Article Figures & Data
Tables
Item Result Number (Percentage) Gender Male 23 (56.1) Female 18 (43.9) Ethnicity White or European 33 (80.5) Othera 7 (19.5) Profession Staff psychiatrist 39 (95.1) Fellow 2 (4.9) Primary work Forensic psychiatry 38 (92.7) Other 3 (7.3) Location of employment Academic center 25 (61.0) Mental health hospital 6 (14.6) Private practice 6 (14.6) Othera 4 (9.8) Length of time practicing forensic psychiatry 0–5 years 8 (19.5) 6–10 years 3 (7.3) 11–15 years 7 (17.1) 16–20 years 7 (17.1) 21–25 years 4 (9.8) 26+ years 12 (29.3) Pattern of work Full-time work 38 (92.7) Part-time work 3 (7.3) ↵aCategories combined owing to cell size <5 for individual categories.
- Table 2
Results of Fisher’s Exact Test for Association between Demographic Characteristics and Attitudes with Burnout and Fulfillment
Burnout Fulfillment Demographic Characteristic No Yes P No Yes P Number of years in forensic psychiatry 0–10 2 (18.2) 9 (81.8) .002 10 (90.9) 1 (9.1) .430 11–20 5 (35.7) 9 (64.3) 10 (71.4) 4 (28.6) 20+ 13 (81.3) 3 (18.8) 11 (68.8) 5 (31.3) Gender Female 6 (33.3) 12 (66.7) .08 14 (77.8) 4 (22.2) .606 Male 14 (60.1) 9 (39.1) 17 (73.9) 6 (26.1) Considered leaving job? No 12 (70.6) 5 (29.4) .535 13 (76.5) 4 (23.5) .914 Yes 8 (33.3) 16 (66.7) 18 (75.0) 6 (25.0) Considered leaving forensic psychiatry? No 18 (58.1) 13 (41.9) .040 22 (70.8) 9 (29.0) .219 Yes 2 (20.0) 8 (80.0) 9 (90.0) 1 (10) Professional values align with your institution? No 3 (20.0) 12 (80.0) .005 14 (93.3) 1 (6.67) .047 Neutral 17 (65.4) 9 (34.6) 17 (65.4) 9 (34.6) Yes 20 (48.8) 21 (51.2) 31 (75.6) 10 (24.4) Values align with colleagues? No 0 (0) 4 (100) .117 3 (75.0) 1 (25.0) 1.00 Neutral 4 (50.0) 4 (50) 6 (75.0) 2 (25.0) Yes 16 (55.2) 13 (44.8) 22 (75.6) 7 (24.1) Amount of time on telemedicine <25% 10 (45.5) 12 (54.6) .449 15 (68.2) 7 (31.8) .373 25–50% 5 (41.7) 7 (58.3) 11 (91.7) 1 (8.33) >50% 5 (71.4) 2 (28.6) 5 (71.4) 1 (28.6) Impact of pandemic on workload Working less 3 (50.0) 3 (50.0) .482 4 (66.7) 2 (33.3) .887 Working more 6 (37.5) 10 (62.5) 12 (75.0) 4 (25.0) No change 11 (57.9) 8 (42.1) 15 (79.0 10 (24.4) Amount of time on EMR High 12 (54.6) 10 (45.5) .132 16 (72.7) 6 (27.3) .89 Medium 5 (71.4) 2 (28.6) 6 (85.7) 1 (14.3) Low 3 (25.0) 9 (75) 9 (75.0) 3 (25.0) How much control do you have over workload? Low 1 (10.0) 9 (90.0) .017 9 (90.0) 1 (10.0) .212 Medium 10 (62.5) 6 (37.5) 13 (81.3) 3 (18.8) High 9 (60.0) 6 (40.0) 9 (60.0) 6 (40.0) Variable Odds Ratio z P 95% CI Gender 0.51 −0.79 .428 0.06–2.71 Length of time in practice 0.27 −2.30 .021 0.09–0.82 Values align with division 0.16 −2.06 .04 0.03–0.91 Control over work 0.53 3.16 .26 0.17–1.60 Factor Quotation from Survey Volume of Work Unpaid work Was working too much on uncompensated work Virtual work Virtual work and meetings have completely taken over my life. There is an unspoken expectation to work remotely, respond to e-mails, attend zoom meetings, etc., at all times, even while not being paid for that time. Bureaucracy and administration Incredible bureaucracy in hospitals (mandatory training, inefficient EMR, etc.)
Lack of autonomy for physicians within the provincial health care system. The provincial health care system is increasing the level of bureaucracy in the system without improving patient care.
Lack of opportunities to do the work I want to and feeling “stuck in the system.”Leadership and culture Lack of say in decisions made by management…. We get told to “put your head down and do your job” when concerns are raised.
Relationships with some negative colleagues
Hospitals never take physician inputSARS-CoV-2 (COVID-19)–related factors The pandemic and other current social issues and crises make my work seem less meaningful in comparison.
I have serious ethical and moral qualms regarding the restrictions we have placed on inpatient [provincial review board] patients over the course of the pandemic. It seems like an abuse of power that’s not related to forensic risk and I struggle with my participation and complicity in it.
Constant adaptation during pandemicNon–work-related stressors High demands and difficulty to conjugate life with young children
Factors outside of work (grief, illness…)Factors inherent to the nature of the work in forensic psychiatry Responsibility for decisions regarding therapeutic risks Factor Quotation from Survey Informal support of colleagues and teams Very collegial and flexible colleagues; good relationships with multidisciplinary staff
Free time to connect with colleagues and coworkers “in the hallway”
Interdisciplinary team work … Discussions with colleaguesFlexibility and autonomy in their workplace Control over my schedule
Working part-time, flexible work hours and the ability to work primarily from home
Control of my time
Control of work loadMeaning, purpose and stimulation of their work Patient-related factors Intellectually challenging cases that I feel challenge my skills
The patient and evaluee population
Making a difference to people's livesTeaching and research Teaching to the residents Feeling valued and supported in their workplace Receiving positive feedback from leadership and lawyers Feeling appreciated by leadership. Feeling that my superiors have my back.
Receiving positive feedback from legal community and other clinicians about the quality of my work.
Recognition by peers and supervisors of my value
Feeling included, being informedFair financial compensation Compensation for extra work Lifestyle factors Outside activities and exercise
An office with a window- Table 6
Items Identified by Respondents as to What They Enjoy about the Field of Forensic Psychiatry
Factor Quotations from Survey Intellectual challenge and stimulation The intellectual challenge of figuring out complex cases The interface of psychiatry and the law and translating knowledge back and forth
Rigor, the intellectual challenge, medico-legal analysis
Love the reports for court. Love legal analyses. Enjoy working with lawyers and providing testimony
The complexity of the cases
There are always new challenges and difficult cases to keep me engaged and interestedMeaning and impact Seeing patients recover and safely reintegrate; managing really challenging cases where others have failed I feel good in knowing that I am trying my best to help my correctional population who have dealt with extremes in pain and suffering.
Feels like the issues are really meaningful
I believe I am contributing to Canadian society by working intensely with the criminal justice system and mentally abnormal offenders.
Ability to treat patients successfully and reintegrating them in to community as valued memberThe work environment, including colleagues and teams Rehab work and the possibility of treating patients in an interdisciplinary team Enjoy working in a team-based environment
Great colleaguesVariety The variety of areas of practice (inpatient, outpatient, corrections, variety of content in cases) Variety of work (assessment, rehabilitation) Flexibility Flexibility of work
The patient population, flexibility, and breadth of experiences flexibility to choose what I do
