Burnout has long been an issue in the healthcare community, but especially for residents and fellows as they can work long hours with very little pay. In the Panacea Financial 2024 Resident & Fellow Survey, we asked current U.S. residents and fellows about their burnout levels and how it interacted with other areas of their training. Here’s what we found.
What is burnout?
Burnout is defined as a state of extreme exhaustion and disengagement caused by prolonged stress, often from work or caregiving. Symptoms include fatigue, cynicism, and decreased productivity.
How burned out are residents and fellows?
We asked residents and fellows to rate the frequency of their feelings of burnout on a scale from 1 (rarely) to 10 (daily). The average rating was 6.8 out of 10. Here’s the breakdown by rating:
| Rating | Percentage of Respondents |
|---|---|
| 1 | 1.1% |
| 2 | 2.6% |
| 3 | 5.4% |
| 4 | 3.1% |
| 5 | 12.1% |
| 6 | 16.4% |
| 7 | 19.7% |
| 8 | 17.6% |
| 9 | 9.4% |
| 10 | 12.5% |
59.2% of respondents said the frequency of their burnout was at a 7 or higher out of 10.
Residents vs. fellows
When divided between residents and fellows, their average scores remained the same for both groups, 6.8.
By gender
Female residents and fellows reported more frequent burnout (7.1) than male trainees (6.4).
By age
Reported rate of burnout increased slightly as respondents got older.
| Age | Average Score |
|---|---|
| 26-30 | 6.8 |
| 31-35 | 6.9 |
| 36-40 | 6.9 |
| 41-45 | 7.0 |
By ethnicity
There was very little difference when burnout frequency was broken down by ethnicity. Asian and Black/African American respondents indicated slightly higher burnout frequency than white and Hispanic/Latino residents and fellows.
| Ethnicity | Average Score |
|---|---|
| Asian | 7.0 |
| Black/African American | 7.1 |
| Hispanic/Latino | 6.7 |
| White | 6.6 |
How does perceived workload affect burnout?
We asked residents and fellows to rate their workload on a scale from 1 (manageable) to 10 (overwhelming). The average was 6.4 out of 10. Here’s the breakdown by rating:
| Workload Rating | Percentage of Respondents |
|---|---|
| 1 | 2.8% |
| 2 | 2.0% |
| 3 | 6.3% |
| 4 | 5.9% |
| 5 | 10.4% |
| 6 | 17.6% |
| 7 | 24.1% |
| 8 | 17.8% |
| 9 | 7.7% |
| 10 | 5.5% |
Residents vs. fellows
Residents rated their workload slightly more overwhelming (6.5) than fellows (6.2).
By gender
Similar to burnout levels, female residents and fellows perceived their workload slightly higher (6.6) than their male colleagues (6.1).
How do hours worked impact burnout?
We asked residents and fellows how many hours they work per week, including on-call duties. The average for all trainees was 64.7 hours per week. Here’s how surveyed trainees answered:
| Hours Worked | Percentage of Respondents |
|---|---|
| <40 | 1% |
| 40-49 | 8% |
| 50-59 | 16% |
| 60-69 | 31% |
| 70-79 | 24% |
| 80-89 | 15% |
| 90-99 | 2% |
| 100+ | 2% |
Based on these responses, 19% of residents and fellows work more than 80 hours per week, double the traditional work week.
Residents vs. fellows
Residents reported more hours worked per week than fellows.
Residents: 65.9
Fellows: 59.7
How do hours worked impact perceived workload?
We took a look at how the actual number of hours worked related to a resident’s or fellow’s perceived workload. Average hours worked rose steadily as perceived workload increased. Individuals who rated their workload as a 1 worked, on average, 57 hours per week, the lowest average hours of all ratings. Those who rated their workload as a 10 worked, on average, 79.9 hours per week, the highest of all ratings.
| Workload Rating | Average Hours Worked |
|---|---|
| 1 | 57 |
| 2 | 57.9 |
| 3 | 58 |
| 4 | 59 |
| 5 | 61.1 |
| 6 | 62 |
| 7 | 65.2 |
| 8 | 69 |
| 9 | 69 |
| 10 | 79.9 |
How do hours worked impact burnout?
When compared to hours worked, burnout levels also rose steadily as hours worked increased.
| Burned Out Rating | Average Hours Worked |
|---|---|
| 1 | 55.7 |
| 2 | 57.8 |
| 3 | 57.3 |
| 4 | 59.1 |
| 5 | 61.1 |
| 6 | 62.5 |
| 7 | 65.2 |
| 8 | 66.6 |
| 9 | 65.7 |
| 10 | 74.5 |
What do residents & fellows have to say about burnout?
We asked what else residents and fellows had to say about their burnout levels. Here’s what they said:
- “Extremely burnt out especially in patient rotation. I am completely dependent on mental health counseling to be able to keep going. Discrimination is felt based on gender and race a lot of times and it adds to our burnout.”
– Third-year resident - “A hostile work environment is the biggest burnout instigator in my case.”
– Second-year resident - “Constant switching rotation adds to feeling overwhelmed and burnout.”
– First-year resident - “Fellowship this year is much better than my burnout and hours worked during residency.”
– Sixth-year fellow - “I would feel somewhat less burned out if I was at least fairly compensated, or at least made some form of overtime for the weekends and holidays away from family.”
– Fourth-year fellow - “The first year of fellowship was much worse than my current year in terms of hours worked, but the burnout occurred in residency and there has been no time to recover.”
– Second-year fellow
The (many) problems with burnout in residency
Burnout can be extremely detrimental to the health and wellbeing of residents and fellows. According to a study from StatPearls, burnout can have the following symptoms:
- Physical: headache, fatigue, gastrointestinal distress, flu, and sleep and appetite changes
- Psychological: irritability, reduced concentration, procrastination, delaying vocational tasks and paperwork, daydreaming, and substance use disorder
Burnout can also increase the likelihood of developing depression, suicidal ideation and cardiovascular disease.
In addition to the negative impact of burnout on residents and fellows, it can also damage patient care and outcomes. A 2008 study found that the depersonalization aspect of physician burnout led to lower satisfaction with patient outcomes and longer post-discharge recovery time.
Addressing burnout in residency
Burnout is a prevalent issue for residents and fellows. The data shared above is just one glimpse at the challenges these trainees face. Find the full 2024 Resident & Fellow Survey Report here.
We hope these findings will continue the necessary conversation around medical trainees’ needs and how residency and fellowship programs should be improved. Given the complexities of running hospital systems that rely on residents and fellows, the answer may not be simple or easy. But continuing to ignore the reality of residents’ and fellows’ burnout is only leading to poor experiences for trainees, sub-par patient outcomes, and people leaving the field.
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