Burnout in Medical Students & Residents: What to Do About It

There are multiple worrisome statistical trends among medical students and resident physicians, the most poignant of which is the fact that doctors, including medical students and resident physicians, have the highest suicide rate of any profession.

In this post, we discuss burnout, a common precursor to depression and suicide, in medical trainees. We’ll go over what burnout is, what causes burnout, and how you can reduce your own risk of burning out.

What Is Burnout & Why Should I Care?

Burnout is a physical or mental collapse caused by overwork or stress, often related to caregiving or work. It is thought to be derived from three distinct elements: Emotional exhaustion, depersonalization, and a reduced sense of personal accomplishment. Keep those three elements in mind, as we’ll be referring to them throughout this article.

Burnout is everyone’s business. Burnout has reached epidemic levels, in some studies exceeding 50% of medical trainees or doctors in practice. It’s not exclusive to medical students and residents; it applies to workers across all industries.

In this article, we’ll focus on data on burnout among medical trainees and doctors. This, too, is everyone’s business, as burnout contributes to an increased risk of medical errors, depression, and adverse effects on patient safety. You don’t want your doctor to burn out.

What Causes Burnout?

There are several theories on what causes burnout, the most convincing of which is the Job Demands-Resources Model. In its simplest terms, the Jobs Demands-Resources Model states that high job demands lead to exhaustion and low resources lead to cynicism and feelings of low personal efficacy.

Overall, chronic stress exposure is the main risk factor. It’s no surprise, then, that medical students and residents in particular are subject to extraordinarily high rates of burnout. It’s common for medical trainees to be deprived of sleep, have a high workload, earn relatively low salaries, and have several responsibilities at work. Additional stressors include carrying the great responsibility for the health of other people and dealing with sick people, people in pain, and their families.

In a meta-analysis and systematic review by Rodrigues and colleagues, residents in surgery, including general surgery and orthopedics, and in urgent specialties, including anesthesiology and OB/GYN, demonstrated significantly higher rates of burnout.

Interestingly, students who are single are significantly more emotionally exhausted than classmates in relationships. This doesn’t mean running out and getting into a relationship pronto, but it does highlight the importance of social support in warding off burnout.

If you look at burnout rates over the past few decades, you’ll see a steady rise. After scouring the literature and trends in medical training, I attribute this to three main factors:

1 | Increasing Competitiveness

Over the past 10 years, medical school has become significantly more competitive. There has been a significant rise in the number of applicants, but not enough new positions in medical school to accommodate the increase.

In such a landscape, premed and medical students are subject to ever-increasing levels of stress.

2 | Modern Medicine & Technology

Dr. Atul Gawande wrote an excellent piece in The New Yorker about how technological changes in medicine have contributed to burnout.

In short, increasing requirements for computer documentation are highly correlated with burnout, which is why neurosurgeons are less likely to be burned out than emergency physicians. They simply spend less time documenting.

Additionally, decreased physician autonomy is a major factor, as outlined by the Job Demands-Resources Model.

How Do We Address Burnout?

To address burnout, we must consider both preventive and therapeutic interventions. How do we reduce the risk of it happening, and if it has happened, what can we do about it? Similarly, we must examine how individuals can best address burnout and what we need to change at the systemic level to reverse the trend of increasing burnout over the last several decades.

Addressing Burnout on an Individual Level

On an individual level, there are 4 main pieces of actionable advice:

1 | Social Support

The most consistent finding throughout the scientific literature is that social support reduces burnout.

My advice to you is two-fold: First, seek professional help if you believe you are burned out, depressed, or suicidal. Second, seek support from your friends, family, and colleagues. I suggest doing a shared activity where you can speak at ease and with some privacy, such as hiking, a relaxed sport, or grabbing a meal or coffee.

2 | Sleep

Sleep duration is negatively correlated with burnout, meaning the more you sleep, the less likely you are to be burned out. Unfortunately, if you’re burned out, your sleep quality is likely to suffer. We have other posts going over the best ways to optimize your sleep, with actionable advice on improving sleep hygiene and consistently waking up significantly more refreshed.

3 | Optimize Your Day-to-Day Life

Life optimization is the name of the game here at Med School Insiders. In creating a future generation of happier, healthier, and more effective doctors, we understand that your personal and professional lives are not siloed; instead, they are closely intertwined.

Optimizing your sleep, productivity, and overall efficiency will go a long way. However, there are frequently overlooked aspects that deserve to be highlighted.

First, shorten your commute. During my plastic surgery residency, I paid a premium to live near the hospital. This reduced my commute drastically and also allowed me to cycle to and from work. Ultimately, this meant more time for sleep, and I was able to get cardio twice daily just from my commute.

Other ways you can buy yourself more time include ordering healthy takeout or meal plans instead of cooking yourself, getting a housecleaning service, or using ride-sharing services like Uber or Lyft rather than driving. Maintaining healthy habits, such as proper nutrition and regular exercise, will also go a long way in sustaining this intense lifestyle and warding off burnout.

4 | Vacations Are Not as Helpful as You Think

Now, an important point about vacations. Contrary to popular belief, they may not be as helpful as you think. The reduction in burnout symptoms is short-lived, lasting on average less than 3 weeks. Plus, we want sustainable fixes, and vacations are relatively infrequent in the medical profession.

Addressing Systemic Burnout

Now on to the systemic causes. Ultimately, burnout is more of a systemic issue than a personal issue. While we must all take responsibility and mitigate it in our own lives, the fact that burnout among medical students, residents, and attending physicians has been consistently rising for decades points to a systemic cause.

More and more medical schools and residency programs are pushing wellness programs to address this growing issue. While these programs may have good intentions, their utility and ultimate benefit are questionable. A major point of contention is that these programs push the message that burnout is the responsibility of the medical student or resident and a failure of individuals to properly self-care, sleep, and mitigate stress.

Rather, we need to urge our programs and institutions to make meaningful changes. Facilitating social support, sleep, and autonomy are areas that, according to the scientific literature, would be beneficial for this growing issue.