Written by Angel Joseph
Edited by Tasnim Sumaita
Mary Sue recently graduated medical school and is enrolled in a residency program at her dream hospital in her hometown. She is enrolled in residency at this hospital for three years and she will get the best hands-on and clinical training to become the best physician she can be. As a first year student, she is excited and curious to see what she might learn with peers who share her goals of specializing in cardiology. The dreams of her becoming a doctor, being called Dr. Sue, and seeing patients improve is very rewarding for her. However, she can’t help but feel emotionally and physically tired. She feels like she doesn’t belong in the hospital and concluded that she must be facing burnout. This is a growing problem in healthcare worldwide.
Burnout is a state of chronic stress that is defined by repeated signs of stress and exhaustion, prolonged for periods at a time setting three parameters: emotional fatigue, detachment, and a reduction in individual achievement. These issues affect not just residents but also patient treatment and the entire healthcare system. Despite growing awareness, burnout rates among residents remain high, indicating the need for systemic reforms in medical training, the work setting, and personal well-being methods for students. A 2020 review paper published by the American Medical Association estimates that nearly half of medical residents experience burnout during training (Dyrbye et al., 2020). This is quite concerning, considering that residency is such a key stage in a doctor's career, it is important to evaluate the causes and consequences of resident burnout to identify targeted interventions.
The rigorous work schedule of residency is one of the primary causes of burnout. Most residents are required to work constantly for extended periods of time, typically at night, and depending on their specialty can even be on call 24/7, working over 80 hours per week. Sleep deprivation, along with the stress of heavy patient loads, increases risk of emotional fatigue (a symptom of burnout) from the taxing workload and routine (Shanafelt, 2012). This is not only harmful for emotional and physical health, such as fatigue, heartburn, gastrointestinal problems, depression, PTSD, and anxiety disorders. Furthermore, it has a poor influence on cognitive function, increasing the risk of errors, which can lead to residents feeling guilt and, in the worst case scenario, put their medical career at stake.
The medical training hierarchy also exacerbates burnout in resident doctors. Upon training, residents are immersed in a culture of intense monitoring and criticism by clinical advisors, which, although meant to improve their clinical skills, is mentally and physically draining. The frequent scrutinization may cause emotions of inadequacy and stress. Clinical advisors often control and monitor decisions in the clinic instead of allowing the residents to practice the training they’ve received. In a condescending and degrading way, they are constantly forced to impress their superiors, which increases the pressure the residency program puts on them as well as the internal pressure they put on themselves. Decision-making with this lack of liberty is another component that contributes to feelings of powerlessness, which are a hallmark of burnout (West, 2016). Furthermore, the emotional strain of dealing with critically sick patients and their life-or-death dilemmas contributes significantly to the formation of burnout. Residents routinely encounter patient suffering, mortality, and family relationships in difficult situations, which can contribute to mental exhaustion. Residents face an ongoing, constant battle in striking a balance between developing sympathetic relationships with patients and mentally investing into patient’s and families’ stories.
Burnout among resident physicians has serious repercussions. Firstly, burnout has an impact on the quality of treatment delivered to patients. Several studies have found a link between resident physician burnout and decreased patient satisfaction with medical treatment, medical mistakes, and safety (Shanafelt, 2012). Burnout impairs a resident's ability to communicate effectively with their patients, make sound clinical decisions, and manage stress—all of which are necessary components of comprehensive treatment. Furthermore, burnout among medical residents has long-term implications for clinician wellness and professional fulfillment. Residents who are burned out are more likely to experience melancholy, anxiety, and even suicidal ideations. One study published in The Lancet found that medical students and residents have an 11% greater risk of suicide thoughts than the general population with 5% annually (Rotenstein, 2016). This leads to a sense of loss of purpose in one's job, and an increased incidence of attrition in medicine. Aside from that, healthcare systems confront other challenges such as turnover and a lack of experienced physicians, which puts further strain on existing staff to manage higher patient loads in tighter working conditions. Burnout also has significant economic implications since it causes more tardiness, decreased productivity, and a rise in healthcare expenditures owing to the need for mental health assistance and treatment (Kumpfer, 2020). As a result, addressing burnout and raising awareness for it would be economically beneficial, in addition to enhancing the physical and mental well-being of resident doctors and promoting their careers.
Burnout among resident doctors is a challenging issue that must be addressed holistically. Aside from the necessity of individual recovery approaches, it is critical to identify and address the underlying systemic causes of burnout. Residency programs can address resident well-being by introducing structural workplace improvements, creating friendly surroundings, and fostering an open culture that promotes self-care. For instance, they can provide some sort of monthly check-in with their residents, so that they can appropriately voice their concerns. There have been initiatives taken by prestigious hospitals, like the Mayo Clinic, which provides surveys about the leadership programs and hospital management for resident doctors to critique. If neglected, burnout will continue to erode health-care systems, harming both physicians and patients. Resident doctors must also take initiative in taking care of their mental and physical well-being. For instance, they can find a hobby that relieves them of stress, try to find time to meet friends and family, and have a disciplined schedule that allows them to eat and sleep in healthy portions. It is avoidable with devoted effort at both the managerial and personal levels, bringing forth a new generation of balanced resident training experiences and a healthy, resilient medical professional community.
References
Dyrbye, L. N., Shanafelt, T. D., & Sinsky, C. A. (2020). Burnout in medical professionals: A systematic review and meta-analysis. JAMA, 324(1), 74-84.
Kumpfer, K. L., Alvarado, R., & Smith, P. (2020). A review of the effectiveness of interventions for resident burnout. Journal of Graduate Medical Education, 12(2), 163-170.
Rotenstein, L. S., Torre, M., Ramos, M. A., et al. (2016). Prevalence of burnout among physicians: A systematic review. The Lancet, 388(10057), 2272-2281.
Shanafelt, T. D., West, C. P., Sinsky, C. A., et al. (2012). Changes in burnout and satisfaction with work-life balance in physicians during the first two years of the residency program. JAMA, 308(19), 1966-1972.
West, C. P., Dyrbye, L. N., & Shanafelt, T. D. (2016). Physician burnout: Contributors, consequences, and solutions. Journal of Internal Medicine, 283(5), 517-529.
West, C. P., Shanafelt, T. D., & Kolars, J. C. (2014). Quality of life, burnout, educational debt, and medical knowledge among internal medicine residents. JAMA, 292(1), 199-204.
Komentar