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Burnout Plagues 1 in 3 Residency Program Directors

Analysis  |  By Christopher Cheney  
   November 23, 2018

A strong association is found between burnout and considerations of resigning among residency program directors.

In 2016, one third of medicine residency directors were burned out and about half had considered resigning in the preceding year, recent research shows.

Residency director burnout and turnover can have several negative consequences for health systems, hospitals, and physician practices, including lower educational program effectiveness and long-term adverse effects on physicians in training.

"Turnover of a residency program director impacts not just the physician and clinical practice, but the residency program and residents in it. Over the past two decades, the proportion of program directors in the role three or fewer years has ranged from one third to one half; since 2009, the median tenure of an internal medicine program director has ranged from four to six years," researchers wrote in the American Journal of Medicine.

The researchers examined residency program director survey data from 2012 to 2016. The study focused on questions related to emotional exhaustion, depersonalization, and whether program directors had considered resigning in the previous year.

  • Less than half of residency program directors in 2012 remained program directors in 2016.
  • In 2016, 33% of program directors were burned out and 48% had contemplated resignation in the prior year.
  • In strong indicators of a relationship between burnout and resignation, 85% of the program directors who were burned out in 2016 had considered resigning, but only 30% of other program directors had mulled resignation.
  • The rate of burnout among program directors is lower than reported physician burnout, which rose from 46% in 2011 to 54% in 2014.

"While burnout was associated with program director turnover, we found a particularly strong association between consideration of resigning and program director turnover. Alarmingly, almost one half of the program directors in our sample had considered resigning in the preceding year," the researchers wrote.

Burnout sources and solutions

For residency program directors, the level of support from department chairmen and hospital leaders is likely a significant contributor to burnout, the lead author of the American Journal of Medicine research told HealthLeaders this week.

"This has many important practical manifestations, including the amount of administrative (non-clinical) time protected for the program director and the receptiveness of the chair to helping fix the highest priority problems facing the residency program," said Alec O'Connor, MD, MPH, professor of medicine and director of the Internal Medicine Residency Program at the University of Rochester School of Medicine and Dentistry in New York.

Lack of support from department chairmen can fuel burnout, he said.

"Ultimately, if the program director feels like he or she has to fight with the department chair every time a critical issue has to be addressed—and loses some or all of these critical issue fights—then frustration and feelings of being put into an impossible position will outstrip feelings of accomplishment, leading to burnout and resignation," O'Connor said.

Maintaining time for residents to pursue academics can be a draining challenge for residency program directors, he said.

"One of the most common critical issues program directors face is protecting residents from growing volumes of patient care in academic medical centers, which crowd out time for education and contribute to resident and faculty burnout. These issues can be costly and difficult to fix with a non-resident workforce, but they are core to maintaining the educational mission at residency programs."

O'Connor said more research is required to determine how burnout of residency program directors can be limited, but he said mentoring new program directors could be helpful. Mentoring efforts could ease navigation of stressful duties such as dealing with a struggling resident as well as striking a healthy balance between work and home life, he said.

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.


Turnover of residency program directors has significant negative consequences for healthcare organizations, including long-term adverse effects on physicians in training.

Survey data shows that less than half of residency program directors in 2012 remained program directors in 2016.

One likely cause of residency program director burnout is lack of support from department chairmen and hospital leaders.

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