Looking back on her time as a first-year emergency medicine resident, Victoria Gordon, DO, described the experience with the oft-used expression that it was like “drinking from the fire hose.” As she approaches the midway point in her second year of residency training, she has found the move from PGY-1 to PGY-2 to come with an entirely different set of taxing challenges.
“When you become a PGY-2, you are more confident,” said Dr. Gordon, an emergency medicine resident at HCA Houston Healthcare Kingwood. “You sort of know what you are doing because intern year is your greatest growth curve. You feel like you have your sea legs, then all of a sudden … you have all these new responsibilities, you are still getting comfortable with them, but you also have just enough time to realize how difficult residency really is.”
Dr. Gordon’s experience is not unique. Second-year residents feel increased job stress and are more susceptible to burnout, according to exclusive data based on survey responses from more than 1,600 resident physicians across 17 organizations using the AMA’s Organizational Biopsy® (PDF).
Reflective of 2022 trends in organizational well-being, burnout and other outcomes from the working environment of residents and fellows, the data shows that the burnout rate among second-year residents was 47%.
That figure is 10 percentage points higher than the PGY-1 burnout rate and is 4 percentage points higher than the next-highest burnout rate among respondents by year, which 43% among third-year residents. With 49% of PGY-2 respondents indicating that they feel “a great deal of stress because of their job,” the group also registered the highest job stress rate.
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Changing responsibilities
Though Dr. Gordon has actually found her second year to be a bit less difficult than intern year, she has found the stresses of the second year of residency to be related to an increase in responsibilities.
“You are carrying a larger patient load,” said Dr. Gordon, an AMA member. “Let’s say you are an intern and your cap is 10 patients. The next day you’re a PGY-2 and that grows to 15 patients. So you are immediately expected to see this bigger load of patients.”
Additionally, there’s a role shift. PGY-2s have a more senior role on the care team and often have a first-year resident working with them, which can decrease efficiency.
“You have this larger workload to start with and then every few minutes someone is asking who to write a note or how to do a workflow,” she said. “It’s adding a lot of work before you are comfortable with your own workload.
“Our program director is great because he tells us to focus on yourself and if you have time to [focus on the teaching component of residency] that’s fine, but also you feel like you want to help the interns. You want to be there for them. You were just in their position. And you want to be supportive.”
Main stressors
The AMA data revealed stressors across the spectrum of residency training. When asked to list their biggest stressors, the top five were:
- Lack of adequate physicians and support staff—24%.
- Too many administrative tasks—21%.
- No control over schedule—16%.
- EHR system is ineffective—14%.
- Educational stress—12%.
Many of these stressors can grow more common for second-year residents, according to according to Nancy Nankivil, the AMA’s director of practice transformation.
“PGY-2s are feeling more stress and burnout most likely because they're getting more exposure to the practice efficiency-related triggers such as work outside of work and overloaded workflows that are bogged down because of administrative burden,” she said.
The exclusive AMA survey data backs that up. One example: When asked about after-hours. At-home workload on EHRs over the previous month, 37% of PGY-2s said the time they spent on the EHR was moderately high or excessive. For PGY-1s, that number was 31%.
The AMA Thriving in Residency series has guidance and resources on navigating the fast-paced demands of training, maintaining health and well-being, handling medical student-loan debt, and other essential tips about succeeding in graduate medical training.
A new approach
Across the entire spectrum of training, the most common stressors are created at the system level, Nankivil noted. Addressing them will require a revamped approach to the topic of burnout and stress management.
“When we talk about burnout for residents or really any physicians, there tends to be a focus on individual resiliency,” she said. “But this data reveals how these systems-level drivers impact stress and burnout of our residence.”
“Residency program directors need to advocate for their residents that the system drivers, such as workload, workflow, work outside of work, task delegation need to be considered for residents as well as faculty and practicing physicians in the system.”
Nankivil added that the AMA is primed to be a collaborator in this new approach to addressing the factors that cause resident burnout and stress. She pointed to efforts such as the AMA Joy in Medicine™ Health System Recognition Program as enabling training institutions to take concrete steps in the right direction.
“This is a major challenge, but the AMA is here to help residency programs address these system-level drivers of burnout,” she said.
The AMA GME Competency Education Program delivers education to help institutions effectively meet ACGME common program requirements. The program provides an award-winning virtual experience, with quality education designed for residents on the go. It’s easy to use, saves time and cuts administrative burdens with simple reporting tools. Learn more.
