The relationship between burnout and work hours among U.S. resident physicians may be complex and vary among distinct populations of those in training, according to a study recently published in JAMA Network Open™.
Researchers found that residents in some high-burnout specialties were not more likely to suffer from burnout if they worked more hours, even though they were more likely to report feeling stressed.
In the study, “Work Hours, Stress, and Burnout Among Resident Physicians,” 540 residents were surveyed in 2024 about their burnout, stress, sense of personal accomplishment and performance on Accreditation Council for Graduate Medical Education (ACGME) milestones.
The study found no significant relationship between burnout and the average hours worked by the residents, though it did find a relationship between stress and hours worked. Those who worked more hours were also more likely to report doing better on ACGME competency milestones.
“Resident burnout is influenced by more than just number of hours worked,” says the study. “It depends on what occurs during work hours, life outside of work, an individual’s relationship to work, and the organizational culture and broader systems within which residents work.”
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Resident burnout a continuing problem
As among all physicians, resident burnout rates have fallen from the historic heights seen in recent years. But work remains to be done, with a national survey showing about half of residents and fellows still reporting symptoms of burnout.
The ACGME in 2003 moved to restrict resident work hours—formerly referred to as “duty hours”—to a maximum monthly average of 80 hours a week, with no shift being longer than 24 consecutive hours. The AMA has comprehensive policy that supports these limits as well as ongoing research on the matter and the connection between resident work hours and well-being, patient safety and other important outcomes.
Some research has found that limiting the number of duty hours may not improve patient care. Further complicating the matter is the reality that residents need adequate time with patients and experience with different types of cases to hone the skills they need to excel in practice.
The research team behind the JAMA Network Open study found that more work hours were associated with residents having a higher perception of their abilities in ACGME core competencies of patient care, practice-based learning and improvement, professionalism, and interpersonal and communication skills.
The study was co-written by Sydney F. Tan, MD; Hana Siddiqui; Alex Pinto, MS; Bridget Paur; Guanhua Chen, PhD; Dawn M. Elfenbein, MD, MPH; Vincent Minichiello, MD; Bruce Barrett, MD, PhD; Richard J. Davidson, PhD, and Simon B. Goldberg, PhD.
Resident burnout defies simplistic conclusions
A separate study published in the journal Academic Medicine late last year, however, found that working more hours may increase a resident’s risk of burnout.
For that study, co-sponsored by the AMA, researchers surveyed 3,486 residents and fellows in late 2023 and early 2024. The physicians in training were asked questions about burnout and depression and about how satisfied they were with their work-life integration.
Overall, 50% of the residents and fellows surveyed for the Academic Medicine study reported symptoms of burnout. Adjusting for personal and professional factors, residents and fellows had a 50% higher risk of burnout than did similarly aged U.S. adults. But, when average weekly work hours were added to the burnout model, residents and fellows were at lower risk of burnout than were the workers in other fields.
There were, however, important distinctions between the populations surveyed in the two studies.
In the JAMA Network Open study, the residents were training in a mix of “high-burnout” medical and surgical specialties, for example, with 43.9% of respondents in surgical specialties and 7.2% in emergency medicine. Additionally, those who were already participating in well-being efforts such as regular meditation were excluded from the results. The residents were also self-selecting, representing those who wanted to participate in a well-being intervention. And the number of residents and fellows surveyed was much smaller than in the Academic Medicine study.
“Our results should not be used to support arguments to eliminate work-hour restrictions, either,” the authors of the JAMA Network Open study wrote. “Rather, these findings indicate that further limiting work hours to prevent burnout is an overly simplistic proposal. Well-being is not simply decreasing negative factors; it is doing so while not affecting the positive indicators such as self-efficacy and personal accomplishment.”
The AMA has resources to serve as a collaborator in addressing the factors that cause physician burnout and stress. These include the Joy in Medicine Health System Recognition Program that empowers health systems to reduce burnout and build well-being so that physicians and their patients can thrive, and the AMA STEPS Forward toolkit, “Resident and Fellow Well-Being: Optimize Well-Being at Work for Physician Learners.”
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®.
