Resident & Student Health

Learn about 2 big risk factors for medical resident burnout

The results of a survey of more than 3,500 second-year medical residents show that 45 percent reported physician burnout symptoms. The research, published in JAMA, found big differences by medical specialty, but it also uncovered physician burnout risk factors that extend beyond specialty choice.

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“We know the prevalence of burnout among residents is high, that it varies by clinical specialty and that it largely mirrors findings in physicians in practice—suggesting that there are different stressors in different practice settings,” said the study’s lead author, Liselotte Dyrbye, MD, co-director of the Program for Physician Well-Being at the Mayo Clinic in Rochester, Minnesota.

One in seven residents reported regret about their career choice, says the study, “Association of Clinical Specialty With Symptoms of Burnout and Career Choice Regret Among U.S. Resident Physicians.” The prevalence of reported burnout symptoms was highest among urologists (63.8 percent) and lowest among dermatologists (29.6 percent).

Committed to making physician burnout a thing of the past, the AMA has studied, and is addressing, issues causing and fueling physician burnout—including time constraints, technology and regulations—to better understand the challenges physicians face. An AMA STEPS Forward™ module offers a five-step plan to help prevent resident and fellow burnout.

Here are two medical resident characteristics—beyond clinical specialty—that are associated with higher risk of resident burnout.

Gender

The frequency of burnout symptoms was higher among women physicians, which can be due to difficulties with work-life balance and work-home conflicts, sexism, stereotype threat and discrimination.

Among the female residents surveyed, 48.8 percent reported burnout, compared with 41.5 percent of the men. The researchers’ statistical analysis found that women residents’ relative risk of burnout was 17 percent higher than that of their male counterparts.

“That wasn’t that surprising of a finding—that residents who were women were at a higher risk of burnout relative to male residents—because we have seen the same thing in physicians in practice,” said Dr. Dyrbye, an AMA member. “In our studies we have collaborated on with the AMA we have also found that being a woman physician in practice is an independent predictor of burnout.”

“It is probably an array of factors that are impacting both women physicians in training and in practice. It's a challenge to figure out exactly how to solve that or what might be some of the contributing factors,” she said.

Medical-school anxiety

Lack of social support, lower empathy and high levels of anxiety during the last year of medical school also are linked to higher risk of burnout during residency. It can also influence career and specialty choice regret.

“The higher your level of anxiety is at the end of medical school, the more likely you are to have burnout in residency,” said Dr. Dyrbye. “And sort of the inverse with empathy. So the higher your reported level of empathy at the end of medical school, the lower your likelihood of burnout in residency.”

Medical students with higher levels of anxiety—as measured during year four of their undergraduate medical education—had an 8 percent higher relative risk of burnout compared with those reporting less anxiety during med school.

“That points to opportunity for both individual-as well as school-level strategies,” she said. “What can we do to nurture the development of empathy so more students graduate with high degrees of empathy? And what can we do as both an individual medical student, but also as a medical school, to reduce students’ anxiety?”

AMA’s STEPS Forward is an open-access platform featuring more than 50 modules that offer actionable, expert-driven strategies and insights supported by practical resources and tools. Based on best practices from the field, STEPS Forward modules empower practices to identify areas or opportunities for improvement, set meaningful and achievable goals, and implement transformative changes designed to increase operational efficiencies, elevate clinical team engagement, and improve patient care.

Several modules have been developed from the generous grant funding of the federal Transforming Clinical Practices Initiative (TCPI), an effort designed to help clinicians achieve large-scale health transformation through TCPI’s Practice Transformation Networks.

The AMA, in collaboration with TCPI, is providing technical assistance and peer-level support by way of STEPS Forward resources to enrolled practices. The AMA is also engaging the national physician community in health care transformation through network projects, change packages, success stories and training modules.