 Poor sleep or insomnia
👉 Headaches or migraines
👉 Stomach aches
👉 More frequent viral illnesses or the reduced ability to recover from viral-type illnesses
If you think you might be suffering from burnout, try this quiz: https://sensa.health/burnout/
❓How Can Locuming Contribute to Feelings of Burnout?
As a locum, you have more freedom in your schedule and where you work, you earn more money (per hour) than trainees, and you have more autonomy as a person. These benefits can be empowering, but when your boundaries or goals are off-kilter, they can each become causes of stress and burnout.
👉 Overfilling Your Schedule
When designing your own schedule, it’s easy to get swept up in the offers for shifts and overbook yourself. You might not see the big picture enough to realise that you haven’t factored in rest days, holidays, or time to enjoy your hobbies and interests outside of work.
👉 Working far from home
Long commutes or working far away from home can be very stressful if you highly value quality time at home. Maybe you have been told by your agent that these shifts are all that are available, or maybe you are choosing the shifts for the higher rates. Whatever the reason, maybe being away from home is pushing you over the edge.
👉 Inconsistency in your routine
The consistency and stability of a regular routine can be really important for people. As a locum, spreading yourself across departments can feel destabilizing and you may feel constantly out of your comfort zone if you don’t know the team, the processes, or the role that you are being asked to work within.
👉 Inappropriate upskilling
Being asked to do something that feels out of your depth like acting up, or performing a skill that you aren’t confident with can be very scary for locums. You might find ‘letting people down’ very difficult and be unsure of when you can and can’t say no to a request.
👉 Financial pressure
Just because it’s possible to earn over £100,000 as a locum SHO, or even out-earn your consultant, doesn’t mean that this is the best thing for you to do. Being over-ambitious in earning goals may be putting unnecessary pressure on yourself.
🤔 How to Manage Burnout:
Maybe you started locuming as a means of combatting burnout in your training post, and now you feel helpless as the feelings have not gone away. You might be asking yourself whether you should leave medicine altogether, and while this is certainly one option, it is not the only option.
🍎 Focus on the Fundamentals
Make sure that you are properly taking care of yourself. This might include:
✅ Get some proper sleep
✅ Stay hydrated
✅ Eat wholesome meals
✅ Move your body and elevate your heart rate
✅ Step away from your stressors by putting that research project on hold, or going on holiday
✅ Avoid substances like cigarettes, alcohol and other drugs.
These recommendations are based on the six pillars of health which are evidence-based recommendations for promoting physical and mental well-being (references here and here).
Here is a free NHS resource for a personalised mind plan of evidence-based interventions to boost your mental well-being.
💭 Communicate and Escalate
Don’t keep your struggles to yourself. Bringing others into the fold can help you find solutions you might not have been able to identify on your own.
Try talking to:
👉 Your Friends and Family:
They may have had similar struggles and could provide valuable insight and support.
👉 A peer group:
Joining a peer group to discuss the issues you’re facing and get the group’s perspective and support. If you haven’t joined a peer group or don’t know what this involves, check out this article on peer groups for locum doctors here.
👉 Your Rota Co-ordinator / Medical HR / Your Agent:
Whoever is sending you shifts, let them know exactly what shifts might be right for you and what isn't. If you don't want to travel, then tell your agency to look for work more locally, and if you are moving departments too frequently then tell your rota coordinator that you want consistency over frequency. Once they know exactly what you want, they are more likely to message you when the right shifts are available.
👉 Your GP:
As an outsider, they may be able to offer more objective support and help manage any additional symptoms of anxiety or depression.
👉 Occupational Health:
If you need a referral from your line manager, then you may not be able to use OH for support as a locum. However, if you locum for the same trust regularly, then you may find that medical HR will still refer you if you ask them to. If OH accepts self-referrals then give that a go. Alternatively, your agency may have its own OH department or a company that they work with to speak to them about your options.
🙏 Regain Control
Anyone who has built a house knows that you spend most of your money laying foundations which aren’t ever seen again. Even though they lie under the surface, setting strong and stable ground from which to build your working life is essential to creating a lasting and secure structure.
