The Current Landscape of Resident and Fellow Burnout and the Importance of Addressing It


According to international data accumulated by the U.S. National Library of Medicine, National Institutes of Health (NIH), up to as many as 75 percent of medical residents across specialties experience some form of burnout. In addition to the toll that burnout can take on personal well-being and professional satisfaction, it also poses a significant threat to patient care.

Why Medical Residents and Fellows Are Feeling Burned Out

Painfully grueling hours and lack of sleep have long been a staple of medical residencies, and many argue that the practice is actually essential to training effective doctors and surgeons. However according to statistics, physician burnout reportedly jumped from 40 percent to over 50 percent by 2017. There are a number of factors that can account for the rise in burnout rates, which most commonly manifest by way of physical and mental exhaustion, depersonalization (disconnect from patients) and "reduced accomplishment."

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Some of the more common factors attributed to the rising rates of burnout among doctors across practice areas include:

  • Increased bureaucracy and administrative compliance mandates such as ICD-10 and EHRs
  • Higher patient loads
  • Salary concerns
  • Longer hours
  • Effects of the Affordable Care Act (ACA)
  • Lack of work/life balance

According to one study of burnout rates on a group of residents, the burnout rates were as high as 70 percent, with little differentiation between factors such as field of specialization, gender, marital status and race. Among the more obvious factors that contribute to physician burnout, residents and medical fellows often experience the additional stressors of feeling inadequately prepared for their work by their academic programs, and a lack of time to pursue self-care activities like exercise, balancing family obligations, and the ability to maintain an active social life outside of work. The growing burden of unmanageable student debt burdens, which can reach close to $200,000 on average, according to the Association of American Medical Colleges, can also weigh more heavily on medical residents.

The Importance of Addressing Burnout at the Resident and Fellow Level

Few topics that can have such a profound impact on both physician performance and the quality of care that patients ultimately receive are swept under the rug or considered as taboo as the topic of burnout, especially at the resident and fellow level. As with any field, the habits and patterns that residents develop when they leave medical school are likely to continue throughout their careers, but with much higher stakes. As Dr. Emily Holmes, chief resident at the University of North Carolina, Chapel Hill, put it when she addressed the 2015 annual meeting of the American Psychiatric Association (APA), "burned out residents become burned out physicians."

The Impact of Not Addressing Fellow and Resident Burnout

Depression, stress, anxiety and loss of empathy for patients are some of the common side effects of burnout for residents and physicians. The National Institutes of Health have recommended taking an interventional approach to identifying and helping to manage burnout, as well as recognizing the importance of mental health and well-being for medical professionals. According to the NIH:

In order to provide medical training that both prepares trainees to become skilled physicians and preserves their mental health in the process, we must implement innovative, evidence-based interventions aimed at individual trainees, medical schools and residency programs, health care institutions, and educational systems. Despite the alarmingly high rates of burnout and depression among medical trainees, they do not readily seek appropriate mental health treatment from qualified professionals, due, in part, to concerns about confidentiality and stigma.

Recognizing the problem and taking steps to address it are critical in order to prevent resident burnout from become a full-blown epidemic.

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