Advertisement

High Prevalence of Burnout Among US Emergency Medicine Residents: Results From the 2017 National Emergency Medicine Wellness Survey

      Study objective

      Previous work shows that emergency medicine attending physicians have higher-than-average rates of burnout. Preliminary data suggest that emergency medicine residents are also at risk for burnout. The objective of this study was to conduct the first national survey assessment of US emergency medicine residents to determine the prevalence of burnout.

      Methods

      This prospective 2017 National Emergency Medicine Resident Wellness Survey study was conducted through the Wellness Think Tank, whereby emergency medicine residents from 247 residencies across the United States were invited to participate in a national survey. The primary measure of burnout was the Maslach Burnout Inventory–Human Services Survey. In accordance with others' work, "burnout" was defined as a dichotomous variable represented by high levels of emotional exhaustion or depersonalization. Because of interpretative variability with the survey tool, we also calculated burnout rates by using a more restrictive definition and a more inclusive definition that have been reported in the literature.

      Results

      Surveys were completed by 1,522 residents (21.1% of all US emergency medicine residents), representing 193 of 247 US emergency medicine residency programs (78.1%). Within this sample, the prevalence of burnout was 76.1% (95% confidence interval 74.0% to 78.3%). With alternative definitions applied, burnout prevalence rates for this same sample were 18.2% (95% confidence interval 16.3% to 20.1%) with the more restrictive definition and 80.9% (95% confidence interval 78.9% to 82.9%) with the more inclusive definition.

