Half of Internal Medicine Residents Report Burnout

Despite limitations placed on the number of hours medical residents spend working, more than half of internists in training exhibit signs of burnout and suboptimal quality of life, according to a large study of workforce stress from the Mayo Clinic.

Overall burnout and high levels of emotional exhaustion and depersonalization were reported by 8,343 of 16,192" students responding, or 51.5%.

In fact, quality of life was described as being "as bad as it can be" or "somewhat bad" by 14.8%, and 28.4% described it as "neutral." Only 15.3% described it "as good as it can be," while another 41.5% said it was "somewhat good."

The report collected information on internal medicine residents who took the Internal Medicine In-Training Examination or IM-ITE survey during the 2008-2009 academic year. Results are published Wednesday in the Journal of the American Medical Association's special theme issue on medical education.

"Distress is common, and some might argue this comes with the job," said Colin P. West, MD, associate professor of medicine and biostatistics at the Mayo Clinic in Rochester, MN in a recorded interview posted on jama.com.

This is important, he continued, because "factors such as physician burnout, depression, job dissatisfaction, and low quality of life have been associated with negative effects on important outcomes like patient care, medical and medication errors, and other suboptimal care practices and decreased patient satisfaction."

Additionally, physician stress, both in training and in practice, has been associated with the ability to learn and remember, said West, who also is the co-director of the Mayo Clinic Department of Medicine Program on Physician Well-Being.

In an effort to assess burnout, emotional exhaustion and depersonalization, the residents were asked questions like "How often do you feel burned out from your work?" and "How often do you feel you've become more callous toward people since you started your residency?"

West added that he and co-authors, Tait D. Shanafelt, MD, and Joseph C. Kolars, MD, also of the Mayo Clinic, said they believe the study is the first of its kind to look at the issue that was not concentrated in a single institution, but in a large nationally representative group. It included 7,743 U.S. medical graduates and 8,571 international graduates.

Ironically, quality of life and satisfaction with work-life balance was highest among residents who reported moonlighting, or working at a second job outside of their regular residency training hours, and was higher for residents carrying educational debt.

In fact, those residents with more debt appeared to achieve lower scores on the IM-ITE test. "The highest 2 categories of debt involved 13.1% and 14.3% of residents, respectively," they wrote.

It also was higher for international graduates than U.S. graduates.

The authors noted that limits on duty hours for medical residents, which took effect in 2003, did not seem to influence the survey's outcome. "These results suggest that distress remains common despite these regulations," they wrote.

Emotional exhaustion was more common among postgraduates in the first year of training, and decreased thereafter, "symptoms of depersonalization (which may manifest as cynicism and callous attitudes toward patients) increased as training progressed," West and colleagues wrote.

They added that additional research is required to learn how these factors affect the way resident doctors interact with each other and the impact it has on their clinical competency.