How doctors can ensure a smooth return to workBMJ 2016; 352 doi: https://doi.org/10.1136/bmj.i1601 (Published 24 March 2016) Cite this as: BMJ 2016;352:i1601
Emma Plunkettset up a return to work programme in her region after she encountered a lack of support for returning doctors
Whatever the reason for a break from medicine, returning to work can be a time of apprehension and anxiety. Returning doctors often think they are expected to pick up instantly from where they left off, even after many months away.
I’ve had three breaks from work, all for maternity leave. My first return to work in 2009 was to a hospital that I had never worked at before, and there was no acknowledgment that I was returning from a break. Before my second return to work I attended the excellent Giving Anaesthesia Safely Again course in London,1 which focuses on improving confidence through simulation and workshops.
I wondered what others’ experiences were, and to investigate I did a regional survey of trainee anaesthetists who had returned to work after maternity leave. The survey showed that most doctors had some supervised sessions before resuming on-calls; however, many encountered problems. These were mostly with administrative matters, but a minority reported being allocated to inappropriate lists or thinking that they were put on call too soon. The self reported length of time it took for confidence to return was variable: from several weeks to up to six months.2 This lack of confidence may well be appropriate and ensure safe practice, but it can also be associated with stress and anxiety.
Around the same time, two pieces of guidance were published by the Academy of Medical Royal Colleges and the Royal College of Anaesthetists.34 These both set out recommended return to work plans with questions and actions, aimed at both the returning doctor and those supporting and supervising them.
In our region we introduced a return to work programme: a three stage process, with each step including a structured meeting between the returning doctor and their supervisor. The first step is a pre-leave planning meeting, which, of course, is possible only for periods of anticipated leave, although the paperwork can be used by the individual even if the meeting is not possible.
Then, at least four weeks before the doctor’s return, a meeting takes place where any continuous professional development to prepare is listed and arrangements for a supervised return are agreed. The final step is a record of the re-introduction period, at the end of which a final meeting takes place to agree that the doctor can resume normal duties. The re-introduction period can be altered as everyone’s needs are different. The programme was initially for anaesthetics, but it has since been adapted for all specialties with an identical process. The uptake in my specialty seems good, but it is not yet embedded everywhere.
To investigate the impact of the programme, we sent a second survey to junior doctors and this time extended the survey to include consultants in anaesthesia who had had time away from the specialty. Things are still not perfect, but in the junior doctor group returning from maternity leave (a comparable group to the first survey) we saw an improvement: almost two thirds had used the programme, and everyone had a period of supervision before resuming on-calls, with the shortest period being eight days. Only a few doctors encountered problems and we saw a reduction in the length of time for confidence to return, although the groups were different so we must be careful about drawing conclusions. The picture for consultants was different, with only one third using a return to work programme. Most reported that they had not done anything specific to prepare for their return to practice—it seems there is more work to be done here.
The use of return to work programmes is now relatively commonplace in anaesthesia, and the one introduced by the Wessex team in 2012 was recognised by the Royal College of Anaesthetists as an example of good practice.5 The London Less Than Full Time Anaesthesia forum has recently published results of their return to work survey of junior doctors.6 I am proud that anaesthesia as a specialty seems to be embracing this concept.
Breaks from practice will remain relatively common, and it should be standard practice to have a structured and supported re-introduction. If you would like to know more about what we have done in the West Midlands, then please get in touch.
Competing interests: I have read and understood the BMJ Group policy on declaration of interests and declare the following interests: I am a co-editor of the book Returning toWork in Anaesthesia, which is due to be published in May this year.