Before you decide that medicine is no longer for you, try using this locum workbook to redefine your goals and boundaries. Once you have reflected on your individual circumstances and needs, you will find it easier to identify areas in your locum life that are contributing to your feelings of burnout.
✅ Re-balance your schedule:
👉 Reduce the number of shifts you are working each week.
👉 Opt-out of antisocial shifts
👉 Use our Locum Salary Calculator to see what you need to work to earn the same as a trainee.
✅ Look closer to home:
👉 Register with a new agency and stipulate local shifts only.
👉 Register with your local staff bank.
👉 Be prepared to compromise on speciality or salary in order to preference of working locally.
✅ Establish a routine:
👉 Speak directly to the rota coordinators and express your boundaries about only working in one particular department for a while.
👉 Consider agreeing to a number of shifts on the same rota line instead of across departments.
✅ Protect yourself:
👉 Practice saying ‘No’ when you are not comfortable with the things being asked of you during your shifts.
👉 Confirm your medical indemnity cover is up to date, and that you always document clearly and carefully your conversations and decisions.
👉 If you aren't sure whether you are allowed to do something, then check first with the other doctors you are working with, the hospital legal team, the coroner, or even medical HR. Most requests can wait long enough for a proper answer that covers your back and you’d be surprised how quickly you can get answers to most queries. If the request can’t wait, then delegate to another doctor who is willing to take on that responsibility, or escalate to a senior.
👉 As you continue to get to know a particular department or team, you may eventually feel that you are confident and capable of pushing yourself, and the leap may eventually feel more palatable, but don’t try and get there before you are ready. Read more about acting up as a locum here.
✅ Re-assess your finances:
👉 Work backwards from what you need to earn each month, and then calculate the number of shifts that you need to do in order to earn this amount. Our Salary Calculator tool will help you do this.
👉 As a side note, all locum doctors should consider income insurance in the event that they need to take time off work for any reason. As a locum, you don't get sick pay like contracted doctors so is important to protect your interests and yourself, particularly if you have debts and other obligations to pay for.
There are so many ways to have a fulfilling career in medicine. Read this article about medical careers as a non-trainee doctor.
🩺 What did Amelia, Messly’s own junior doctor do?
‘Before locuming, I was a total people pleaser but after I started locuming, I practised saying ‘no’ and standing up for what I wanted and needed more. Establishing clear personal boundaries and goals made it much easier for rota coordinators, agents, and team members to know what I was and wasn’t willing to do, and to my surprise, they all respected those boundaries. I still get work, but now it’s even better as it aligns with what I actually want to do. I earn the amount that I want to by establishing my financial goals up front and refusing things that don’t fit into my financial plans. I often get asked to do things outside of my skill set, or things that I know I am not allowed to do, but I have become very good at delegating to the right team and getting advice from the right people. It helps to remember that other people don't know what you are and aren’t capable of, and generally, no one is offended if you refuse - they just want to see what they can get away with!’
In Summary:
✨ Burnout is an occupational phenomenon, not a mental health condition.
✨ Burnout is caused by chronic exposure to intense occupational stress, usually from work.
✨ Burnout is similar to stress and depression in some ways but is its own thing.
✨ It is important to recognise burnout for the sake of your own well-being, that of your patients, and the NHS as a whole.
✨ There is lots that you can do to manage burnout without needing to leave medicine forever.
✨ Focus on the fundamentals.
✨ Communicate and escalate.
✨ Regain control.
If you are a doctor in training and you are worried about burnout, this article offers helpful coping mechanisms.
Your Ultimate Guide to Succeeding as a Locum Doctor
This article is part of a wider series of resources and guides that are designed to support you as a locum doctor, covering areas such as getting your first job, managing your finances, understanding your rights, and many more. Visit our Locum Doctor Hub for everything you need to know about locuming today.
Additionally, if you're considering an F3 year, you might also find it useful to look through the selection of resources we've put together in our F3 Resource Hub.”
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