Dr. James Maskalyk, at the ER entrance of St. Michael's Hospital in Toronto. He has returned to work with a new sense of purpose: helping his colleagues stay healthy at a time of unprecedented stress and burnout in the field.Eduardo Lima/The Globe and Mail
Dr. James Maskalyk felt the irregularity in his neck in May of 2020, just as he and his emergency-room colleagues were bracing to be overwhelmed by COVID-19 patients. Tests showed it was Stage 4 cancer in his lymph node. Surgery soon followed.
“You go through the roller coaster of thinking, ‘I’m dying’ then thinking, ‘No, I’m still here and things are pretty stable,’ ” he said in an interview.
More than two years later, Dr. Maskalyk, a 49-year-old emergency-room physician in Toronto, is healthy again and he has returned to work with a new sense of purpose: He wants to help his colleagues stay healthy at a time of unprecedented stress and burnout in the field.
The recently named executive editor of the Canadian Medical Association Journal, Dr. Maskalyk is also starting a new position as wellness director for nine hospitals affiliated with the University of Toronto.
His new focus comes at an opportune time. All across the country, emergency rooms – and especially pediatric emergency rooms – have been hit by a triple whammy of RSV, influenza and COVID-19, overwhelming staff who were already reporting high rates of burnout.
A 2020 survey by the Canadian Association of Emergency Physicians (CAEP) found that 86 per cent of emergency doctors had experienced burnout and almost 6 per cent had considered suicide in the previous year.
The pressure has only intensified since.
“Volumes are up probably 70 or 80 per cent and staff numbers are down 30 or 40 per cent,” said Rodrick Lim, an emergency-room doctor and chair of the Canadian Association of Emergency Physicians’ wellness committee who co-authored the survey. “These are people that are exhausted from having experienced a pandemic but haven’t really had a return to normalcy. Lots of them are leaving the profession.”
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The state of the health care system depends on stanching the exodus. That’s where Dr. Maskalyk hopes he can help.
Why him? That same CAEP survey found that emergency physicians aged 30 to 39 were four times more likely to suffer burnout than those aged 40 to 49. As someone who’s at the tail-end of that latter cohort and has found endless fulfilment in his work, he feels he’s in a good place to help the helpers.
“I must confess, I love the clinical act,” he said. “The way I want to spend my time is doing patient care, talking to patients, laughing with patients, hearing their jokes.”
Dr. James Maskalyk in the wellness center for ER doctors at St. Michael's Hospital in Toronto.Eduardo Lima/The Globe and Mail
As a start to the wellness work, he wants to tap one doctor in each of Toronto’s university-affiliated ERs to act as a wellness lead. That person will liaise with staff and bring forward possible changes, big and small, to improve staff well-being.
“It can be anything, right up to physical structural level, like creating quiet rooms where staff can take a rest or cry or talk to their kids or anything,” Dr. Maskalyk said.
Next, he’d like to ensure every physician has a therapist, part of his belief, based in scads of research, that a practice of reflection – whether it’s meditation alone or therapy with someone else – can help combat burnout.
“Wellness is different things to different people,” he said. “You can’t just say everyone should meditate for 10 minutes a day – and, by the way, I think they should – but it’s just not realistic for some people. We do need to recognize that there is a way to metabolize the worst of what happens at work.”
He’d like to see hospitals borrow some popular perks from other workplaces such as free food and sabbatical programs.
In the hospital where he practises, St. Michael’s in downtown Toronto, there’s a critical incident debriefing program where staff can talk through tough cases, such as patient deaths or medical mistakes, with colleagues. Every ER could benefit from the approach, Dr. Maskalyk said.
“I’d like to help create a community and a vocabulary where people are allowed to express vulnerability in order to make them feel safe in their environment,” he said.
Before his illness, Dr. Maskalyk was working on a new book, his third, titled Doctor, Heal Thyself, a tour through traditional healing practices around the world. Both the title and the content carry more meaning to him these days.
“You really don’t understand how precious life is until you feel death’s shadow,” he said. “And I think that’s the attitude that I take toward these new roles. The clinical act and medicine saved my life. I cherished it before but now it feels like someone turned up the colour knob on the TV and suddenly things are more vivid and precious.”