Thursday, September 15, 2011

Quality of life, debt, and burnout among doctors-in-training (residency)

A recent JAMA article titled, "Quality of Life, Burnout, Educational Debt, and Medical Knowledge Among Internal Medicine Residents," concludes:
In this national study of internal medicine residents, suboptimal QOL and symptoms of burnout were common. Symptoms of burnout were associated with higher debt and were less frequent among international medical graduates. Low QOL, emotional exhaustion, and educational debt were associated with lower IM-ITE scores (Internal Medicine In-Training Examination (IM-ITE) scores).
Here's what the researchers found:
  • Quality of life was rated “as bad as it can be” or “somewhat bad” by 2402 of 16 187 responding residents (14.8%). 
  • Overall burnout and high levels of emotional exhaustion and depersonalization were reported by 8343 of 16 192 (51.5%), 7394 of 16 154 (45.8%), and 4541 of 15 737 (28.9%) responding residents, respectively.
  • In multivariable models, burnout was less common among international medical graduates than among US medical graduates (45.1% vs 58.7%; odds ratio, 0.70 [99% CI, 0.63-0.77]; P < .001). Greater educational debt was associated with the presence of at least 1 symptom of burnout (61.5% vs 43.7%; odds ratio, 1.72 [99% CI, 1.49-1.99]; P < .001 for debt >$200 000 relative to no debt).
  • Residents reporting QOL “as bad as it can be” and emotional exhaustion symptoms daily had mean IM-ITE scores 2.7 points (99% CI, 1.2-4.3; P < .001) and 4.2 points (99% CI, 2.5-5.9; P < .001) lower than those with QOL “as good as it can be” and no emotional exhaustion symptoms, respectively.
  • Residents reporting debt greater than $200 000 had mean IM-ITE scores 5.0 points (99% CI, 4.4-5.6; P < .001) lower than those with no debt. These differences were similar in magnitude to the 4.1-point (99% CI, 3.9-4.3) and 2.6-point (99% CI, 2.4-2.8) mean differences associated with progressing from first to second and second to third years of training, respectively.
So, what does this suggest? For one thing, residency is grueling and many people burn out or feel that life is terrible. Does this change once physicians complete their residency and enter the busy working world of high-volume patients and stressful working conditions? For some, their outlook improves because their salary has significantly gone up. For others, they battle with greater stress and anxiety because they now have more responsibilities to shoulder as an attending. They no longer have that backup or safety net they used to have during residency training. 

It sounds to me like residency programs need to take a hard look at collecting feedback from their residents and implementing some new steps to boost workplace morale and to provide more emotional support. Otherwise, we'll find more residents and physicians dropping out of clinical medicine. They'll be leaving to search for alternative careers that are less stressful and that provide an improved work/life balance. Some will be drawn to jobs that pay more. Others will be drawn to career opportunities that may appear lucrative but that end up becoming enslaving in different ways. 

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