      Conclusion

      The majority of US emergency medicine residents responding to this survey reported symptoms consistent with burnout, highlighting that physician burnout in the emergency medicine profession seems to begin as early as residency training. These findings may provide a baseline against which future work can be compared.
      To read this article in full you will need to make a payment
      ACEP Member Login
      ACEP Members, full access to the journal is a member benefit. Use your society credentials to access all journal content and features.
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Maslach C.
        • Jackson S.
        • Leiter P.
        Manual—Maslach Burnout Inventory.
        4th ed. Mind Garden, Inc, Menlo Park, CA1996 (Available at:)
        • Schaufeli W.B.
        • Bakker A.B.
        • Hoogduin K.
        • et al.
        On the clinical validity of the Maslach Burnout Inventory and the burnout measure.
        Psychol Health. 2001; 16: 565-582
        • Eckleberry-Hunt J.
        • Kirkpatrick H.
        • Barbera T.
        The problems with burnout research.
        Acad Med. 2018; 93: 367-370
        • Doulougeri K.
        • Georganta K.
        • Montgomery A.
        “Diagnosing” burnout among healthcare professionals: can we find consensus?.
        Cogent Med. 2016; 3: 1-10
        • Dyrbye L.N.
        • West C.P.
        • Shanafelt T.D.
        Defining burnout as a dichotomous variable.
        J Gen Intern Med. 2009; 24: 440
        • Rotenstein L.S.
        • Torre M.
        • Ramos M.A.
        • et al.
        Prevalence of burnout among physicians: a systematic review.
        JAMA. 2018; 320: 1131-1150
        • Dyrbye L.N.
        • West C.P.
        • Satele D.
        • et al.
        Burnout among US medical students, residents, and early career physicians relative to the general US population.
        Acad Med. 2014; 89: 443-451
        • Shanafelt T.D.
        • Hasan O.
        • Dyrbye L.N.
        • et al.
        Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014.
        Mayo Clin Proc. 2015; 90: 1600-1613
        • Williford M.L.
        • Scarlet S.
        • Meyers M.O.
        • et al.
        Multiple-institution comparison of resident and faculty perceptions of burnout and depression during surgical training.
        JAMA Surg. 2018; 153: 705-711
        • Attenello F.J.
        • Buchanan I.A.
        • Wen T.
        • et al.
        Factors associated with burnout among US neurosurgery residents: a nationwide survey.
        J Neurosurg. 2018; 129: 1349-1363
        • Lebares C.C.
        • Guvva E.V.
        • Ascher N.L.
        • et al.
        Burnout and stress among US surgery residents: psychological distress and resilience.
        J Am Coll Surg. 2018; 226: 80-90
        • Ramey S.J.
        • Ahmed A.A.
        • Takita C.
        • et al.
        Burnout evaluation of radiation residents nationwide: results of a survey of United States residents.
        Int J Radiat Oncol Biol Phys. 2017; 99: 530-538
        • Guenette J.P.
        • Smith S.E.
        Burnout: prevalence and associated factors among radiology residents in New England with comparison against United States resident physicians in other specialties.
        AJR Am J Roentgenol. 2017; 209: 136-141
        • Elmore L.C.
        • Jeffe D.B.
        • Jin L.
        • et al.
        National survey of burnout among US general surgery residents.
        J Am Coll Surg. 2016; 223: 440-451
        • Kimo Takayesu J.
        • Ramoska E.A.
        • Clark T.R.
        • et al.
        Factors associated with burnout during emergency medicine residency.
        Acad Emerg Med. 2014; 21: 1031-1035
        • Lu D.W.
        • Dresden S.
        • McCloskey C.
        • et al.
        Impact of burnout on self-reported patient care among emergency physicians.
        West J Emerg Med. 2015; 16: 996-1001
        • Prins J.T.
        • van der Heijden F.M.M.A.
        • Hoekstra-Weebers J.E.H.M.
        • et al.
        Burnout, engagement and resident physicians’ self-reported errors.
        Psychol Health Med. 2009; 14: 654-666
        • Holmes E.G.
        • Connolly A.
        • Putnam K.T.
        • et al.
        Taking care of our own: a multispecialty study of resident and program director perspectives on contributors to burnout and potential interventions.
        Acad Psychiatry. 2017; 41: 159-166
        • West C.P.
        • Shanafelt T.D.
        • Kolars J.C.
        Quality of life, burnout, educational debt, and medical knowledge among internal medicine residents.
        JAMA. 2011; 306: 952-960
        • Leach P.K.
        • Nygaard R.M.
        • Chipman J.G.
        • et al.
        Impostor phenomenon and burnout in general surgeons and general surgery residents.
        J Surg Educ. 2019; 76: 99-106
        • Pantaleoni J.L.
        • Augustine E.M.
        • Sourkes B.M.
        • et al.
        Burnout in pediatric residents over a 2-year period: a longitudinal study.
        Acad Pediatr. 2014; 14: 167-172
        • Chaukos D.
        • Chad-Friedman E.
        • Mehta D.H.
        • et al.
        Risk and resilience factors associated with resident burnout.
        Acad Psychiatry. 2017; 41: 189-194
        • Kemper K.J.
        • Wilson P.
        • Schwartz A.
        • et al.
        Burnout in pediatric residents: comparing brief screening questions to the Maslach Burnout Inventory.
