How residents are increasingly feeling burnout

Burnout is a problem across healthcare, with caregivers struggling to provide quality patient care in spite of numerous barriers, sleep deprivation, and compassion fatigue.

In a new study, researchers found that 40% of pediatric residents are faced with burnout, and few evidence-based interventions currently employed seem to help.

Tamara Baer, MD, MPH, of the division of adolescent and young adult medicine at Boston Children’s Hospital in Massachusetts, led the study, and says early identification and intervention is key to managing burnout.

“Burnout is common, and it has the potential to impact patient care,” Baer says. “Pediatricians who experience burnout should find ways to address it so that it does not affect their care of patients, and residency programs should develop effective burnout interventions. It is crucial for the healthcare system to address burnout among residents-and among all members of healthcare teams-and to focus on systemic interventions and changes in workplace culture that will mitigate the effects of burnout.”

As part of their training, resident physicians work long hours; have high levels of stress; encounter sleep deprivation; and lack leisure time. It’s been well documented in previous studies that resident burnout has a negative impact on patient care and professional conduct, and it is associated with a higher rate of medical errors.

Burnout can take many forms and is often centered around the workplace, manifesting as lack of enthusiasm and motivation for one’s job, feelings of ineffectiveness and frustration, callousness toward people, and reduced work efficacy and quality, Baer says.

“As our study demonstrated, residents with burnout reported impacts to the care they provide to patients, such as making more errors, not fully discussing treatment options, and paying less attention to the impact of illness on a patient’s life,” Baer says.

A 2014 clinical report for the American Academy of Pediatrics acknowledged the high rate of burnout among pediatric practitioners and residents and called for a national movement to promote physician well-being, but data supporting burnout in pediatric fields are limited, focusing instead on internal medicine and surgical residents.

In this latest study, more than 250 residents were polled. The majority were white married females with no children completing residencies in their first, second, or third postgraduate years. Overall, 39.1% expressed feelings of burnout. Although there were no differences in the rate of burnout reported across relationship or parental status, gender, or ethnicity, residents aged older than 30 years were more likely to endorse burnout.

Interestingly, other residency factors, such as year of residency training, location of the residency program, current rotation schedule, and hours worked in the past week also had little impact on the rates of burnout reported. Sleep did play a role, however, with residents reporting sleep deprivation experiencing higher rates of burnout. Sleep deprivation was also strongly associated with poor quality of patient care, although the study found no interaction between sleep and burnout as a combined factor in reduced quality of patient care, according to the report.

Relationships with patients play a role, too, with residents who experienced suboptimal patient attitudes and behaviors also reporting higher rates of burnout. Residents endorsing burnout related to suboptimal patient attitudes and behaviors report feeling guilty about how they had treated a patient from a humanitarian perspective and for their lack of attention to the personal or social impact of an illness.

In an effort to improve patient safety, a number of residency programs have implemented changes to reduce burnout, such as limiting consecutive work hours. The Accreditation Council for Graduate Medical Education has made efforts over the last decade to revise residency program standards, limiting residents in 2003 to 80 hours of work per week, with that subsequently limited to 30 consecutive hours. Those standards were further limited in 2011 to reduce first-year residents to 16 continuous hours of work. Those changes, however, do not appear to have had a positive impact on reports of burnout, well-being, sleep, or perceptions in quality of patient care.

Some studies have found that residents who are able to separate their personal feelings from patients fare better when it comes to staving off burnout. More compassionate residents are able to compensate their feelings for a brief period, but then are overcome by burnout and begin a cycle of perceived poor patient care, according to the study.

Previous studies examining the effects of self-care workshops as interventions, however, did little to improve rates of burnout. More research is needed to find interventions that are more effective in preventing and managing burnout among pediatric residents, the report states. There has been some improvement among internal and pediatric residents in studies where acceptance, active coping, positive reframing, self-compassion, and mindfulness strategies were employed.

“Although data on effective burnout interventions are limited, we believe that systematic workflow changes that reduce administrative burden, increase time at the bedside, and address workload compression may have the greatest effects on burnout,” Baer says. “Additional structural supports, such as loan forgiveness programs and parental leave policies, should also be addressed. Although open dialogue and coping strategies are important mechanisms to address burnout on an individual level, physicians, including pediatricians, must advocate for humanistic and family-friendly work environments, not just for ourselves, but for our patients and society at large.”

Quality patient care is a top priority across the profession, but to take good care of patients, physicians must also remember to stay healthy and motivated, Baer says. Medical training is a particularly stressful time for physicians, she adds. Whereas burnout among pediatric residents has not been well studied up to this point, Baer says research in other specialties shows that internal medicine residents were more likely to self-report suboptimal patient care attitudes and behaviors.

“We hope that our research brings awareness of the impact of burnout on patient care, and the importance of addressing burnout in the healthcare system,” Baer says.