Food insecurity might seem like a danger to which physicians would be immune, but with new research suggesting the problem may be surprisingly widespread, well-being efforts in Geisinger’s graduate medical education (GME) programs are targeting nutrition as part of a holistic approach to their resident and fellow physicians’ well-being.
“While resident physicians are finally making a salary, the salary is not typically commensurate with the number of hours worked and what most would consider to be a high hourly rate,” noted Kelly Shaw, PsyD, a licensed clinical psychologist and program director for GME well-being at the Geisinger College of Health Sciences. “Oftentimes our residents and fellows find themselves living paycheck to paycheck.”
Danville, Pennsylvania-based Geisinger is part of the AMA Health System Member Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
Shaw said Geisinger takes a multipronged approach to physician well-being during training, one that incorporates residents and fellows’ bodies, as well as their minds.
The extent of the problem
A study published in December in JAMA Network Open™ shows that a surprisingly high proportion—almost 14%—of resident and fellow physicians reported having uncertain access to or not enough food at some point in the previous year.
Employing the “Hunger Vital Sign” screening tool, researchers categorized those who said they either had uncertain access to food or not enough food in the previous year as having food insecurity. Researchers also found that residents and fellows’ food insecurity was linked to higher rates of doctor burnout and social isolation.
The overall prevalence of food insecurity among the survey’s respondents was 13.7%, but varied geographically, with greater percentages of those in GME in large metropolitan areas reporting food insecurity, as well as by program year, with those earlier in training more likely to say they had either uncertain food access or not enough food at times.
By comparison, the USDA found that in 2023, 13.5% of all U.S. households were categorized as having either “low” or “very low” food security. One limitation the of the resident study noted by authors is that while the survey covered four training sites at two academic medical institutions, “experiences at other institutions may differ.”
Shaw said Geisinger seeks to have its residency and fellowship programs reflect the communities in the surrounding area, which, in rural locations especially, means the physicians may not come from privileged backgrounds. Some send pay back to family members to help make ends meet. Often, residents are entering the repayment period for their medical student-loan debt, which nationally exceeds $200,000 on average.
“There’s financial insecurity that could play into access to food and nutrition,” Shaw said. Residents “need access to consistent nutrition to nourish their bodies and their minds so that they can be thinking clearly, they can be partnering well with others in the interprofessional health team, they can be thinking creatively and coming up with treatment plans that are going to meet the needs of the patients and their families.”
Study uncovers coexisting problems
The study was co-written by Larissa R. Thomas, MD, MPH, Liselotte N. Dyrbye, MD, MHPE, Daniel Satele; Saadia Akhtar, MD, Jonathan A. Ripp, MD, MPH, Katherine A. Julian, MD, Diane Sliwka, MD, and Colin P. West, MD, PhD. These researchers incorporated data from surveys of 1,656 residents and fellows in 2023 about their well-being, and also their experiences with food. They were surprised by the extent of the problem but warned that their research should not be taken to suggest that food insecurity is a more pressing problem among physicians-in-training than the public at large.
Residents and fellows with food insecurity were about 1.4 times as likely to say they felt burned out and were less likely to want to stay at their institution after their training had ended. They also had higher social isolation scores than their peers.
Shaw, of Geisinger, noted the complex interplay between burnout and food insecurity, creating a self-sustaining cycle.
“DoorDash from McDonald's costs a heck of a lot more money than having time to meal prep and bring in and heat up your leftovers that you had time to make on Sunday night,” she said. “But if you're working an extended, inordinate number of hours, you aren't going to have the time, the physical and the mental energy to do thoughtful, nutritious meal planning, which is going to then save you money. So it does become this really cyclical thing.”
The AMA has resources to serve as a collaborator in addressing the factors that cause resident burnout and stress, including the AMA Joy in Medicine® Health System Recognition Program, which empowers health systems to reduce burnout and build well-being so physicians and their patients can thrive, and the AMA STEPS Forward® open-access toolkit “Resident and Fellow Well-Being: Optimize Well-Being at Work for Physician Learners.”
Food insecurity’s impact on resident physicians
In addition to the physical effects, food insecurity can take its toll in other ways. Physicians talk to patients all the time about healthy eating and caring for the body to prevent illness.
“That leads to a psychological incongruence,” Shaw said, between how residents may need to live their lives and how they tell their patients to live theirs. Due to training demands, some might sideline their nutrition or exercise needs. “So much of our psychological health and well-being comes from congruence lived out and finding that I am who I say I am—I live out who I say I am to the best of my ability.”
As the leader in physician well-being, the AMA is reducing physician burnout by removing administrative burdens and providing real-world solutions to help doctors rediscover the Joy in Medicine®.
Actions to take
The research shows addressing food insecurity and other cost-of-living concerns among residents and fellows may benefit physicians-in-training as well the patients they care for and the health care organizations where they work.
In the JAMA Network Open study, the authors concluded that “institutions should include attention to systemic solutions to address FI [food insecurity] in residents and fellows as a critical component of supporting resident and fellow well-being.”
Potential residency program food-security interventions outlined in the study include:
- Free or reduced-cost food available at hospital or clinic sites, including outside of regular mealtimes.
- Partnerships with local establishments for discounts.
- Disseminating information about local options for lower-cost meals and groceries.
- Benefits that reduce other costs of living, such as flexible spending accounts for health and child care expenses or commuter benefits.
At Geisinger, residents and fellows have access to snacks in the GME lounge at the health system’s primary hospital in Danville, Geisinger Medical Center. They also get financial literacy training to help with budgeting, and Shaw said residents get a yearly well-being stipend that can be used for meal-prep classes, meal kits, meal delivery services or any other expense they feel supports their well-being. In addition to the well-being stipend, residents and fellows who work 55 or more hours per week on average receive additional GME funds that can be used at Geisinger’s in-house food venues.
Shaw said it’s also key to challenge “the stigma around seeking help, around acknowledging that they are not alone,” adding that some Geisinger residents come “from families and experiences where they didn't have consistent access, and they're bringing that to their adult selves. And while, yes, they are anticipated to make a pretty comfortable living eventually, they may not be at that point now, and yet they may face the societal expectation of ‘Who are you to complain?’”
