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More than 2 out of 5 residents are burnt out, with female and second year residents particularly at risk, according to the AMA’s exclusive Organizational Well-being Assessment report.
Joining to discuss the report’s key findings and implications in recognition of National Physician Suicide Awareness Day is Mark Greenawald, MD, vice chair of Academic Affairs, Well-being and Professional Development in the Department of Family and Community Medicine at Carilion Clinic and vice chair of Family and Community Medicine at the Virginia Tech Carilion School of Medicine, in Roanoke, Virginia. AMA Chief Experience Officer Todd Unger hosts.
- Download the full AMA Organization Well-being Assessment report.
- Dr. Lorna Breen Heroes’ Foundation aims to reduce burnout of health care professionals and safeguard their well-being. Learn more.
- Call or text 9-8-8 if you or anyone you know needs help. The National Suicide Prevention Lifeline (Formerly @800273TALK) is now: 988 Suicide and Crisis Lifeline. It provides free 24/7 confidential support for people in distress, crisis resources for you or your loved ones, and best practices for professionals in the U.S. Visit: 988lifeline.org.
- Learn more about the AMA Recovery Plan for America’s Physicians.
- The AMA is your powerful ally in patient care. Join now.
Mark Greenawald, MD, vice chair, Academic Affairs, Well-being and Professional Development Department of Family and Community Medicine, Carilion Clinic
Unger: Hello and welcome to the AMA Update video and podcast. Today we're talking about insights from the AMA's exclusive report on resident well-being. And here to discuss that is Dr. Mark Greenawald, vice chair of Academic Affairs, Well-being, and Professional Development in the Department of Family and Community Medicine at Carilion Clinic and vice chair of Family and Community Medicine at the Virginia Tech Carilion School of Medicine in Roanoke, Virginia. I'm Todd Unger, AMA's chief experience officer in Chicago. Dr. Greenawald, welcome back.
Dr. Greenawald: Thank you, Todd. It's a pleasure to be here and to spend some time sharing this important information.
Unger: The AMA's Organizational Well-being Assessment surveyed residents at 17 different institutions across the country in 2022. Let's get right into it. Dr. Greenawald, what were some of the top takeaways from the report?
Dr. Greenawald: Yeah, so Todd, overall, residents showed that they had about an 82% level of program satisfaction, which is about 10% higher than what we see with practicing physicians within health systems. So that was a good sign. In terms of job stress and burnout, both of them were in the 40 percentile range, which is better than what we see with practicing physicians, but still something that certainly is very, very concerning.
The number of hours worked per week was over 60. And what we know about that Todd, is that once you get above 55 hours per week in terms of work, the increase of job distress, as well as anxiety and burnout, go up. So that becomes a significant statistic.
And then finally, the idea of feeling valued was something that really stood out for us. And we're going to talk about that a little bit more in just a moment. But I want to emphasize that was a very important part of the survey.
Unger: Now you mentioned that burnout percentage, relative to physicians—and of course, we've been seeing record levels of burnout on the physician front, over 60% in this past year. So that number looks good. But let's talk a little bit more broadly about the comparables. Should residency directors and their institutions feel good about the results that we're seeing?
Dr. Greenawald: Well Todd, when you look at the statistics and say 41% is good, I think we should all hit pause on that. And that basically as you know, says that two out of five residents are struggling mightily when it comes to their particular work. The other thing that we do know about that is that that doesn't mean that 59% are doing wonderfully. It means that most of them, who are not burned out right now, are in what I would call pre-burnout or survival mode. And that's certainly an area that we can have a great impact in terms of making sure they don't slide down that well-being continuum into burnout.
Unger: Well, the fact that so many residents are burnt out so earlier in their careers shows how much work we have to do. And when you took a deeper look at the data, did you discover any key differences among resident populations?
Dr. Greenawald: Sure did, Todd. One of the things that really stood out to the group was that both in terms of stress and in terms of burnout, female residents scored much higher than male residents, to the order of about 28% for the men versus about 49% for the women. So certainly, that was a statistic that jumped right out as being something very, very important.
The other thing that we found is that there was also a difference by year group. And the second year of residency seems to be a particularly important time, both in terms of distress and burnout, but also potentially in terms of an opportunity to begin to address that. We found about a 10% increase in burnout between the first year and the second year, so certainly something for all program directors and leaders within residencies to make note of.
Unger: Now, the differences that you just talked about are pretty striking. And so, I wanted to dig a little deeper there and get your perspective on both, starting with the gender differences, how can residency directors and institutions begin to address that?
Dr. Greenawald: As we thought about this more, one of the things that stood out for us is not necessarily just the gender difference, but this idea of feeling valued and really beginning to understand what does make a difference in terms of being valued between perhaps genders? And the only way to really determine that is not necessarily even look just to gender, but to individuals, and to be able to begin to understand what would it be for you to feel valued within the organization. We know, as I said earlier, that becomes important because feeling valued will impact anxiety. It will impact stress and distress. And it will impact burnout.
Unger: Really interesting. Let's talk about that second dimension that you mentioned. The increase in stress and burnout between first year and second year residents, what do you think is driving that difference?
Dr. Greenawald: Yeah, it's a great question, and one again, that really jumped out to the group. As we think about the amount of resources that go into orienting first year residents and really in many ways nurturing them through the first year process, as you get to second year, often that stops. And you just transition to second year.
Within my own specialty of family medicine, what we know is that second year is actually by far the harder year and the hardest year of the three in terms of residency. So, the idea of being much more intentional about orienting residents to their second year as well as then continuing, in many ways, with the same kind of support resources that we provide for first year residents, to be able to make sure that continues on into second year could become vital in terms of program directors and other leaders.
Unger: And Dr. Greenawald, as we're talking about burnout, it's also really important to acknowledge the tragic issue of physician suicide. And given the high level of burnout that we're seeing really this early in the physician career, do we need to address physician suicide with even greater urgency?
Dr. Greenawald: Well Todd, when it comes to suicide, I don't think there is anything in terms of greater urgency. The answer is there should be all hands on deck all the time when it comes to that. This Sunday, September 17, happens to be National Physician Suicide Awareness Day.
And when you think about pausing, the fact that we even need to have a day like that is tragic in itself. And yet, we know that the data is real in terms of approximately one physician a day chooses to take their life through suicide because they felt they didn't have any other outlet or any other choice. And so, the ability to engage our colleagues in those conversations and keep it real in terms of the stress and the pressures of being a physician really becomes an essential part of the work that we need to be doing.
Unger: Well, this is just the start of a conversation that all residency institutions need to have. And I would encourage anyone out in those residency institutions to grab a copy of this full report. We're going to include a link to that report in the description of this episode. Or you can just search right into Google, AMA GME Resource Program, again, AMA GME Resource Program, or follow the link in the description below.
Dr. Greenawald, it's really been great to talk to you again. Thanks so much for joining us. We'll be back soon with another AMA Update. In the meantime, you can find all our videos and podcasts at ama.assn.org/podcasts. Thanks for joining us and please take care.
Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.