Adanmışlıktan Tükenmişliğe, Tükenmişlikten Vazgeçişe: COVID-19 Pandemisi’nde İstifa Eden/Emekli Olan Hekimlerin Çığlığı
Göksel Altınışık Ergur, Şadiye Nuhoğlu, Cansu Çobanoğlu, Nazlı Çetin, Pınar Bostan, Ali ErgurCOVID-19 Pandemisi’nde haziran ayı itibariyle esnek çalışma düzeni sonlandırılmış, “normalleşme” uygulamalarına geçilmiş, devlet memurlarına, özellikle sağlık çalışanlarına uygulanan istifa/emeklilik yasağı kaldırılmıştır. Çalışmamız, COVID-19 Pandemisi’nde istifa eden/emekliye ayrılan hekimlerin bu kararlarını sosyolojik açıdan değerlendirmeyi amaçlamaktadır. Nitel özellikteki bu araştırma, yarı-yapılandırılmış, yüz yüze mülakat tekniğiyle, çevrimiçi olarak hekim görüşmecilerle gerçekleştirilmiştir. Yaşlarının ortancası 50 olan 19 görüşmeciden 9’u istifa etmiş, 10’u emeklilik kararı vermişti. Görüşme ifadelerinin kodlarında, işten ayrılma kararını etkileyen etmenler, organizasyon sorunları, yönetimin yaklaşımı, mesleği icra etme koşulları, meslek anlayışı, kişilik özellikleri, yakın çevrelerinin yaklaşımı araştırılmıştır. Pandemi döneminde sağlık çalışanlarının istifa ve emeklilik eylemi, enfekte olma-başkasına bulaştırma korkusu, sağlık sistemindeki sorunlar, ağır çalışma şartları; sürecin ne kadar süreceğini bilememekten kaynaklı tükenmişlik hissiyle açıklanmaktadır. Bireyin toplumsala olan inancını yitirdiği ve toplumsal dayanışmanın çözüldüğü bir anomi hâli olarak kriz bağlamında, adaletsiz görev dağılımı, organizasyon bozuklukları, belirsizliğin sorumluluk kavramını muğlaklaştırması, meslektaşların görevden kaçınma davranışları, takdir görmeme ve kişilik özellikleri, ayrılma davranışına zemin hazırlayan başlıca unsurlar olarak saptanmıştır. Toplumla mübadeledeki dengesizlik, bireyin adanmışlıkla çalışmasının hak ettiğine inandığı ödülü kendi kendine vermeyi seçmesine yol açmıştır. Bu araştırmada, COVID-19 Pandemi sürecindeki istifa ve emeklilik olgularının arkasında yatan etmenleri, vazgeçiş salgınına dönüşmesinin önlenmesi için yapılması gerekenleri anlamaya yönelik bir tür otopsi yapılmaktadır.
From Dedication to Burnout to Turnover: The Cry for Help from Doctors Who’ve Resigned or Retired during the COVID-19 Pandemic
Göksel Altınışık Ergur, Şadiye Nuhoğlu, Cansu Çobanoğlu, Nazlı Çetin, Pınar Bostan, Ali ErgurIn the COVID-19 pandemic, flexible work schedules were terminated in June 2020, normalization practices were initiated, and resignation/ retirement bans on healthcare workers were lifted. This study aims to evaluate the decisions of doctors who’ve resigned or retired during the COVID-19 pandemic from a sociological perspective. This qualitative research was conducted online using the semi-structured face-to-face interview technique with physician interviewees. Of the interviewees (Mage = 50.9 years), 9 had resigned and 10 had decided to retire. When coding the interview statements, the factors affecting the decision to leave employment were investigated such as organizational problems, managerial approaches, the conditions for cognizance in performing and understanding the profession, personality traits, and approaches in their immediate environment. During the pandemic, healthcare workers’ acts of resigning or retiring have been explained through the fear of being infected/infecting someone else, problems in the health system, intense work conditions, and feeling burned out due to not knowing how long the process will take. In the context of the crisis as an anomie in which the individual loses faith in society and social solidarity dissolves, the main factors setting the basis for leaving work have been identified as unfair distribution of tasks, organizational disorders, ambiguity regarding the concept of responsibility due to uncertainty, collegiate behaviors that shirk duty, lack of appreciation, and personality traits. The imbalance in exchange with society has led individuals to choose to give themselves the rewards that they are unable to get from others. This research performs a kind of autopsy to understand the factors behind cases of resignation and retirement during the COVID-19 pandemic and what needs to be done to prevent this from turning into a contagion turnover.
