Some Physician Specialties More Burnout-Prone Than Others

A longitudinal study tracking students from medical school through residency suggests the grueling process leaves many young physicians questioning their career choice.

Resident physicians concentrating on certain specialties are particularly prone to burnout, a Mayo Clinic-led study shows.

The longitudinal study, which appeared this month in JAMA, found that 45% of second-year resident physicians reported experiencing at least one symptom of burnout, which can include exhaustion and depersonalization of patients.

Urology, neurology, emergency medicine and general surgery residents were at the highest risk of burnout, but the study authors don't know why.

"That is a great question for a separate research study," says Liselotte Dyrbye, MD, a Mayo Clinic researcher and first author of the article.

"We know that at the beginning of medical school, there isn't much burnout. But even in medical school we start to see burnout develop after a couple of years. It starts early and continues from training into practice," she said.

The years-long study, which involves 50 medical schools and 3,600 medical trainees, is the first national study to follow medical students from the beginning of medical school into residency to track predictors of burnout.

Residents were asked about their specialty, ethnicity, educational debt and other demographics, and completed surveys to measure anxiety, emotional social support, empathy and burnout. The survey found that residents with burnout were three times more likely to regret becoming a physician.

Dyrbye says she can only speculate on why some specialties are more prone to burnout, but she's spotted a trend.

"We see high rates of burnout in resident physicians in urology, neurology, ER and general surgery and that mirrors our previous findings of physicians in practice that we conducted with the AMA a few years ago," she says.

"There may be something unique in the particular work environments related to workload, practice efficiencies, autonomy, control, work life balance," she says. "Another possibility could be that the supervising physicians who are impacting the learning environment in such a way that these residents-in-training are impacted and at higher risk of burnout."

"Maybe there is more harassment or belittlement going on in these specialty training programs relative to other specialty training programs, which probably more reflects the practice environment," she says. "When a supervising physician is working in the same practice environment as the resident, then it's not so much of a surprise that they are both impacted by work-related stresses that drive burnout."

In an interesting wrinkle, the study found that self-identified minority students were more likely to regret their specialty choices, and the study authors suggest that one reason might be that these time-strapped minority physicians are being pressed to serve in their institutions' diversity programs.

"There are a lot of initiatives at academic medical centers across the country to really improve diversity, because that improves the science, patient care and research," Dyrbye says. "As a result, we have all of these diversity committees looking at retention and recruitment and various issues and people of diverse backgrounds get overtaxed when they're asked to be on those committees. In addition to the stress of being a resident, now you're worried about getting tapped on the shoulder 'Oh would you mind? Pretty please!'"

"There is nothing else that goes off that resident's plate to accommodate that institutional service," Dyrbye says. "We speculate that it could be a bit too much for those residents it could contribute to some of their specialty choice regrets."

Dyrbye takes some comfort in knowing that, given the rigors of physician training, more than 50% of the survey respondents say they were happy.

"But we should be concerned about the prevalence of burnout. It shouldn't be that high," she says. "We know that burnout is associated with suboptimal patient care. If these resident physicians continue to struggle with symptoms of burnout, they are also more likely to quit or not see as many patients and that impacts all of our ability to access care."