Resident well-being isn’t one size fits all. That is evident in trends revealed in an AMA report, drawing more than 1,600 responses from physician residents and fellows from about twenty residency programs from across the United States.
The report—Organizational Well-Being in Residency: 2022 National Comparison Report—features the aggregate data from the Organizational Biopsy® (PDF). The AMA offers comprehensive resources, including the Organizational Biopsy, that allow residency institutions to measure and take action on the systemic level of burnout in their trainees. In addition to measurement, the AMA also offers development training for learners and faculty members that address contributing factors to burnout.
The report reflects 2022 trends in organizational well-being, burnout and other outcomes from the working environment of residents and fellows. A recent AMA Insight Network webinar presented the findings. Here are some key takeaways.
Women report higher stress
When offered the statement “I feel a great deal of stress because of my job,” as part of the survey, 37% of women residents agreed with it and 15% agreed strongly. Those figures are higher than their male counterparts, 24% of whom agreed, with 7% agreeing strongly.
As that stress continues to mount, it translates to higher levels of burnout among women residency trainees in comparison with men, the survey found. When asked if they felt professionally valued, a factor that has shown to protect against burnout, women residents were 8 percentage points less likely to respond they felt valued “to a great extent.”
“We don’t often ask the question: What would it be for you to feel valued?” said Mark Greenawald, MD, vice chair of family and community medicine at the Virginia Tech Carilion School of Medicine and vice chair for academic affairs, well-being and professional development at Carilion Clinic. “If we believe that is an important aspect of residency well-being, what do we know about this not just of residents in general, but different individuals. How do they measure feeling valued?”
Burnout varies by year
Second-year residents demonstrated the highest job-related stress levels of any residency training year. As is the case with the gender-related correlation, higher burnout rates among PGY-2 residents was identified, with the number of residents who indicated they felt “completely burned out” being twice as high as the figure was for PGY-1s.
“Often we know that our PGY-1 residents are going to have challenges and therefore may get a different type of attention,” Dr. Greenawald said. “As we approach PGY-2s, we don’t necessarily think about the same type of orientation even as the level of responsibility increases exponentially in most programs.
“Since I’ve seen this data and started working with our incoming PGY-2s, we’ve been much more intentional around orientation and checking in on them, particularly throughout the first month of their second year.”
Many are shying away from health services
When asked about barriers to pursuing mental health care, the common themes among residents were a preference to pursue those avenues personally, concerns about confidentiality and limited access to mental health services.
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The go-it-alone attitude may be a learned behavior that residents pick up from peers and faculty members, Dr. Greenawald opined. The data opens an opportunity for peer support in this arena.
“Peer support becomes very important,” Dr. Greenawald said. “How do we encourage the residents to talk to each other about their journey.”
At Virginia Tech Carilion, Dr. Greenawald said residents take part in “facilitated resident support groups where the whole purpose of them is to talk about the journey. It’s not to solve any problems. It’s not to do any therapy. It’s really to say the health care journey can be many things. It’s a wonderful opportunity and chance to serve, but it’s also really challenging. We need to normalize that conversation with them.”
At the 2023 AMA Annual Meeting, the House of Delegates adopted policy calling for resident physicians to automatically get mental health screenings unless they opt out, and have access to mental health, substance-use awareness and suicide-prevention screening programs.
Data indicates that opt-out and automatic-enrollment mental health and wellness programs are effective in engaging residents. One program for first- and second-year resident physicians at West Virginia University yielded 93% attendance in auto-enrolled wellness appointments.
