A Burnout Prevention Prescription for Med Students and Residents

Alexa M. Mieses, MD, MPH

Disclosures

May 05, 2016

Just weeks ago, I learned that a second-year internal medicine resident in New York City committed suicide. She jumped out of a window. Of course, I was shocked. But then I began to remember how I felt at the start of my own third year.

A cluster of suicides occurred in New York City in 2014. One resident from New York-Presbyterian and another from New York University leapt from a window within weeks of each other. I remember thinking, "What did I sign up for?"

The word is buzzed about and discussed but rarely internalized and unpacked: burnout. It is defined as a syndrome of emotional exhaustion and depersonalization, combined with a sense of low personal accomplishment, that leads to decreased effectiveness at work.[1] Each of these features may manifest in various ways and to different degrees. It should come as no surprise that the effects of burnout are similar to those of depression. I've come to think of it as being on the same spectrum, just not as severe.

Most of us know how common burnout is among healthcare professionals. A Duke University study surveyed nearly 1000 postgraduate trainees and found that 65% met criteria for burnout.[2] Another study, published in Academic Medicine, found 60% of medical students and residents to be burned out, along with 50% of early-career physicians.[3] Quite simply, burnout is higher among medical professionals compared with the general population. For example, one study surveyed more than 7000 physicians and found that 38% of them were burned out, compared with only 23% of workers in the general population.[4] Medscape's most recent Physician Lifestyle Report found a burnout rate of 40%-55% among the 25 specialties surveyed.

Burnout affects not only the individual but also the patients whom that individual serves. One study found that self-reported patient care was rated lower among burned-out internal medicine residents.[5] Another study found that as burnout increases over the course of a long-call shift, empathy decreases.[6] Yet another study reported that the depersonalization dimension of physician burnout was associated with lower patient satisfaction and longer postdischarge recovery time.[7] Burned-out physicians may retire from medicine or, even worse, commit suicide, robbing the field of talented and compassionate practitioners.

We talk and talk about the statistics and numbers. We even discuss how to recover when burnout has set in. But as medical professionals, we know that the true value comes in prevention. And that means starting as a medical student entering residency. As I prepare, I have done my best to write a prescription for burnout.

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