Burnout of junior doctors and skills retention.

1 paint a dismal picture: 95% of junior doctors at the Red Cross Children's Hospital in Rondebosch, Cape Town, intend to leave at the end of their rotation. However, the 95% is derived from only 22 of the 39 junior doctors who were mailed a questionnaire. The findings should be expressed as a proportion of all 39 junior doctors – an intention to treat analysis. Using 39 instead of 22 as the denominator implies that half of the doctors surveyed were burnt out; still a cause for concern, but a more credible number. Senior house officers (SHOs) come to the Children's Hospital to learn, and to become competent and self-confident in managing seriously ill children, which is stressful for inexperienced doctors. Registrars are more experienced, training as specialists. To group them together as junior doctors is odd. The authors assert that poor working conditions and administrative inefficiency and incompetence cause unacceptable levels of emotional stress that poses a risk to patients. But this does not follow from the results, which are misinterpreted, and statistical measures and graphs do not support their serious assertion that children are placed at risk. If dissatisfaction were great, would repeated reminders have been necessary to elicit only 22 (56%) responses from 39 eligible junior doctors? To say that this 'response rate represents a 90% confidence interval with a 10% margin of error' is meaningless and distracts from the fact that only just over half ultimately replied. Perhaps the junior doctors did not understand what the questionnaire was about because, to reduce bias, 'the questionnaire was presented as a survey on skills retention and did not make any mention of burnout. ' I doubt whether that could disguise the fact that the questionnaire was about stress and dissatisfaction. Conclusions about 'recruitment, improved management and planning, increased support, mentorship and a more empathetic administration' come presumably from the 'semi-structured' interviews of 4 selected registrars, and therefore reflect the opinion of only 10% of 39 eligible junior doctors. That 95% of junior doctors intended leaving after their rotation does not confirm that they were discontented and burnt out. Contracts determine when junior doctors leave: for SHOs, 6 months to a maximum of 1 year, and registrars at the end of their training period. Had junior doctors been asked whether they would like to remain if a post were available, could not very different results have been obtained? Considering …