        Acad Pediatr. 2018;
        • Kuhn G.
        • Goldberg R.
        • Compton S.
        Tolerance for uncertainty, burnout, and satisfaction with the career of emergency medicine.
        Ann Emerg Med. 2009; 54: 106-113.e6
        • Soltanifar A.
        • Pishbin E.
        • Attaran Mashhadi N.
        • et al.
        Burnout among female emergency medicine physicians: a nationwide study.
        Emerg Med Australas. 2018; 30: 517-522
        • West C.P.
        • Huschka M.M.
        • Novotny P.J.
        • et al.
        Association of perceived medical errors with resident distress and empathy: a prospective longitudinal study.
        JAMA. 2006; 296: 1071-1078
        • Krasner M.S.
        • Epstein R.M.
        • Beckman H.
        • et al.
        Association of an educational program in mindful communication with burnout, empathy, and attitudes among primary care physicians.
        JAMA. 2009; 302: 1284-1293
        • Bellini L.M.
        • Baime M.
        • Shea J.A.
        Variation of mood and empathy during internship.
        JAMA. 2002; 287: 3143-3146
        • Dyrbye L.N.
        • Burke S.E.
        • Hardeman R.R.
        • et al.
        Association of clinical specialty with symptoms of burnout and career choice regret among US resident physicians.
        JAMA. 2018; 320: 1114-1130
        • Bullock G.
        • Kraft L.
        • Amsden K.
        • et al.
        The prevalence and effect of burnout on graduate healthcare students.
        CMEJ. 2017; 8: e90-e108
        • Shanafelt T.D.
        • Mungo M.
        • Schmitgen J.
        • et al.
        Longitudinal study evaluating the association between physician burnout and changes in professional work effort.
        Mayo Clin Proc. 2016; 91: 422-431
        • Brazeau C.M.L.R.
        • Schroeder R.
        • Rovi S.
        • et al.
        Relationships between medical student burnout, empathy, and professionalism climate.
        Acad Med. 2010; 85: S33-S36
        • Harris P.A.
        • Taylor R.
        • Thielke R.
        • et al.
        Research Electronic Data Capture (REDCap): a metadata-driven methodology and workflow process for providing translational research informatics support.
        J Biomed Inform. 2009; 42: 377-381
        • R Core Team
        R: A Language and Environment for Statistical Computing.
        R Foundation for Statistical Computing, Vienna, Austria2017 (Available at:) (Accessed February 19, 2019)
        • Accreditation Council for Graduate Medical Education
        Summary of changes to ACGME common program requirements section VI.
        (Available at:)
      1. Association of American Medical Colleges. 2017 State physician workforce data book: data and reports: workforce: data and analysis: AAMC.
        (Available at:)
      2. Association of American Medical Colleges. 2018 Physician specialty data report: data and reports: workforce: data and analysis: AAMC.
        (Available at:)
        • Artino A.R.J.
        • Durning S.J.
        • Sklar D.P.
        Guidelines for reporting survey-based research submitted to academic medicine.
        Acad Med. 2018; 93: 337-340
        • Johnson T.P.
        • Wislar J.S.
        Response rates and nonresponse errors in surveys.
        JAMA. 2012; 307: 1805-1806
        • Shettle C.
        • Mooney G.
        Monetary incentives in US government surveys.
        J Off Stat. 1999; 15: 231-250
        • Singer E.
        The use of incentives to reduce nonresponse in household surveys.
        in: Groves R.M. Dillman D.A. Eltinge J.L. Survey Nonresponse. John Wiley & Sons, New York, NY2002: 163-178
        • Shanafelt T.D.
        Physician burnout: stop blaming the individual.
        (Available at:)
        • Schwenk T.L.
        • Gold K.J.
        Physician burnout—a serious symptom, but of what?.
        JAMA. 2018; 320: 1109-1110
        • Kashani K.
        • Carrera P.
        • De Moraes A.G.
        • et al.
        Stress and burnout among critical care fellows: preliminary evaluation of an educational intervention.
        Med Educ Online. 2015; 20: 27840
        • Williams D.
        • Tricomi G.
        • Gupta J.
        • et al.
        Efficacy of burnout interventions in the medical education pipeline.
        Acad Psychiatry. 2015; 39: 47-54
        • West C.P.
        • Dyrbye L.N.
        • Erwin P.J.
        • et al.
        Interventions to prevent and reduce physician burnout: a systematic review and meta-analysis.
        Lancet. 2016; 388: 2272-2281
        • Jones D.
        • Molitor D.
        • Reif J.
        What Do Workplace Wellness Programs Do? Evidence From the Illinois Workplace Wellness Study. 2018.
        (Available at:) (Accessed February 19, 2019)
        • Shanafelt T.D.
        • Noseworthy J.H.
        Executive leadership and physician well-being: nine organizational strategies to promote engagement and reduce burnout.
        Mayo Clin Proc. 2017; 92: 129-146
        • Linzer M.
        • Poplau S.
        • Brown R.
        • et al.
        Do work condition interventions affect quality and errors in primary care? results from the Healthy Work Place study.
        J Gen Intern Med. 2017; 32: 56-61
        • Garza J.A.
        • Schneider K.M.
        • Promecene P.
        • et al.
        Burnout in residency: a statewide study.
        South Med J. 2004; 97: 1171-1173