From burnout to balance. From excluded to inclusion. 

By Keir Johnson

Dr. Candace Bradshaw is nearly half-way into her year as President of Doctors Manitoba. As she started her term back in May, she delivered a speech at the Doctors Manitoba gala where she made a commitment to her peers.

But, first she started by introducing herself. 

“Good evening, everyone. My name is Dr. Candace Bradshaw and my pronouns are she/​her.”

That small gesture — stating her pronouns— was just one simple demonstration of what’s truly important to her. She used her time at the podium, surrounded by an audience of over 500, to make a clear statement that the profession needs to be more inclusive. 

A more inclusive medical community, she believes, is the cure for many of the issues ailing the profession today. Progress in this area is long overdue for some, but it’s important work that she believes will ultimately benefit every physician.

During her speech Dr. Bradshaw recalled dreaming of being a doctor as a young girl.

“Nobody in my family had gone to university before. I didn’t know anything about becoming a doctor. So, I studied hard. I got straight A’s.”

She stayed focused on her goal, but in high school she was discouraged from pursuing medicine by a guidance counsellor because it could be too difficult for a woman. 

Nevertheless, she stuck with it, inspired by seeing other women physicians and knowing it was where she belonged. 

After sharing this story, she talked to the audience about a photograph from a 1925 Manitoba Medical Association event that hangs on the wall in the Doctors Manitoba office. She explained how the photo was a good visual reminder about how far the profession has come over the last century. There’s a lesson here, she explained. ​“You cannot be what you cannot see.” 

While there’s more women in medicine than ever before, they are still not well-represented in leadership roles. It’s even worse for women of colour. 

A month after the Gala, Dr. Bradshaw led Doctors Manitoba in its first-ever appearance in the Winnipeg Pride Festival, holding the banner during the parade. She described it at the time as a ​“long overdue” symbol of physicians’ commitment to caring for all Manitobans, including those in the LGBTQ2S community.

Under her leadership, the Board of Directors is embarking on a journey to develop an equity, diversity, inclusion and decolonization strategy, both to make Doctors Manitoba more inclusive as a medical association, as well as to inform its advocacy for making the broader medical community more inclusive as well. Of course, this strategy will involve broad member consultation and engagement, ensuring it is developed using an inclusive approach. 

For Dr. Bradshaw, inclusivity extends well beyond race, ethnicity, gender and sexual diversity, and other personal attributes. 

It means ensuring all members have not only an opportunity, but feel welcomed and invited to have a say on issues facing the profession. This is critical, she believes, to ensuring the decisions and advocacy of the organization she leads is rooted in the views and experiences of the broader membership.

During her inaugural speech back at the Gala, she opened up about a time she and many of her colleagues felt excluded by both Doctors Manitoba and the College of Physicians and Surgeons of Manitoba. 

Back in 2014, CPSM surprised many by issuing a new directive called Statement 190. The directive would require all physicians to ensure on-call coverage was in place for all of their patients around the clock. While the principle behind the statement – continuity of care – was and remains important, the move was seen by many as the College arbitrarily directing physicians to fix a gap in the health system. They contended that the health system, and not physicians alone, should be tasked with fixing that gap. 

Without any support, resources or coordination, doctors knew it would lead to burnout, retirements, and challenges with recruitment and retention. 

Initially, Dr. Bradshaw along with the many other physicians raising these concerns, felt excluded, even abandoned, by CPSM and Doctors Manitoba. 

“How could they do this without first consulting doctors and seeking our advice,” she recalled asking.

Eventually, physician feedback was sought. Statement 190 was put on hold for further review. Then, in 2019, the statement was formally rescinded and CPSM acknowledged that ​“the method of mandating its implementation was incorrect in the absence of health care system supports.”

Dr. Bradshaw went from feeling excluded, criticizing Doctors Manitoba for not advocating about physicians’ concerns, to seeing the potential for how a medical association could support physicians’ interests more broadly. The goal, ultimately, should be to strengthen the whole physician, including their economic, physical, mental and professional well-being.

Statement 190 posed a risk to physician health, and served as a reminder that the system needs to be more supportive for physicians and medical learners who are struggling. This is another key to a more inclusive profession.

“Physicians aren’t exactly the poster children of good health. We have a long history of working ourselves into the ground, working until we get sick, working when we are sick. Sometimes we have poor insight into when we need a break.” 

During that inaugural speech, she opened up and talked about her experiences with burnout and isolation earlier in her career. In doing so, she hoped to break down the isolation and stigma that has traditionally surrounded these issues. 

“In third year, during clerkship, I was getting my first taste of real life as a doctor. I had no idea we would be expected to stay up for 30 hours straight, and learn the whole time in that sleep-deprived condition. While I learned a lot of medicine that year, I also learned how poor my tolerance for sleep-loss was.” 

“Let’s just say I burned out early,” she explained.

She found her way by leaning into the support of her family, and she rediscovered her passion for medicine.

Burnout, however, was still stalking her. 

A few years later, she decided to start her practice in a small town in Northern Ontario. Rural medicine would offer diversity and breadth in her practice, a good way to start out and solidify all of her clinical training. She signed on for a three year contract.

Knowing how challenging rural recruitment is, she was clear about her intentions to leave after three years to return to Winnipeg and start her family. She ended up staying an extra year, but there were still no plans in place to recruit her replacement. 

As others on similar contracts left, her call schedule became overwhelming and unsustainable with no end in sight. 

“Burnout was breathing down my neck, yet again,” she recalled.

She knew she couldn’t continue, so she made the difficult decision to leave. She couldn’t put her family on hold anymore.

Burnout was a major issue for physicians before the pandemic, with about 30% experiencing the occupational health syndrome. But the last two years have taken their toll, she explained. A survey earlier this year found half of physicians and medical learners are now experiencing burnout. INSERT GRAPH

“We are in crisis.”

Taking on her role at this moment — with the profession experiencing record levels of burnout and widespread frustration with the health system — has galvanized her resolve to lead and fight for the support physicians and medical learners need. The support all physicians and medical learners need.

“I think it’s important for every physician to feel reassured when they hear the word inclusive. It means all of our members should have a bigger say in Doctors Manitoba, and they should each be supported to thrive as a physician.” 

During that speech last May at the Gala, Dr. Bradshaw ended by making a commitment to her colleagues. 

“I say to you, and to all physicians in Manitoba, you are what motivates and inspires me.” 

“You are the reason I am here doing this.”

“And so, I pledge to you that I, and we here at Doctors Manitoba, have your back, every step of the way forward.”