A nationwide survey of thousands of physician residents and fellows shows that 50% reported symptoms of burnout in 2023, a drop from the 60.3% burnout rate found in a similar survey led by the same research team in 2012.
Meanwhile, the burnout rate for practicing physicians was 45.2% in 2023, says the study published online ahead of print in Academic Medicine in September. The improvement comes amid more than a decade of widespread, consistent efforts by the AMA and other leaders in medicine to address the systemic factors that drive burnout among all physicians, both those who have made the transition to practice as well as those still in training.
Despite the progress shown by the study findings, researchers found that residents and fellows were at higher risk for occupational burnout when compared with similarly aged workers in other fields.
However, physicians in residency and fellowship training were less likely to report symptoms of moderate or severe depression than were those in the rest of the workforce—17.4% for physicians in training compared with 21.9% for other workers. Of practicing physicians, 13.1% had moderate or severe symptoms of depression.
Meanwhile, researchers found that practicing physicians were more likely to be satisfied with work-life integration than were residents and fellows—42.2% compared with 33.2% for those in training. In 2012, satisfaction on this measure of work-life balance was also higher among practicing physicians (48.5% compared with 28.2%).
The results “simultaneously affirm the efforts to improve the training experience of trainees during the past two decades and emphasize that there remains more work to do,” the study says.
At the same time, the results show there is lots of room for improvement to ensure that the nation’s future physician workforce is protected from burnout and depression in graduate and postgraduate medical education.
“The news is generally better, which is good because there's been significant action in the last decade to try to improve the training environment,” said Michael Tutty, PhD, MHA, one of the study’s authors and the AMA’s group vice president of professional satisfaction and practice sustainability. “There's still work that needs to be done. The good news is that the data is getting better, and, hopefully, if we do this study again in another five years, it'll be better again.”
For the study, co-sponsored by the AMA, researchers surveyed 3,486 residents and fellows between Nov. 30, 2023, and Jan. 2, 2024. They were asked questions about burnout and depression and about how satisfied they were with their work-life integration.
The results, Tutty said, can help guide health care organizations and residency and fellowship programs as they work to address the systemic factors that affect well-being for physicians in training.
“It's an opportunity for programs to continue to support residents and fellows,” he said. “People recognize the stress that goes into the residency and fellow training environment,” but the importance is in how to “get them to be well-trained and excited to become a practicing physician and not be so burned out during the training experience.”
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®.
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Work hours make a difference
The study’s authors noted that duty-hour limits and well-being initiatives for residents and fellows have resulted in improvements over the years.
“Initiatives to drive progress have moved beyond personal resilience training and support for individuals in distress to include structural changes to enhance the learning environment and provide support during the formative postgraduate training years,” says the study.
In some instances where residents and fellows reported worse states of well-being, once the researchers adjusted for the number of hours worked, the gap narrowed or disappeared.
Residents and fellows reported working an average of 60 hours a week, or 10 hours more each week than practicing physicians did. Additionally, 30.1% of residents and fellows and 11.1% of practicing physicians worked more than 70 hours a week. Those in residency and fellowship training also worked an average of 20 hours more than similarly aged U.S. workers in other fields, with only 1.2% of other U.S. workers passing the 70-hour weekly workload.
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. Also, the difference in depression scores among residents and fellows when compared with practicing physicians was no longer statistically significant after adjusting for gender, relationship status and weekly work hours.
Additionally, the depersonalization scores were higher for residents and fellows than they were for practicing physicians, with 40.8% of those in training scoring in the high depersonalization range, compared with 28.6% of practicing physicians.
Residents and fellows had lower rates of satisfaction with work-life integration, at 33.6%, than did U.S. workers in other fields, at 58%. But, once again, when weekly work hours were factored in, the gap with the results of similarly aged workers disappeared.
But improving resident and fellow well-being is not as simple as cutting back further on duty hours. The issue is complicated by research showing that adequate time with patients and exposure to different types of cases is crucial for residents and fellows to develop the skills they will need to excel as practicing physicians in their chosen specialty.
The AMA has resources to serve as a collaborator in addressing the factors that cause resident 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.”
