Given the long duty hours that resident physicians put in and the intense pressure they face in residency training, it is no surprise that residents report high degrees of stress and burnout.
Compared with similarly aged U.S. workers in other fields, residents have a 51% higher risk of burnout, according to a survey of nearly 3,500 residents whose results were published in Academic Medicine in September.
Just as residency programs set a high bar in training, so should residents in turn have elevated standards for the kind of help they get to prevent and mitigate burnout during this stressful period.
“Residents should have high expectations of support because their day-to-day is really hard,” said Emily Lisco, MD, a psychiatrist and director of the Emotional Health & Wellness Program for House Staff at Philadelphia-based Jefferson Health. “We should be thinking creatively about how to meet those expectations.”
Jefferson Health 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.
Dr. Lisco and her colleagues built a campus pilot for counseling services into a systemwide model serving nearly 2,000 residents.
Removing barriers to care
Dr. Lisco joined Jefferson Health in 2020 as a part-time psychiatrist for residents at the system’s Center City campus in Philadelphia. Within 18 months, she was able to hire another therapist and last year she was named full-time director and added three more therapists, one psychiatrist and an administrative assistant.
Jefferson Health had expanded to five graduate medical education sites and was training twice as many residents and fellows. The persistent problem of burnout and depression, combined with the stigma often attached to mental health issues, spurred Jefferson Health to make well-being a priority.
The issue extends far beyond Jefferson Health. An AMA issue brief (PDF) outlines systemwide approaches that reduce burnout and strengthen a culture of well-being across organizations.
The AMA has policy that—among other things—encourages medical schools, residency and fellowship programs “to provide or facilitate the immediate availability of urgent and emergent access to low-cost, confidential health care, including mental health and substance-use disorder counseling services.” According to AMA policy, these services should:
- Include appropriate follow-up.
- Be outside the trainees' grading and evaluation pathways.
- Be available—based on patient preference and need for assurance of confidentiality—in reasonable proximity to the education or training site, at an external site, or through telemedicine or other virtual, online means.
“We started with a student-counseling model,” Dr. Lisco said, with three free visits and then referral to an outside physician or mental health professional. However, “I wanted to continue to see the residents. Why not continue this care over the long term?” She wanted the services to remain free for residents and make the program financially sustainable. Because Jefferson Health is self-insured, the counseling center could bill the system’s own plan for residents’ visits, creating internal revenue without residents incurring out-of-pocket expenses.
The Jefferson Health program addressed residents’ specific needs. Telehealth, evening appointments and specialized services such as couples counseling are now available through a confidential system operating independently of residency training programs.
“Being able to remove barriers was important,” Dr. Lisco said. “After that, it grew because residents encouraged one another to come in.”
For the 2025–2026 year, Jefferson Health was honored with gold-level recognition as part of the AMA Joy in Medicine® Health System Recognition Program. “That reinforces the work we’ve been doing,” Dr. Lisco said during a presentation at this year’s American Conference on Physician Health. “It reflects our residents’ trust in the system and our leadership’s commitment to making mental health support part of their training.”
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 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.”
From pilot to systemwide model
Expanding the model across Jefferson Health’s multiple campuses meant asking questions, listening and meeting stakeholders where they are.
“Some already had some kind of support in place for their residents,” she said. “But we were able to make leadership understand that we weren’t redundant, but additive.”
Dr. Lisco believes that resident well-being strengthens the entire organization.
“I think of us as being an ecosystem,” she said, noting that even one thriving part makes the whole stronger. Because residents occupy dual roles as learners and practicing physicians, supporting their mental health benefits them individually while improving patient care and performance throughout the system.
Use of the Emotional Health & Wellness Program has grown dramatically. From 2023–2024, appointments grew by 44%. Up to 20% of residents access the services, which Dr. Lisco said is nearly double the national average for student-counseling centers, and Jefferson Health surveys show that up to 97% of residents believe the program helped them make their time in residency training more successful. Others said that the program prevented them from dropping out while becoming better physicians and colleagues.
Services are confidential and protected by HIPAA, Dr. Lisco said. “We do not disclose any information, and their records and history are protected,” she noted, adding that “notes and documentation are kept in a separate EMR.” While bills are generated manually through Epic, “there are no accompanying notes in Epic.”
Sharing the model
Residency programs interested in developing similar initiatives should thoroughly assess existing resources, Dr. Lisco said.
“What exists around the residency program?” she asked. “A student-counseling center is a great place to start because it’s infrastructure that’s already in place.” Many already fund a portion of a physician or mental health professional’s time, which could be shared across departments or specialties, and others might consider partially funding a therapist’s schedule to provide services for residents.
Buy-in requires curiosity and flexibility. “Ask a lot of questions, find out what leadership’s and residents’ pain points are and create a Venn diagram where they overlap,” she said. “That’s where you can sell the idea that this will help everyone.” Also, start small. “Pick one thing to workshop and pilot. If it doesn’t work, choose another. But if it does, grow it across different areas.”
Residents must also recognize the difference between common stress levels for this stage of their education and serious mental health issues.
“The biggest red flag is thoughts of self-harm,” Dr. Lisco said. “That can be scary, but having those thoughts doesn’t automatically mean hospitalization. Instead, talk to someone who can monitor that and be in it with you.”
Also: pay attention to recovery cycles.
“If someone works through two or three blocks but during the lighter week can’t clean their apartment, talk to people or make dinner, that’s definitely something to address,” she said. “Having an unbiased person to talk with about struggles at work—even if it’s not a major depressive episode—is really useful.”
Jefferson Health’s elevation of well-being shows that even large, complex health systems can provide effective mental health care for physicians in training.
“Every day, I feel like I’m learning about other hospitals that are doing excellent work,” she said. Utilization among Jefferson Health residents remains strong and their patient satisfaction is high.
The ripple effect, she said, goes far beyond the individual resident. “Helping physicians during training and knowing it will shape how they care for their own patients is the best thing I can do.”
