Burnout Among U.S. Med Students, Residents, and Physicians
Burnout Among U.S. Med Students, Residents, and Physicians
Purpose: To compare the prevalence of burnout and other forms of distress across career stages and the experiences of trainees and early career (EC) physicians versus those of similarly aged college graduates pursuing other careers.
Method: In 2011 and 2012, the authors conducted a national survey of medical students, residents/fellows, and EC physicians (≤ 5 years in practice) and of a probability-based sample of the general U.S. population. All surveys assessed burnout, symptoms of depression and suicidal ideation, quality of life, and fatigue.
Results: Response rates were 35.2% (4,402/12,500) for medical students, 22.5% (1,701/7,560) for residents/fellows, and 26.7% (7,288/27,276) for EC physicians. In multivariate models that controlled for relationship status, sex, age, and career stage, being a resident/fellow was associated with increased odds of burnout and being a medical student with increased odds of depressive symptoms, whereas EC physicians had the lowest odds of high fatigue. Compared with the population control samples, medical students, residents/fellows, and EC physicians were more likely to be burned out (all P < .0001). Medical students and residents/fellows were more likely to exhibit symptoms of depression than the population control samples (both P < .0001) but not more likely to have experienced recent suicidal ideation.
Conclusions: Training appears to be the peak time for distress among physicians, but differences in the prevalence of burnout, depressive symptoms, and recent suicidal ideation are relatively small. At each stage, burnout is more prevalent among physicians than among their peers in the U.S. population.
Numerous studies have found that many medical trainees experience burnout, a syndrome resulting from work-related stress characterized by emotional exhaustion, feelings of cynicism and detachment toward patients (depersonalization), and a low sense of personal accomplishment. This finding is problematic as burnout may erode professionalism, contribute to medical errors, lead to suicidal ideation and attrition, and be a factor in substance abuse and relationship difficulties. Partially in response to the high prevalence of burnout and other forms of distress, medical schools are required to have student wellness programs, and residents' work hours have been restricted in recent years.
Coupled with these institutional approaches to addressing distress in trainees are individualized ones. For instance, many trainees adopt a survival attitude to cope with the stress. By relying on the belief that, in the near future, their efforts will pay off and stress will decrease once their training is complete, many persevere. Yet, little is known about the experiences of early career (EC) physicians (i.e., ≤ 5 years in practice). The transition from training to practice may be a particularly challenging time as physicians establish themselves in their profession, adjust to a new environment, and learn the business aspect of medicine. Indeed, previous studies have documented an inverse relationship between the prevalence of burnout and age among physicians in practice, suggesting that, early in their careers, physicians may experience little relief from the high levels of work-related stress documented during training.
To date, no national study has evaluated the rates of burnout and other forms of distress across different stages of training or compared the experiences of trainees with those of EC physicians. Although a recent national study found a substantially higher prevalence of burnout among U.S. physicians (68% of whom were 20 years or more removed from medical school graduation) than among other U.S. workers, how medical trainees' well-being compares to that of similarly aged college graduates who are pursuing other careers is unknown.
In this study, we compared the prevalence of burnout in a large national sample of medical students, residents/fellows, and EC physicians. In addition, we obtained data from a probability-based sample of the general U.S. population to compare their experiences with those of medical students, residents/fellows, and EC physicians.
Abstract and Introduction
Abstract
Purpose: To compare the prevalence of burnout and other forms of distress across career stages and the experiences of trainees and early career (EC) physicians versus those of similarly aged college graduates pursuing other careers.
Method: In 2011 and 2012, the authors conducted a national survey of medical students, residents/fellows, and EC physicians (≤ 5 years in practice) and of a probability-based sample of the general U.S. population. All surveys assessed burnout, symptoms of depression and suicidal ideation, quality of life, and fatigue.
Results: Response rates were 35.2% (4,402/12,500) for medical students, 22.5% (1,701/7,560) for residents/fellows, and 26.7% (7,288/27,276) for EC physicians. In multivariate models that controlled for relationship status, sex, age, and career stage, being a resident/fellow was associated with increased odds of burnout and being a medical student with increased odds of depressive symptoms, whereas EC physicians had the lowest odds of high fatigue. Compared with the population control samples, medical students, residents/fellows, and EC physicians were more likely to be burned out (all P < .0001). Medical students and residents/fellows were more likely to exhibit symptoms of depression than the population control samples (both P < .0001) but not more likely to have experienced recent suicidal ideation.
Conclusions: Training appears to be the peak time for distress among physicians, but differences in the prevalence of burnout, depressive symptoms, and recent suicidal ideation are relatively small. At each stage, burnout is more prevalent among physicians than among their peers in the U.S. population.
Introduction
Numerous studies have found that many medical trainees experience burnout, a syndrome resulting from work-related stress characterized by emotional exhaustion, feelings of cynicism and detachment toward patients (depersonalization), and a low sense of personal accomplishment. This finding is problematic as burnout may erode professionalism, contribute to medical errors, lead to suicidal ideation and attrition, and be a factor in substance abuse and relationship difficulties. Partially in response to the high prevalence of burnout and other forms of distress, medical schools are required to have student wellness programs, and residents' work hours have been restricted in recent years.
Coupled with these institutional approaches to addressing distress in trainees are individualized ones. For instance, many trainees adopt a survival attitude to cope with the stress. By relying on the belief that, in the near future, their efforts will pay off and stress will decrease once their training is complete, many persevere. Yet, little is known about the experiences of early career (EC) physicians (i.e., ≤ 5 years in practice). The transition from training to practice may be a particularly challenging time as physicians establish themselves in their profession, adjust to a new environment, and learn the business aspect of medicine. Indeed, previous studies have documented an inverse relationship between the prevalence of burnout and age among physicians in practice, suggesting that, early in their careers, physicians may experience little relief from the high levels of work-related stress documented during training.
To date, no national study has evaluated the rates of burnout and other forms of distress across different stages of training or compared the experiences of trainees with those of EC physicians. Although a recent national study found a substantially higher prevalence of burnout among U.S. physicians (68% of whom were 20 years or more removed from medical school graduation) than among other U.S. workers, how medical trainees' well-being compares to that of similarly aged college graduates who are pursuing other careers is unknown.
In this study, we compared the prevalence of burnout in a large national sample of medical students, residents/fellows, and EC physicians. In addition, we obtained data from a probability-based sample of the general U.S. population to compare their experiences with those of medical students, residents/fellows, and EC physicians.
