Table 5 Contributing Factors

 Emergent Code

Descriptive Examples

 Lack of Influence on Policy and Administration

“I’m realizing policies were all built to exclude physicians – to exclude physicians and physician leadership […] and if you work in an institution that does that, you’re going to burn out all your docs and they’re going to leave.”

“Physicians have this recurring sense of feeling consumed or used like a product or a resource rather than being treated as a human - which is ironic as our goal is to treat our patients with dignity as human beings, but we don’t feel our work, for structural or interpersonal reasons, gives us the same dignity.”

 Systemic Failures in Cultural Safety

“This is a particular problem with locums coming in and not understanding the North. I’ve had to really self-educate on cultural competence because it wasn’t really a thing when I first arrived, and that can definitely contribute to burnout because it contributes to so many communication issues and problems with patients. I think now the government is actually recognizing the need and I actually just attended my first official cultural competence training this week. And that actually felt really good – that my employer actually cared enough to allow me to schedule two days off from my clinical duties, protected time, to actually learn these things formally instead of just learning by trial and error.”

 Discontinuity of Care

“Because we’re not adequately resourced to serve our population, we end up having this hamster wheel where we’re racing to meet the access needs of the population rather than supporting continuity of care.”

 Upshifting of Tasks

Doctors are carrying a lot of administrative burden – hours and hours of it … It’s very demotivating to do work that’s not only not at the top of your scope, but shouldn’t really be within your work description at all. It’s morale-killing.”

 Physician Turnover

“One of the issues is that almost everyone who works here is really working in a sort of expatriate position because they’re working with such a large Indigenous population. They see themselves as coming here for 5 years, making some money and leaving, or working for the federal government, coming here for 10–15 years, getting a pension and then leaving. They don’t have a real personal stake in the system and how it should work.”

“I think [we need] an effort to keep people here, to keep people coming back, to see what keeps them here, a recognition from administration that there is a higher value to people who keep coming back and continuity rather than just filling spots with a heartbeat.”

 Lack of Systemic Supports

“There technically are programs that physicians can access, but few of them are actually tailored to the situation that we find ourselves in in the North. So for example, through the Canadian medical association, there is a financial planning service, but there’s still not any particular service that speaks to the experience of physicians who practice remotely or in the North – that speaks to our unique financial situation, having a very high cost of living and most of us working in a salary based practice.”

“Through time, what’s happened is they’ve basically said “if you’re not doing well, it’s because you’re personally not resilient enough. You need to work harder at yoga, meditation, eating right,” all that kind of stuff that’s really important. What is now more recognized in terms of what people don’t do well as physicians is it tends to be more systemic issues, so issues of overwork, lack of being able to have a voice, feeling this moral outrage that they’re unable to provide the kind of care they know they need to but being medically responsible if the care is bad; those sorts of things that cause poor physician health. And there’s been a complete lack of understanding up here in regard to those issues.”