The first three months of the COVID-19 pandemic began in Wuhan, China in December 2019 and has been a peak period of struggle and increased workload for healthcare workers all around the world. Turkey instated an official and general ban on turnover for healthcare workers. After that period, the flexible work orders were terminated in June 2020, normalization practices were initiated, and the resignation/ retirement ban on healthcare workers was lifted. The gradual increase in the number of COVID-19 patients and the unfair shift of responsibilities to certain branches and organizations have increased the workload on these healthcare professionals and obliged them to maintain this pace without flexibility in their schedules. At that time, the news of doctors who had resigned or taken early retirement started to be heard sporadically, but that issue has become taboo, possibly due to those healthcare professionals having refrained from giving interviews and the fragility of the situation. Therefore, addressing this wave of renunciation is crucial from a sociological perspective as it may have the potential to influence the future of the pandemic in terms of public health. This study aims to evaluate the decisions of doctors who’ve resigned or retired during the COVID-19 pandemic according to visible as well as background factors, results, and future reflections.
This qualitative research was conducted online using the semi-structured face-toface interview technique with physician interviewees from different cities in Turkey. Of the 19 interviewees (Mage = 50), 11 are female and 8 are male; 9 had resigned and 10 had decided to retire. The interviews were completed between August 21 – September 1, 2020. Immediately designing and studying the subject is important due to the likelihood of a new ban on the resignation and retirement of healthcare workers as a result of the high frequency of similar resignation/retirement cases in addition to the remarkable increase in the number of new COVID-19 patients, related issues, and predictions that the workload might exceed the capacity of the health system.
In coding the interview statements, the factors affecting the decision to leave employment have been investigated in terms of organizational problems, managerial approaches, cognizance of the conditions for performing and understanding the profession, personality traits, and the approaches in their immediate environment. Real-life experiences have been analyzed based on the interviewees’ expressions and been discussed in accordance with theoretical approaches.
According to the results from our research, the backbreaking effect of increased workload and the fear of being infected and transmitting it to others in particular are the most common anxieties among healthcare workers who have decided to resign or retire. According to our interviewees, the common reasons for their decision to resign or retire are their intense working conditions, not knowing how long it would take to end under these conditions, the appearance of psychiatric disorders, and increased levels of burnout. However, our research has observed the negative effects of organizational disorders and inequality in work distribution at various levels on healthcare workers. The interviewers shared their experiences on the demanding managerial policies in their work places and on situations where they were unable to ensure team cohesion. The expectation for better and healthier working conditions is prominent among the conditions that they stipulated for not resigning or retiring.
One can say the act of leaving that is realized by resigning or retiring is not a reflex of avoidance of duty but an act derived from the experience of loneliness caused by the weakening of social ties and trust systems in the clinic. The decision to quit from healthcare professionals who lost faith in their institution due to ineffective or rightsviolating management or in their profession and division of labor due to their colleagues’ shirking duties, and who have experience a kind of loneliness is thus not only related to individual causes but also to the essence of social relations that led the individual to this behavior. In the context of the crisis that emerged as a kind of anomie in which individuals had lost faith in the social order and solidarity had dissolved, this study has determined the unfair distribution of tasks, organizational disorders, colleagues’ shirking duties as a result of the uncertainty ambulating the definition of responsibility, the lack of appreciation, professional disappointment, and personality properties as the main factors predisposing them to resign/retire. Moreover, shirking duties among colleagues has caused a kind of dissolution in the network of solidarity within the clinic, and this dissolution of the bonds that hold the social fabric together has facilitated both a questioning of professional belonging and feeling of isolation. The interviewees emphasized resigning/retiring to have not only been a reflex response specific to the crisis, but to also have been related to the problems in the pre-pandemic period.
Doctors who struggle with dedication at the level of not hesitating to risk death and sacrifice their personal life to work since the pandemic began may choose to withdraw from professional life because of anomia. The reasons for anomia might be the heavy working conditions, organizational problems, unjust and ineffective management, and burnout, in addition to the frustration caused by the lack of support from both patients and society. Afterward, they have sought opportunities for rebirth while heading toward different areas or changing their workplace for more optimum conditions. The interviewees showed signs of having personalities such as fighters and altruists. The imbalance in exchange with society has led them to choose to give themselves the reward they were unable to get from others.
In conclusion, our study supports the documentation of sociological backgrounds on and outcomes from the decisions to resign or retire made during the COVID-19 pandemic. Thus, a kind of autopsy has been performed to understand the factors behind those cases and to help clarify what needs to be done to prevent this from turning into a contagion turnover. Studies on social sciences would create valuable knowledge in the near future to improve health systems and interrelated health policies.
