Burnout and resident physicians: A review of contributing factors

Burnout, a psychological syndrome that develops in response to chronic emotional and interpersonal stressors on the job, occurs more frequently in medical professional trainees than in age-matched non-medical peers. There are three dimensions of burnout: emotional exhaustion, depersonalization, and decreased personal achievement. Burnout is a significant concern among medical residents as it has been associated with reduced ability to learn, increased medical errors, and delivery of suboptimal patient care. There is a personal cost to burnout, with risks of depression, suicide, and substance use being significantly increased in distressed medical residents. Despite implementation of the 80-hour weekly work limit and various interventions put in place by various residency programs, burnout during medical training remains a complex issue to be addressed. The aim of this literature review is to investigate the protective and risk factors in burnout in resident physicians. A literature review was conducted November 2018 to January 2019 using the PubMed and Google Scholar databases to search for articles published in English pertaining to burnout in resident physicians. There are a number of contributing factors to burnout in resident physicians, and these can be broadly categorized into demographic, personal, and occupational factors. In terms of demographic factors, most studies demonstrate no sex differences while a few studies report higher rates in males. Other demographic risk factors include: younger age during training, being married or having a spouse who works part time or is unemployed. Some studies report that physicians in specialties at the front line of care (e.g., emergency medicine, internal medicine, and family medicine), or are in surgical specialties (e.g., OB/GYN, general surgery) are at the greatest risk of burnout. Various personal factors are correlated with burnout. Higher rates of burnout are seen in residents who are experiencing family-related stress, more dissatisfied with support systems, with poor coping skills for stress, with other health risk-behaviors (e.g., smoking, recreational drug use). Work characteristics including high workload, lack of control over time management, low level of autonomy in job, and stressful relationships with supervisors and co-workers are occupational risk factors for burnout. These risk factors, identified by multiple studies, can be utilized to design personal, organizational, and societal interventions to address burnout in resident physicians. Future directions of this work will be discussed, including recommendations for training programs and policy level changes