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Mental Health Risks for PGDiTs

Overview

Working in healthcare is demanding and well-established research evidence highlights that doctors and dentists experience higher rates of poor mental health, burnout and psychological distress than the general population. This isn’t reflective of the individual or their capacity to cope, it’s the reality of the nature of clinical working and the systems in which that work takes place. 

Understanding the specific risks can help you recognise when you, or a colleague, may benefit from support, and can also help you take preventative steps to protect your wellbeing.

Contents

Specific risks

A combination of factors during postgraduate training makes this phase of a clinical career particularly demanding.

Pressures of training and assessment

Professional examinations, ARCPs, portfolio requirements, workplace-based assessments and revalidation requirements are additional to clinical work, often with little protected time for them.

Frequent transitions

Rotating between posts, hospitals and sometimes specialties mean repeatedly building new relationships, learning new systems and adapting to new environments, affecting continuity of support.

Nature of clinical work

Clinical work involves regular exposure to suffering, distress and complex ethical situations. This exposure can accumulate over time and affect mental health, even when individuals don’t recognise it in themselves.

High and intensive workloads

Long shifts, on-call commitments, filling rota gaps and unpredictable patient cases can contribute to physical and mental fatigue.

Workplace culture

Historically, medical and dental professionals have struggled with help-seeking, often associated with worries about the implications disclosing mental health difficulties will have on their training and careers. Whilst this stigma is reducing, it remains a perceived barrier for many. 

Personal disruption

Training rotations can mean significant travel, frequent relocation, and time away from family, partners, and personal support networks.

Common mental health concerns

The following are some of the most common mental health and wellbeing concerns experienced among PGDiTs. Many people will experience some of these at some point during their training but recognising them early and getting appropriate support makes them more manageable.

Burnout

Burnout is described as a state of emotional, physical and mental exhaustion caused by prolonged or excessive stress. It's often accompanied by feelings of exhaustion, increasing cynicism or detachment from work, and a reduced sense of personal accomplishment. Burnout in doctors and dentists is well documented and should be taken seriously, not only because it has significant personal cost but because it is associated with poorer patient care.

Anxiety and stress

Experiencing stress is normal when you work in a demanding role but when excessive, it can cause persistent anxiety, affect sleep, reduce concentration and interfere with working and personal relationships. 

Depression

Low mood can develop gradually and can be misinterpreted as “just being tired” or “just being stressed”. Persistent low mood, loss of interest in things that usually bring enjoyment, changes in sleep or appetite and feelings of hopelessness or worthlessness as are all signs of possible depression that warrant attention.

Moral injury

Moral distress can occur when clinicians are repeatedly placed in situations where they are unable to provide the care they believe the patient needs. This might be owing to resource constraints, system pressures or organisational decisions. For example, research shows that rates of moral distress amongst PGDiTs increased significantly during the Covid-19 pandemic. Over time, moral injury can be very detrimental to an individual’s wellbeing and their professional identity. 

Vicarious trauma and compassion fatigue

Sustained exposure to others’ suffering can cause intrusive thoughts about patient cases, emotional numbness, hypervigilance or difficulty separating work from personal life.

Substance misuse

Repeated exposure to stress, long working hours and the perfectionism inherent in medicine and dentistry can result in substance abuse, including dependency on alcohol and prescription drugs. Research suggests certain specialties are at greater risk of developing substance dependency, and a reluctance to disclose limits access to support. Confidential, non-judgemental help is available – see the External Support Services Directory for specialist resources.

Suicidal thoughts

Sadly, research consistently shows that doctors are at higher risk of dying by suicide than the general population, with the risk particularly elevated in some groups, such as autistic doctors. 

 

If you are experiencing thoughts of ending your life, please reach out for help

There are many support options available which are genuinely confidential. The deanery funds access to local counselling and psychological support services for our PGDiTs and the BMA’s wellbeing services and NHS Practitioner Health are specialist services for clinicians.

Please see our emergency contact advice if you need urgent or immediate support.

 

Recognising the signs

It’s not always easy to recognise (or sometimes admit) that your mental health is suffering and sometimes your colleagues, family or friends will notice changes before you do.

Common signs to look out for in yourself or others can include:

  • Persistent tiredness that doesn't improve with rest 
  • Increased irritability, frustration, or emotional reactivity 
  • Difficulty sleeping, or sleeping much more than usual 
  • Changes in appetite, weight, or use of alcohol 
  • Loss of interest or enjoyment in things that previously brought satisfaction 
  • Difficulty concentrating, making decisions, or remembering things 
  • Withdrawing from colleagues, friends, or family 
  • A sense of detachment, cynicism, or numbness about work 
  • Feeling that you are not coping, or that things are hopeless 
  • Thoughts of self-harm or of ending your life
     

Experiencing one or more of these symptoms, particularly over a sustained period, is not a sign of failure or weakness. It is a sign that you, like many clinicians before you, may benefit from support.

Confidentiality and your career

All too commonly, the decision not to seek support is underpinned by a concern about implications for training or career progression. Periods of ill mental health are very common in clinical working and seeking help early generally makes things easier personally, clinically and in terms of your training.

The GMC and GDC professional standards refer to the importance of taking care of your health and wellbeing. Fitness to Practice guidance highlights that mental ill-health does not in itself raise fitness-to-practise concerns, but it will amount to a concern where the impact on the clinician poses a risk to patients.

What matters is that you seek appropriate support, follow advice from treating clinicians, and do not put patients at risk.

Remember

Services such as NHS Practitioner Health, the BMA wellbeing service, and our deanery-funded counselling and psychological services are all confidential and specifically focus on support for clinical professionals.

What to do next

If you recognise some of these challenges in yourself or in a colleague, there are several routes to support:

If you are unsure where to start or would like to speak to somebody about your circumstances more holistically, we encourage you to submit a Professional Support Self-referral for confidential advice from the Professional Support Team, including recommendations on the best support options and services for you.

 

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