A silent epidemic of presenteeism and burnout is undermining the NHS and putting doctors’ health and wellbeing at risk, a study by the BMA warns. 

Fear of letting down colleagues or patients and concerns with discrimination or unfair treatment are among the factors driving many doctors to continue working at the expense of their own health, an association survey of more than 3,500 doctors and medical students finds. 

The findings, which can be found in the report The Cost of Carrying On published on 23 January, highlight the shocking scale to which presenteeism is jeopardising medical staff’s wellbeing and potentially undermining patient care. 

Presenteeism is defined as when an employee attends work but can only perform at a reduced level owing to illness, injury or other reason.  

Conducted between July and August 2024, the survey revealed 81 per cent of respondents said they had worked, trained or studied while not feeling well enough to do so at least once in the previous three months. 

When citing their reasons for doing so, 71 per cent said that wanting to support their colleagues was the main factor, with 59 per cent worried about letting down patients and 40 per cent owing to general concerns with understaffing in their workplaces. 

The pressure to ‘be a team player’ even when unwell was summarised by the experience of one resident doctor based in England, who told the survey that there were explicit expectations and a culture of presenteeism at their trust.  

‘I felt horrid, but expectations from a department consultant-manager was clear from our first day of induction,’ they said.  

‘If you’re ill, you’re still expected to come in because it makes their life easier when filling the rota and they don’t want gaps.’  

‘I don’t want to let patients/colleagues down,’ a GP-based in England told the survey.  

‘It’s a nightmare for everyone if someone is off sick. The receptionists have to cancel all the appointments and others have to do my work. [It’s] easier just to go.’ 

When queried about their concerns with the effects presenteeism had on performance in the workplace, 60 per cent admitted to worrying about making mistakes, while 57 per cent felt less able to make complex decisions and 56 per cent said they feared their quality of care to patients would be diminished. 

The survey reveals that presenteeism also affects the productivity of healthcare staff with 48 per cent of survey participants saying they felt less able to deliver all work with 40 per cent less able to take on additional responsibilities. 

The survey also assessed participants using the Oldenburg Burnout Inventory and found that 93 per cent were scored as at risk of burnout based upon their responses. 

The threat of burnout as a result of presenteeism was also greater for doctors and students with a disability or long-term health condition or who were from minority ethnic backgrounds. 

‘There’s no time to recover so you continue to go in and do your best,’ a medical student based in Scotland told the BMA.  

‘But you end up making illness last twice as long and the strain it takes mentally knowing you’re not doing as well, that you’re falling behind and likely not going to take the material in and learn it at the same rate as you need to adds to strain in an already taxing course.’ 

‘As an international medical graduate in training I always fear being off sick,’ a GP registrar based in Wales confided.