Health care organizations looking to recruit physicians are starting to realize they may not have to go very far. The best candidates for open positions could be those already being trained in their residency programs.
That’s why it is increasingly key to find out more about residents’ experiences, burnout and program satisfaction—and to use that data to drive systemic solutions to improve resident physicians’ well-being.
“We are now seeing more and more organizations want to continue the relationship that they've built with their residents by recruiting and retaining them into their organization,” said Nancy Nankivil, the AMA’s director of organizational well-being.
“It's becoming important for residency programs and organizations to really have the dialogue about what does it look like working for us and where is our priority with regard to organizational well-being for the long term with our physicians that we bring in?”
The 2024 AMA National Resident Comparison Report shows that 33.3% of residents reported being likely to stay in their organization, a drop of 5 percentage points over the previous year’s figure. Some specialties reported an even higher intention to leave—perhaps most notably, in obstetrics and gynecology, where only one in four residents hopes to stay with their current institution.
Here’s how the data played out, by specialty, of those who intended to remain with their organizations after residency:
- Pediatrics: 40.5%.
- Family medicine: 35.6%.
- Internal medicine or primary care: 35%.
- Emergency medicine: 33.7%.
- Obstetrics and gynecology: 26.8%.
Women were slightly more likely than men to say that they intended to stay in their current organization, with 34.3% of female physicians saying they planned to remain in their organization after completing residency training, compared to 32.9% of male physicians.
Based on responses from more than 3,600 resident physicians in the U.S., the AMA National Resident Comparison Report reflects 2024 trends on six metrics—job satisfaction, job stress, burnout, feeling valued by an organization, intent to stay after residency and total hours spent per week on work-related activities (known as “time spend”).
The findings, which are exclusive to the AMA and are not published anywhere else, represent data from all organizations that surveyed residents with the AMA’s Organizational Biopsy® in 2024.
Taking the temperature during training
There are some important considerations when examining the data about residents intending to stay with their current organizations. Key variables could influence responses to the question. For example, residents in some specialties may be planning to leave at the end of their residency training to pursue fellowship training, which likely has little to do with satisfaction with their current organization.
Nankivil pointed out that more variation could come from the seeming differences between program years. Resident physicians may learn more about their health care organizations as they progress through training, which could cause them to be more—or less—likely to stay.
Physicians in training might come in their first year thinking, “I love it here,” Nankivil said, then later decide that staffing or other factors are issues, for example.
“The more our data is strengthened in volume and consistency over time through repeat surveys, the more we will understand subpopulations of residents,” Nankivil said of the AMA National Resident Comparison Report. The AMA has offered the resident well-being survey since 2021, and the question about intent to stay was added in 2023.
Resident physicians also make up a small share of all U.S. doctors, with Accreditation Council for Graduate Medical Education data showing 162,644 active residents and fellows, compared with 1.01 million active physicians in the country.
The connection, therefore, between an intent to stay with a health care organization and resident well-being needs to be further explored. Nankivil encouraged more health care organizations with residency training programs to take in part in the AMA’s organizational well-being assessment (PDF) work or email [email protected] for more information.
According to the 2024 AMA resident survey data, 34.5% of residents reported burnout in 2024, a number that fell 8 percentage points from the 2023 findings. Residents reported higher job satisfaction, lower burnout and a greater sense of being valued by their organization than in the previous year’s survey. For comparison, 43.2% of all practicing physicians reported burnout in 2024. There is, however, continued and at-times significant variation in reported resident burnout by program year, specialty and gender.
But AMA data shows that intent to leave in practicing physicians overall dropped in 2024, going from 35.7% to 31.9%, demonstrating the importance of a continued barometer on resident intent to stay in the institution where they trained.
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®.
To retain residents, talk to them
Residents “want to have these candid conversations” with employers about topics such as well-being, Nankivil said.
“They may couch it in compensation,” she said, “They're thinking about debt they need to pay off and what their work-life balance may look like postresidency. But for many residents, it goes beyond that.”
Nankivil said some of the questions residents want answered include:
- What is my schedule going to look like?
- What is the staffing going to look like?
- How much administrative burden have I experienced in these workflows that may not exist as much in another organization?
- What are my career advancement opportunities?
In her transition to practice, family medicine physician Paulina McCabe, DO, opted to stay where she trained—Bayhealth, the nonprofit Delaware health system. Bayhealth has more than 5,000 employees and 400 physicians in Central and Southern Delaware, and is part of the AMA Health System Member Program that provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
Dr. McCabe also shared some of the key questions that she asked herself when considering where to practice after finishing her residency training.
“The most important question that you have to ask yourself is: What kind of lifestyle do I want for myself? That goes for any specialty,” she told the AMA. Two other pivotal questions: Where do you see yourself living down the line? How do you envision your practice? Lastly, she said, it’s important to know whether the employer’s onboarding allows for adequate ramp up.
“Will you be seeing five to 10 patients per day? Or will they ask you to see 20 patients per day immediately? You want your first few weeks to be very light so you can get used to the EHR and all the processes,” Dr. McCabe said, adding that it’s important to know the employer’s policies around matters such as the patient portal. “If you’re getting swamped with patient messages, do you have to answer them within a certain time frame? Will you get help from, say, the nursing staff?”
The AMA gives health care organizations a vital tool in learning about their residents’ experience, which can help attract and retain them after their training ends.
With the Organizational Biopsy, the AMA offers a set of services for health systems and organizations. This includes a well-being assessment tool developed to support holistically measuring and taking action to improve well-being in an organization.
The Organizational Biopsy helps assess progress in four domains:
- Organizational culture such as leadership, teamwork and trust.
- Practice efficiency, which includes workflows and team structure and stability.
- Self-care such as managing post-traumatic stress, post-traumatic growth and work-life balance.
- Retention, which means keeping physicians in practice.
Also explore the AMA STEPS Forward toolkit, “Resident and Fellow Well-Being: Optimize Well-Being at Work for Physician Learners,” which outlines key steps that should be taken to address resident burnout.
