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Table 7 Double-Edged Swords

From: Exploring the impact of rural health system factors on physician burnout: a mixed-methods study in Northern Canada

Double-Edged Swords

 Emergent Code

Descriptive Examples

 Scope of Practice

“I’m encouraged to work to my full scope, I can do multiple different things, I don’t just have to come to the office every single day and see people in clinic. I can do procedure, I can push my scope, I can push my boundaries, I can vary my practice.”

“Always dealing with high acuity, high emergency situations because we don’t see a lot – like big traumas, you know, people who you have to run a code on who are crashing. I was actually talking to a colleague about this recently; one of the hardest aspects of practicing in a rural or remote setting is dealing with babies. Newborn babies who are sick or premature newborn babies – we don’t have pediatricians, we don’t have anybody with specific pediatric training … we put this pressure on ourselves and yet we don’t have the expertise – or we feel like we don’t have the expertise – to adequately manage them. Which is compounded by the fact that in a very remote settings, you’re forced sometimes to care for these patients for a very long time, which would never happen in other settings.”

 Blurring Boundaries

“Being able to see the outcomes of your efforts within your community – you’re actually able to see your patients out and about and how they’ve benefitted or seeing the positive steps that they’ve taken for their health.”

“So doctors have sort of agreed to soft call without any boundaries or limitations on it, so what started out as this very exciting opportunity to do anything and everything has turned into this life-consuming experience. I think what I’ve seen is that there are no boundaries on physician time. And unfortunately there’s this perception that if you pay people well, you can ask them to do anything.”

 Time Away

“At any given time, I would say the majority of physicians are near burnt out. The way they schedule us, when you’re in town you work really hard and don’t really have time to have extra socialization with your colleagues or have good balance. And so they take long breaks and leave town -- they go on these really long holidays so we don’t see them then either...So, even though you know that there’s other physicians around you, you don’t necessarily feel that you’re balanced and have time for each other even when you’re in the same building.”

“That’s probably the only way I survive my job is not being there all the time.”