Resident Scheduling: The Seeds of Physician Burnout?
Physician burnout is rampant across the United States. According to the American Medical Association, 42 percent of doctors are burned out. Research into the phenomenon has identified a variety of potential culprits that rob physicians of their joie de vivre. A Mayo Clinic study found that physicians using electronic health records and computerized physician order entry – which they perceived as “clerical tasks” – exhibited increased burnout. Researchers cite the scrutiny associated with a laser focus on value-based care, greater numbers of employed physicians, and increased workload as all contributing to burnout.
While the changing healthcare landscape may be fueling physician distress, it isn’t a stretch to see that the seeds of burnout may have been planted years earlier, in the resident scheduling process. Residency – which can last between three and seven years following medical school – is notorious for chewing doctors up and spitting them out. Dr. Peggy Bui crunches the numbers to describe her eye-popping first-year residency, during which she averaged 11.1-hour days and one night received 150 alerts on her pager.
The Accreditation Council for Graduate Medical Education sets guidelines for resident “duty hours.” In 1988, the ACGME recommended that resident scheduling include one day off per week and limit on-call duty to once every three nights. Following a 1999 report about resident errors issued by the Institute of Medicine, the ACGME began considering limits, but it would take the threat of federal legislation in 2003 for the Council to act. The most recent requirements, enacted in 2011 and tweaked in 2017, permit resident scheduling up to 80 hours per week – averaged over four weeks – and mandate one day off per week – averaged over four weeks. The limit for a single shift is 28 hours, and residents typically get 10 hours off between shifts. While first-year residents (also known as interns) had been limited to 16-hour shifts, the 2017 rule change permitted extending their shifts to 28 hours as well.
That type of resident scheduling is bound to have an impact. A literature review conducted in 2013 found that limiting the duty hours in resident scheduling enabled the new doctors to get additional sleep, make fewer mistakes, and enhance patient safety. Researchers who surveyed residents found that, compared to similarly-aged non-doctors, medical residents had greater levels of fatigue, were more likely to be depressed, and more often indicated that they had extreme emotional exhaustion. The survey revealed that burnout among medical residents was significantly greater than among non-doctors, and that it was also greater for residents than for medical students or early career doctors.
After doctors are well-established in the medical profession, burnout resurfaces. Physicians are 25 percent more likely to have alcohol abuse problems, and 200 percent more likely to contemplate suicide. Actual suicide rates are 40 percent higher for male doctors and 130 percent higher for female doctors than the rest of the U.S. adults.
The impact of physician burnout is more than personal; it reverberates across the healthcare landscape. Researchers have found that physicians who experience burnout report making a range of medical errors – errors in judgment, misdiagnoses, and technical mistakes. Higher physician turnover translates to increased hospital recruitment and onboarding costs. And, it only makes sense that there’s a relationship between high physician burnout and low patient satisfaction.
While important discussions addressing physician burnout are currently taking place, it may be time to pay more attention to the seeds that were planted during medical residency. Resident scheduling can be organized in a way that properly trains physicians, provides teaching hospitals with a resident workforce, and ensures that residents don’t become familiar with burnout before they’re launched their professional careers.
MDsyncNET.com delivers cloud-based software for resident scheduling, resident shift schedules, and resident on-call schedules. Equally important, MDsyncNET helps reduce residents’ stress by providing a location to share and post documents, have online huddles, and provide feedback to hospital administrators. Call 888-506-5061 to schedule a free consultation.