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Burnout Especially Common Among Emergency Medicine Residents

Analysis  |  By Christopher Cheney  
   April 05, 2019

The country's physician burnout epidemic is taking a heavy toll on emergency department clinician trainees.

Three-quarters of emergency department residents are experiencing symptoms of physician burnout, recent research indicates.

Other research has found that nearly half of physicians nationwide are experiencing burnout symptoms, and a study published in October found burnout increases the odds of physician involvement in patient safety incidents, unprofessionalism, and lower patient satisfaction. Burnout also has been linked to negative financial effects at physician practices and other healthcare organizations.

The recent research, which was published in Annals of Emergency Medicine, found that the prevalence of burnout among ED residents was 76.1% in a survey of more than 1,500 of the early-career physicians.

"The majority of U.S. emergency medicine residents responding to this survey reported symptoms consistent with burnout, highlighting that physician burnout in the emergency medicine profession seems to begin as early as residency training," the authors of the research wrote.

The study's data indicate that ED residents have different rates and causes of physician burnout compared to independently practicing ER doctors and clinicians in other specialties.

Nearly three-quarters of the ED residents in the study reported high levels of depersonalization; whereas, earlier research found 38.9% of attending emergency physicians reported high levels of depersonalization. Other earlier research found 34.6% of clinicians in non-emergency medicine specialties reported high levels of depersonalization.

"We hypothesize that this more negative and cynical attitude toward patients results from working more clinical hours in the ED as a resident, having a greater clerical burden, and interacting more with consultants, admitting services, and ancillary staff as a trainee," the Annals of Emergency Medicine researchers wrote.

Daunting challenges for residents

The lead author of the research, Michelle Lin, MD, told HealthLeaders that emergency medicine is a hotbed for physician burnout.

"Because the physician pool is a very heterogenous population, you can't compare our study results—which focus on emergency medicine trainees—and the entire physician population. However, if you slice it by specialty, it is known that emergency medicine has among the highest rates of physician burnout in the 60% to 80% range, depending on which metrics and studies you look at," she said.

The prevalence of physician burnout among ED residents is alarming, said Lin, a professor of emergency medicine at University of California San Francisco and an ER physician at Zuckerberg San Francisco General. "Our study of emergency medicine residents demonstrates that shockingly most are starting their careers already burned out even before they become attending physicians."

Addressing physician burnout

Physicians are inherently resilient, and wellness initiatives that focus on "fixing" clinicians have been shown to have little to no benefit in alleviating burnout, Lin said.

"While education about stress management may be helpful for some physicians, we are advocating for more system-wide, organizational changes. For example, administrative burden such as using cumbersome electronic medical records and inefficient intra-hospital communication systems are straining emergency physicians, who already are in a stressful, time-critical, and task-switching work environment."

Achieving systemic change is particularly important for ED residents, she said.

"For resident physicians, they also have an extra layer of stress, which is to learn the practice of emergency medicine and learn a new hospital system. Although changing the ingrained practices of healthcare will take some time, we suggested the use of ED scribes in the more immediate-term as an example of a way to offload some task-switching burden."

Measuring ED resident burnout

Lin's research team used three measures of physician burnout for ED residents. A restrictive definition of the condition found 18.2% of residents were experiencing burnout, and a more inclusive definition found 80.9% were experiencing burnout.

She stands by the 76.1% burnout rate, which was determined using key elements of the most widely accepted measurement instrument: the Maslach Burnout Inventory (MBI) tool.

"We feel confident about our reporting of a 76% resident burnout rate because we enrolled more than 1,500 emergency medicine residents, applied the validated MBI tool, and scored the responses based on the most common definition," Lin said.

Christopher Cheney is the CMO editor at HealthLeaders.


Burnout increases the odds of physician involvement in patient safety incidents, unprofessionalism, and lower patient satisfaction.

Emergency department residents are more prone to depersonalization than other physicians, recent research shows.

Wellness initiatives are unlikely to achieve a significant reduction in burnout among emergency medicine trainees.

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