Forty-one percent of resident physicians experience job stress. That number—drawn from exclusive data based on survey responses from more than 1,600 resident physicians across 17 organizations using the AMA Organizational Biopsy® (PDF)—strongly correlates with the frequency of burnout among residents, which sits at 42%, according to the data.
But not all stressors are created equal nor are they experienced with the same frequency across the spectrum of residency training.
Reflective of 2022 trends in organizational well-being, burnout and other outcomes from the working environment of residents and fellows, the data shows that, when residents were asked to list their biggest stressors, these were the most common responses:
- Lack of adequate physicians and support staff—identified as a stressor by 24% of respondents.
- Too many administrative tasks—21%.
- No control over schedule—16%.
- EHR system is ineffective—14%.
- Educational stress—12%.
Putting the onus on the individual resident to reduce these stressors has proven to be an ineffective approach. Instead, Elizabeth Harry, MD, the chief wellness officer at Michigan Medicine, said change must be made at a macro level.
“These are not siloed issues, even though we're talking about a silo of people and they're impacted by everything around them,” Dr. Harry said. “So addressing them at the organizational level is an effective way to approach it.”
How is Michigan Medicine—a participating organization in the AMA Organizational Biopsy—working to address these issues at the organizational level? Physician faculty members offered some insight.
Lack of adequate physician support staff
The problem: Staffing across a number of specialties, even those that give heavy autonomy to advance practice providers remains a challenge. This can, in certain circumstances, cause residents to bear a heavier workload.
The organizational response: “One importance perspective that we hold within graduate medical education at Michigan Medicine is that our clinical services are not meant to be entirely resident-dependent,” said Sarah Mohiuddin, MD, training director of the child psychiatry fellowship program at the University of Michigan Health System. “If there are staffing shortages in clinical operations, we look towards a systems-based and team-based approach to address them in order to help ease the burden on our training programs.”
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Too many administrative tasks
The problem: The expanded administrative workload that residents confront is a problem beyond training. Increasingly, residents are being asked to handle tasks such as prior authorization requests, utilization reviews and care coordination, which detracts from their opportunities for patient interface.
The organizational response: In a nod to the top stressor residents listed, Dr. Mohiuddin—the chair of Michigan’s GME wellness subcommittee—pointed out that adequate staffing is a key in reducing administrative burden. At Michigan, “we function as a team and value all of the roles that many of our staff hold in helping address rising administrative burdens in health care. Having physicians and residents partner with nurses, care managers, and other staff can help address these needs.”
No control over schedule
The problem: Residents are pulled in a number of directions. They have training requirements created by the Accreditation Council for Graduate Medical Education (ACGME) that tend to be difficult to meet during regular rotations. Duty-hour restrictions also create another complication in that programs are charged with ensuring residents don’t work too much, but they may have to get more rigid with scheduling to accomplish that.
The organizational response: Addressing the lack of schedule flexibility at a system level requires policies and plans that account for education and service requirements, Dr. Mohiuddin said. She added that residents often have complex needs outside of work “whether that's parenting needs or their own medical or psychological needs. The idea is to work to provide options and alternatives that can help them adequately address this during training.”
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The EHR is ineffective
The problem: EHRs, combined with in-basket requirements and documentation, take time away from patients and residents are often completing the tasks after work hours.
The organizational response: “We're similar [to many other organizations] at Michigan,” said Dr. Harry. “We have operational issues to improve and culture issues to improve. But we are approaching these common systemic issues strategically in partnerships with leadership across the organization. An example is that we are doing the in-basket 360 redesign with Epic. We have a lot of resources allocated to that institutional priority this year.”
That approach involves getting the right message to the right person with the right information, and in the process removing the low-value or high-cognitive messages flooding residents’ in-baskets.
Educational stress
The problem: Residents have limited time for studying or other research-related work and stress around applications for additional education such as fellowships.
The organizational response: “Residency training provides the opportunity to transition from medical students into autonomous physicians and it is that combination of both learning and working often leads to longer workdays.” Dr. Mohiuddin said. “At Michigan Medicine, we believe that protected education time is vital in ensuring that residents have the time they need to pursue their academic goals.”
