Pauline Anderson

May 17, 2015

TORONTO, Canada — Burnout rates among medical residents are reaching epidemic levels, new research suggests.

A survey conducted by investigators at the University of North Carolina, Chapel Hill, showed that approximately 70% of residents met criteria for burnout.

"We can't continue to ignore this problem of burnout," said Emily Holmes, MD, chief resident, University of North Carolina, Chapel Hill. "Burned out residents become burned out physicians."

Dr Holmes presented the results here at the American Psychiatric Association (APA) 2015 Annual Meeting.

Burnout by Specialty

Burnout is defined as the combination of emotional burnout, depersonalization, and low personal accomplishment. "So it's looking at your schedule in the morning and thinking, how am I going to get through it all," said Dr Holmes. "It becomes harder and harder to do what you need to do in a day's time."

According to the investigators, burned out residents are more likely to self-report that they have provided suboptimal care and have made medical errors. To better understand which factors most contribute to burnout and which interventions may be most helpful in alleviating it, the investigators surveyed 504 resident physicians via electronic survey between May and June 2014.

Residents from all specialties at the University of North Carolina were asked to complete the voluntary, institutional review board–approved electronic survey, which included the Maslach Burnout Inventory, a tool that measures burnout, and the Patient Health Questionnaire.

Results revealed that general surgery (89%), radiology (85%), surgical subspecialties (82%), anesthesiology (81%), and internal medicine (79%) had the highest rates of burnout, whereas pediatrics (53%), family medicine (50%), and pathology (46%) had the lowest.

However, Dr Holmes noted that even pathology, which at almost 50% had the lowest rate of resident burnout, still had a very high rate. "I want to point out that only one program had a rate of less than 50%," she said.

At 70%, psychiatry residents were in the middle of the burnout range.

There were no differences among specialties by sex, age, marital status, number of children, race, or ethnicity. There was also no difference in terms of postgraduate year, which Dr Holmes found surprising.

"We thought that as they advance in their training, there would be less burnout, but we didn't find that to be the case."

Residents who felt that their medical school training did not adequately prepare them for the demands of residency were more likely to experience burnout (P = .03), as were those who experienced a serious medical (not psychiatric) illness before residency (P = .03). Only 1 of the 10 residents who had a serious medical illness did not have burnout.

Dr Holmes also looked at depression and found an overall rate of 17%. Demographic factors did not make a difference to these rates, although married residents were less likely to be depressed than divorced or separated ones.

Suicidal ideation over the previous 2 weeks was reported by eight residents. One of them reported suicide ideation nearly every day.

However, depression did not necessarily correlate with burnout. For example, pathology residents had a greater than average depression rate (23%), but the lowest rate of burnout, and anesthesiology residents had high rates of burnout, but low rates of depression (7%).

"Burnout is not the same thing as depression; having one does not necessarily mean you have the other," said Dr Holmes.

Burnout Contributors

From a list of 10 possible items, residents identified what they felt were the biggest contributors to burnout. Top of the list were lack of time to exercise, take care of oneself, and/or engage in enjoyable activities outside of work; conflicting responsibilities between work, home, and family responsibilities; and time spent on electronic records and documentation.

"This speaks to the overall struggle of work–life balance in residency, and I think that time spent on electronic medical records is just a piece of that," said Dr Holmes.

Compared with other residents, psychiatry residents were more likely to report that feeling underappreciated and having difficulty with patients contributed to burnout. Psychiatry residents were also more likely to support a formalized mentoring program, training on how to deal with difficult patients, debriefing after difficult patient outcomes, and formalized peer support after a difficult patient outcome.

This, said Dr Holmes, indicates that because the "skill set" of psychiatry residents includes connecting with people, that might put "even more pressure" on them to do a good job.

Possible Interventions

Residents were also asked about interventions that might address burnout. Here, they felt that more vacation time, increased support, and on-site childcare and exercise facilities would help alleviate burnout.

"Anything we can do to help residents achieve a work–life balance is going to be beneficial," said Dr Holmes. "It might be something as simple as putting a gym in the hospital, where residents can work out instead of trying to fit that into their schedule after they go home."

Incorporating therapy techniques earlier in the psychiatric training program might also help, she said. "We don't get therapy training until further on in our residency, but we've been having difficult patient encounters since day one."

The researchers also surveyed program directors and got a response rate of 60%. They found that 92% of directors thought the rate of residency burnout would be less than 50%. In addition, 58% reported spending 5 to 20 hours a month supporting a struggling resident.

Need for Support

Commenting on the findings for Medscape Medical News, session chair Edmond Pi, MD, professor emeritus, clinical psychiatry and behavioral sciences, Keck School of Medicine, University of Southern California, Los Angeles, noted that the burnout rates reported by Dr Holmes are higher than those reported in the literature.

Strategies to try to prevent and treat burnout among residents include early recognition of the problem and the creation of both a professional and a personal support system, said Dr Pi.

"Also important are engaging, connecting, establishing the balance between resources and demands and between life and work, and being appreciated."

Dr Holmes has disclosed no relevant financial relationships. Dr Pi reports he is a consultant to Bracket Global.

American Psychiatric Association (APA) 2015 Annual Meeting. Presented May 16, 2015.

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