What are the biggest challenges that residents face in 2016? Is bullying a problem? Is depression? What about suicidality? Do today's residents have time to attend to personal health and wellness? To lead satisfying social lives? Are they too tired to function well owing to long shifts? Are they still looking forward to being doctors? Would they use telehealth in their practices after completing residency training?

Here, more than 1800 residents in 25 specialties offer insights into these and other intriguing issues. All participants were enrolled in a US medical resident program.

Percentages within may not always add up to 100% owing to rounding.

Given that many residents routinely work 80-hour weeks, it's not surprising that work-life balance was cited in 2016 as being the biggest challenge by one third (33%) of residents in years 1 to 4 of their residency programs and 40% of residents in their fifth through eighth years. Work-life balance ranked first in our 2015 report as well. Dealing with time pressures was cited as the second greatest challenge in 2016, regardless of residency year. Fear of failure or making a serious mistake was also high on the list of challenges for residents this year, as was developing the clinical skills required in one's specialty. Although dealing with stress has long been known to be a problem for residents, it was not considered the biggest challenge that they face.

Nearly 1 in 4 (24%) respondents in our 2016 residents report said that bullying was often or occasionally a problem in their residency programs. "These data reveal that one quarter of our doctors in training experience workplace bullying," observes family physician Pamela L. Wible, MD, who often lectures on physician bullying and whose articles on the subject for Medscape have elicited hundreds of comments from doctors, many of whom recall bullying incidents from their days as residents. "Teaching by fear and intimidation is an antiquated and unacceptable way to train our physicians," Dr Wible asserts. "Hospitals, clinics, and medical schools must have a zero tolerance policy with regard to bullying."

Whereas nearly one quarter (24%) of our respondents reported that they were often or occasionally bullied, over three quarters (77%) maintained that they were rarely or never picked on unfairly. But of the hundreds of comments on the subject offered by residents who participated in our 2016 survey, the majority came from victims of bullying. The general sense they conveyed was that being the low man or woman on the totem pole may bring out bullying behavior in a wide range of healthcare clinicians and administrators.

Ten percent of respondents in our 2016 report revealed that they felt depressed all or most of the time—a significantly higher percentage than the general population. (In 2014, 6.7% of all US adults were depressed, according to the National Institute of Mental Health.^[1]) One third of residents (33%) said they were sometimes depressed. Slightly more than one half (53%) indicated that they were never or rarely depressed.

Although no respondents in our 2016 report indicated that they had attempted suicide, a very high 9% of residents stated that they had had suicidal ideation. (According to the 2012 National Survey on Drug Use and Health, 2.9% of adults 18 years of age or older who had completed college had seriously considered suicide.^[2]) The majority of our respondents (87%) said that they had never considered suicide, and 4% preferred not to answer the question. "Forty-three percent (nearly one half) of all residents are sometimes or always depressed," reflects Dr Wible. "Nearly 10% have contemplated suicide. We must confront the system issues that lead so many doctors in training to suffer and offer nonpunitive on-the-job mental healthcare as the norm in all medical institutions."

Residents appear to be making more time to take care of themselves. In our 2016 report, nearly two thirds (65%) of the respondents indicated that, at least some of the time if not more often, they were able to pay attention to personal health and wellness. However, slightly over one third (34%) of residents said they rarely or never have enough time to attend to their health and wellness.

Nearly one quarter (24%) of male residents and nearly one fifth (18%) of female residents regularly attended to their health and wellness. This was higher than in 2015, when 15% of male residents and 11% of female residents said that taking care of themselves was routine. This year, 45% of male residents and 40% of female residents said they sometimes paid attention to personal health and wellness, compared with 53% of male residents and 47% of female residents in 2015.

With work weeks of 60 hours or longer, regular night call, frequent fatigue, and low salaries, do residents have the time, energy, and financial means to date, see friends, and spend quality time with their families? The answer is yes. Over two thirds (70%) of our respondents indicated that they had time to lead satisfying social lives—an even greater percentage than those who said they regularly or at least sometimes had time for personal health and wellness (65%). Still, nearly 1 in 3 (30%) of our 2016 respondents said that they rarely or never had time for friends, family, or romance during their residency years.

Nearly 1 in 2 residents views being in a relationship with another physician desirable. Given the long hours that residents work, and the limited time they have to meet suitable partners outside the hospital environment, this may be practical. In addition, a physician is likely to be a partner who understands and sympathizes with the challenges and stresses of life as a resident.

The longer residents are in the residency program, the more they are likely to wonder whether medicine was the right choice. In our 2016 report, first-year residents were most enthused about their careers as physicians (15% indicated that they look forward to their lives as doctors). Only 10% of second-year residents felt the same. Among third-year residents, enthusiasm for medicine climbed again, with 14% attesting that they looked forward to medical careers. But thereafter, the percentages decreased.

Over two thirds (69%) of residents said they were always, mostly, or sometimes too tired to function well owing to long shifts. That is concerning. In the past decade, some hospitals have tried 16-hour caps for resident shifts, but treatment hasn't improved, nor have hospital errors decreased.^[3] The Accreditation Council for Graduate Medical Education has been evaluating residency work-hour limits. It was due to make recommendations in April, but in May said that more time was needed.^[4]

Given that 69% of residents surveyed this year said they were sometimes, mostly, or always too tired to function well owing to long shifts, it's not surprising that well over one half (58%) of our respondents feared making a serious mistake. Still, 43% of residents in our 2016 report maintained that they rarely or never feared dropping the ball in a way that could seriously harm a patient.

The percentage of residents who have occasional doubts about being a good doctor has remained relatively consistent: Nearly two thirds (64%) of our respondents expressed such doubts in 2016, compared with over two thirds (68%) in 2015. In other categories, however, doubts about being a good doctor appeared to be on the rise. Those who felt doubtful all the time totaled 7% of respondents in 2016 vs 3% in 2015. Those who felt doubtful most of the time totaled 19% of respondents this year, but 9% last year. The percentage of residents who felt completely confident in their abilities has declined to 11% of respondents in 2016 vs 20% in 2015.

Regardless of gender, residents' confidence in their ability to diagnose and treat patients appears to be somewhat less secure this year than it was last year. In our 2016 report, 87% of male residents and 94% of female residents indicated that they had at least some doubts about being a good doctor, and 6% of male residents and 8% of female residents indicated that they were chronically doubt-ridden. In 2015, 76% of male residents and 85% of female residents said they had doubts about their ability as physicians at least some of the time, if not more often.

Telehealth visits are growing in popularity among patients, but among doctors they remain controversial. Critics charge that a visit for even a seemingly minor urgent care complaint carries the risk of missing something important if the patient can't be physically examined. Do residents agree? In our 2016 report, over two thirds (67%) of the respondents indicated that they would have no problem using a webcam or similar technology to conduct a remote patient visit by videoconference. Over one half (59%) would conduct a remote patient visit over the phone, and over one half (52%) would feel comfortable consulting with a patient via email.

Most residents (67%) work in hospital settings. Although serving in the military or an underserved area can reduce medical school debt, it's an option that few residents choose. Similarly, graduate medical education funding is available for community-based teaching sites, which is intended to produce more primary care physicians. But with more than one half of primary care residents looking to switch to higher-earning specialties, this opportunity currently has fewer takers.