March 4, 2002

adopted from the ASSOCIATED PRESS with editorial comments by Peter Dodzik, Psy.D.

Recent reports from the University of Washington have indicated that three out of four medical residents reported suffering from “burnout” and half of those said they sometimes gave less-than-ideal care. The American Psychological Association defined burnout as the phenomenon created when a person provides more effort to get the same results. This stage can occur for many reasons.

Too little sleep, frequent shifts longer than 24 hours and lack of leisure time were most often rated as major stresses by residents in the university’s internal medicine residency program.

Dr. Anthony Back, a University of Washington medical professor and one of the authors of the study, said the research didn’t determine whether patient care was affected. But the survey does raise some disturbing questions about the condition of residents in this country. According to the study in Tuesday’s Annals of Internal Medicine, slightly more than half the residents experiencing burnout reported one or more “suboptimal” patient care practices at least monthly, compared with about 21 percent of residents not experiencing burnout.

Suboptimal care included residents making treatment or medication errors “not due to a lack of knowledge of inexperience, “failing to fully discuss treatment options and answer patient questions and discharging patients “because the team was too busy.”

Doctors generally serve one year as an intern and train for three years as residents following graduation from medical school. Residency rates can be longer for some medical disciplines, but three years is the minimum for almost all of them.

Dr. Julia Gore, chief resident at the Veterans Affairs hospital in the University of Washington system, called the study a “snapshot” that doesn’t fully describe the experience. “Sure, there definitely were times when I felt really tired and probably would say burned out,” said Gore, in her third year as a resident. “After a few days off or after moving onto a different rotation, my response would be completely different.” Even when fatigued, Gore said, she felt “very supported” by other residents and the attending physician on duty. However, even these statements beg the question of whether this model of training should continue to be emphasized.

Another article in the journal said about a third of 4,130 residents surveyed nationwide reported four or five symptoms of depression. The survey, by the Resident Services Committee of the Association of Program Directors in Internal Medicine, concluded that increased cynicism and symptoms of depression were associated with educational debt. Of those surveyed, 42 percent had debt of at least $50,000; 19 percent had debt of at least $100,000 and 43 percent had a monthly disposable income of $100 or less. One-third did medical work outside their training and 349 said they worked more than 20 hours a week at their moonlighting jobs. Many residents, however, are precluded from second jobs or work too many hours to hold supplemental employment.

“We cannot relieve the suffering of others if we, ourselves, are suffering, “Dr. Linda Hawes Clever of California Pacific Medical Center in San Francisco said in an accompanying editorial.