After completion of Medical School, residency training is a requirement, and it is a grueling learning experience. It requires a competitive resume, higher education, taxing work hours, relatively restricted income, and lack of autonomy. As a result, resident physicians’ mental health may be impacted. This may induce symptoms and increase the likelihood of burnout. Burnout describes an emotional depletion and loss of motivation from prolonged exposure to chronic emotional and interpersonal stress on the job. Three dimensions have been used to describe the complex syndrome of burnout: emotional exhaustion, depersonalization, and feelings of decreased personal accomplishment (1, 2). Personal and professional consequences are evident and may become symptomatic. Residents experiencing symptoms of burnout are at an increased risk of delivering suboptimal patient care and contributing to an increase in medical errors (3, 4, 5, 6). Residents are also at a higher risk of substance use, alcohol consumption, depression, and suicidal thoughts and attempts (7, 8, 9, 10, 11).
The prevalence estimates of burnout among residents vary widely between medical and surgical specialties, gender, geographic location, and post-graduate year in training. Standardized tools to assess burnout are currently lacking and therefore, the exact prevalence remains unknown (12, 13). Studies show that more than half of all US physicians experience professional burnout, and the incidence is increasing (14) Burnout is increasing in prevalence with 45.5% of physicians surveyed in 2011 reporting symptoms of burnout compared to 54.4% in 2018. Additionally, feelings of an adequate work-life balance are declining with 48.5% in 2011 and 40.9% in 2014 reporting an inadequate experience (6). Physicians have been shown to have higher levels of burnout, when compared with other professions. Despite higher levels of burnout, the rate of physician suicide is on par with the general workforce in the United States. According to the Center for Disease Control in the United States, the “all occupation” suicide rate for men and women in 2016 was 27.4 and 7.7 per 100,000 respectively. This is compared to the rates for healthcare practitioners which are 23.6 for men and 8.5 for women per 100,000 respectively. Burnout is also a factor that can lead to substance abuse. In a 2015 study that surveyed physicians regarding substance use disorders, 12.9% of men and 21.4% of women physicians who responded met criteria for alcohol abuse or dependence (11).
Systemic causes of burnout involve issues in the learning environment and overall institutional culture (15, 16). The hierarchy in medicine often leads to a paternalistic atmosphere with dominant authority figures. Workplace climate clearly has an influence on overall resident well-being. Notoriously, surgical specialties have had a higher rate of burnout when compared to non-surgical medical residencies (7). Similarly, those in their intern (post-graduate 1st ) year and those who identify as female gender are more likely to experience burnout (17). Previous studies have also suggested that some personality traits are more likely to be associated with residents experiencing symptoms of burnout such as pessimism, neuroticism and high conscientiousness. Those self-identifying as anxious or disorganized are more likely to experience burnout. However, emotional intelligence and perseverance are strong predictors of resident well-being (4, 18, 19, 20).
The COVID-19 pandemic has affected levels of burnout throughout most, if not all jobs in the healthcare field. Many physicians were re-deployed to help care for COVID positive overflow patients, with a large portion of those physicians coming from specialties who were not trained to care for complex intensive care patients, particularly those residents in the surgical specialties. The two specialties that have likely been affected the most are anesthesiology and emergency medicine physicians. Anesthesiologists have been on the front line, putting themselves at much higher risk than most in the medical field during intubations on COVID positive patients. Similarly, emergency room physicians are exposed to patients before their COVID status is known putting themselves at a higher risk of exposure. Additionally, the sheer volume of COVID positive patients is highest in the ED because the clinicians see COVID positive patients who are ultimately discharged home in addition to those who are admitted to the hospital. Physicians in all fields have had to experience sicker patients and significantly more deaths than they likely would have previously. This has taken an enormous emotional toll on the medical health care clinicians overall.
This survey was conducted at a large academic residency program that spans two separate hospitals. The residents and attendings cover an extremely high-volume labor and delivery (L&D) floors with approximately 17,000 deliveries per year. Not only are they high volume, but the acuity of the patients can be quite significant. The L&D are accompanied by a level 3 and a level 4 NICU, so many transferred for neonatal concerns are received. Additionally, the patients may have very high-risk pregnancies, including significant heart failure, end stage renal disease on dialysis, and patients with high order prior cesarean sections or other significant abdominal surgeries.
When physicians have high levels of burnout it affects not only their quality of life and job satisfaction, but also the quality of the care they provide for patients, and this may affect patient safety. There are various factors that may affect perceived burnout that are different during day shift hours when compared with night shift hours, includes fewer support staff, fewer social interactions outside of the workplace, and difficulty adjusting to an opposite sleep schedule.