The growth in mental health awareness and advocacy around the globe has exposed the psychological limits that individuals can reach in academic- and career-based paths. Terms like “burnout” — the intense emotional, physical, and mental exhaustion connected to excessive stress — are often linked to depression and anxiety.

In sensationalized careers like medicine, it might come as a surprise that burnout plagues the medical world to a staggering extent. A 2018 national survey by the Canadian Medical Association indicates that one in four physicians experience elevated levels of burnout, while one in three screen positive for depression.

In a recent editorial published in the Canadian Urological Association Journal, Dr. Martin Koyle, the Head of the Division of Urology at The Hospital for Sick Kids, recounted his personal experiences grappling with burnout and depression as a physician.

The Varsity sat down with Koyle to discuss his challenges with depression and burnout in his lifelong career in medicine. He contended that his experiences stem less from the practice of medicine itself and more from the bureaucracy and social dynamics entangled within the Canadian health care system.

Koyle’s experience in the medical system

Koyle’s recollections began in 1976, when, as a fresh medical school graduate, he moved from Canada to the United States to begin his long and accomplished career. He’s practiced medicine in Los Angeles, Texas, San Francisco, Denver, and Seattle. He was employed in positions varying from academic faculty to Chief of Pediatric Urology and Renal Transplantation.

While practicing in the United States, Dr. Koyle spoke highly of the Canadian universal single-payer health care system, placing it on an esteemed pedestal which he hoped the US could one day emulate. 

However, the intense public scrutiny that came along with his position as Division Chief at the Seattle Children’s Hospital, coupled with a personal family tragedy and a physical injury, led him to return to Canada in 2011. In Toronto, he began his practice as the Head of the Division of Urology at The Hospital for Sick Kids.

Upon returning to Canada, Koyle promptly realized that the Canadian health system was quite different than the romanticized version he had been promoting during his time in the US.

“I realized from day one that all that I was, was a number,” he said. The system, although advertised as universal, lacked strongly in quality of patient care and career gratification. In the US, Koyle discussed his feeling of belonging to a “community” and being “part of a family.” He personally knew other physicians, and trusted them with his patients when referring them to other specialists. He also felt a general feeling of gratification and mutual appreciation within this supportive network.

In Canada, however, this community aspect was lacking for Koyle. He especially felt uncertain of who would assess his patients in the future. “I didn’t know any of my patients. They didn’t know me. I didn’t know who would see them in follow up,” he said. These factors were further discouragement which added to the climate of emotional hardship.

Koyle also mentioned that the sense of entitlement to health care in Canada contrasts to that of the US, where patients failing to respect wait lines and no-shows are more common, causing other patients to wait longer in order to receive the care they need. To top it all off, recent intense hospital budgeting in Ontario has undercut the quality of patient care available, in ways such as limiting operation times for patients during surgery.

As Koyle summed up his contrasting experience practicing in Canada: “My support from the institution is very different, my control in my environment is very different, my relationship with my patients and with their families and with their providers is very different, and the outcomes are very different in that in the States where my primary physician… was the quarterback in the system in that patient’s care.”

“Here, the buck stops at me… I’m not providing the healthcare that I want to provide to people [due to these social dynamics of the Canadian health care system].”

Koyle’s experiences in a wider context

Although Koyle emphasizes that these experiences are his own, and that some aspects of his burnout and depression are connected to personal challenges faced in his life, he is most certainly not alone in his experiences with mental health challenges in medical careers.

A recent review underscores the factors contributing to Koyle’s burnout: most cases of physician burnout in Canada are neither related to patient care, nor to the practice of medicine itself. Factors such as bureaucracy in the health care system, as well as negative social dynamics with other health care professionals and coworkers, play a more prominent role. 

[pullquote]Factors such as bureaucracy in the health care system, as well as negative social dynamics with other health care professionals and coworkers, play a more prominent role [in physician burnout, compared to the practice of medicine itself].[/pullquote]

Notably, with physicians expected to constantly project a “healthy” image, it’s not surprising that studies show that only eight per cent of urologists suffering from burnout seek professional help. This strikes a chord for Koyle, who recalled his own hesitation and fear in initiating regular appointments with his now-psychiatrist.

“You’re afraid that somebody will find out, that you’ll go in and somebody will say, ‘he’s crazy.’” But Koyle, who is now open to discussing his appointments, has found that his psychiatrist has helped him to a great extent, in addition to his yoga and practice of meditation. Today, he is a strong mental health advocate, and encourages those battling with burnout and depression to seek the help that they need.

When asked about his thoughts on hope for the future, Koyle is cautiously optimistic. Having recently finished a Master’s degree in Quality Improvement Patient Safety, with another Master’s connected to international health policy and leadership underway, he aims to develop a skillset to change the climate of the system he works in — both for the benefit of patients under the system’s care, as well as for physicians who impart treatment.