Everything you need to know about physician burnout.
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How to Address Resident and Fellow Burnout

Rightly so, staff wellness within hospitals and healthcare institutions is a hot topic. If physicians, nurses, and other healthcare staff members aren’t well, how can they adequately care for patients?

The topic of well-being is especially important in residency and fellowship programs as habits formed during training generally follow through across an individual’s entire career. Burnout, one of the most prevalent dimensions of distress, has become such an important topic that institutions across the country, as well as organizations such as the Accreditation Council for Graduate Medical Education (ACGME), have made well-being one of their biggest priorities 1.

From a leadership perspective, it’s important to understand what burnout looks like among residents and fellows and what steps they can take to address the issue and improve well-being.

The Current Landscape Of Resident And Fellow Burnout

Research suggests that US physicians experience the most stress during their training years.

Research suggests that US physicians are the most stressed out during their training years and in many cases, that stress leads to burnout in the field. Medical residency programs across the country are coming to similar realizations and starting to promote that maintaining personal well-being is just as important as academic achievements.

Causes of Resident and Fellow Burnout

Unsatisfying Work Conditions

Surprisingly, studies indicate that it may not be the long shift hours that lead to burnout among training physicians. Instead, it may be the overall post-graduate experience. In fact, burnout rates still continue to climb after a mandated shorter work week. 2

Instead, studies indicate poor working conditions and experiences throughout training have a negative impact on well-being. Looking at residency experiences throughout history, studies have indicated that if residents and fellows think their training is not meaningful enough or if they feel unprepared, their risk for burnout and overall distress is much higher. 3

To combat this, institutions have started realigning their resident and fellow duties to ensure they directly relate to future job responsibilities and more patient interaction.

Financial Restraints

Mounting school debt and lower incomes create added stress for residents and fellows. The years that most complete a residency or fellowship training are the same years that many go through other large life events such as starting a family or moving to a new area. These life events require time, money, and other resources to fully invest and thrive.

Financial restraints can become an issue and impact the wellness of many residents and fellows. Proper financial coaching and money management skills can greatly improve the well-being of young medical professionals during this formative part of their lives.

Poor Work-Life Integration

Life during residency is anything but glamorous. Holidays, birthdays, anniversaries, and other events are met with on-call duties. Work conflicts overrule family events and relationships sometimes have to take a backseat to the job.

Physicians-in-training report the importance of fully immersing themselves on-the-job when they’re on rotation and this can sometimes lead to unintentional relationship neglect. When residents and fellows do have a day off, the day is spent catching up on sleep, errands, and other personal tasks that fall by the wayside. 4

More and more institutions are recognizing the importance of work-life integration by promoting self-awareness through online self-assessment tools like the Well-Being Index, as well as encouraging time spent completely separated from their work at the hospital.

Symptoms of Resident and Fellow Burnout

Physical Signs and Symptoms of Resident and Fellow Burnout

  • Exhaustion
  • Anxiety
  • Frequent illness and sickness
  • Headaches and muscle pain
  • Change in appetite
  • Noticeable difference in sleep habits

Emotional Signs and Symptoms of Resident and Fellow Burnout

  • Feelings of helplessness
  • A sense of failure and self-doubt
  • Detachment
  • Lack of motivation
  • Cynicism
  • Decreased career satisfaction

Behavioral Signs and Symptoms of Resident and Fellow Burnout

  • Withdrawn
  • Increased preference for isolation
  • Depersonalization
  • Poor judgment calls
  • Substance abuse
  • Suicidal ideation

The Impact of Resident and Fellow Burnout

How Resident and Fellow Burnout Affects Personal Life

Burnout can affect each person differently. Burnout, along with the other dimensions of distress, may affect personal relationships, lead to poor choices such as substance abuse, and even result in an increased likelihood of depression. Residents and fellows facing distress may question their choice to become a physician.

The personal implications of burnout among residents and fellows may range from extreme exhaustion to even as far as suicidal ideation.

How Resident and Fellow Burnout Affects the Institution

Burnout does not occur in a vacuum, so the side effects can easily spill over onto the institution. Poor judgment calls can arise when a resident is feeling burnt out, resulting in decreased quality of patient care. These medical errors not only reflect poorly on the individual but also on the entire institution.

Resident burnout can easily result in a poor attitude towards patients and colleagues. Empathy may decrease in these situations and end in dissatisfaction – or even anger – for all parties involved. A high resident or fellow turnover rate can be another consequence of not dealing with burnout rates in medical professionals. Turnover rates can cost hospitals hundreds of thousands of dollars in taking on new physicians. Additionally, low patient satisfaction and a higher chance for malpractice can be glaring consequences if burnout is not addressed and resolved.

The Importance of Addressing Resident and Fellow Burnout

Prioritize Authentic Leadership

The key to preventing distress exists at the leadership level. Leadership needs to be proactive when it comes to preventing resident and fellow burnout and take meaningful action to change the organizational culture or policy that has created distress.

Leadership that has an open-door policy provides the support that’s needed for creating a good team. It encourages transparency, extinguishes the negative stigma that comes along with burnout, and encourages positive relationships. These types of leaders are also more able to recognize distress before it becomes an issue.

Address the Distress

The first step to understanding and addressing distress is to get a grasp of where you are and how you compare when it comes to burnout and the various other dimensions. Knowing which specialties are most affected by burnout can allow you to tailor your provided wellness initiatives to specific areas.

Using a validated measurement tool such as the Well-Being Index allows organizations to collect accurate data and pinpoint the groups that need the most support. It’s important to understand where your employees and trainees experience stress the most and how they currently deal with the issue before effective programs and initiatives can be put in place.

Implement a Positive Wellness Program

Once you have a baseline for your employees and their well-being, it is important to build a wellness program that directly addresses their issues and areas of concern.

Popular solutions include counseling groups, team building activities, more time off, and other efforts and policy changes meant to encourage work-life integration and reduce the negative consequences of distress.

Improving well-being is an organization-wide endeavor that starts with gathering the right information. When you have the opportunity to identify burnout symptoms and understand how they relate to well-being, you can take the right approach towards correcting the issue. It takes time to create a well-being plan for your resident and fellows, but putting one in place now can help you avoid major problems in the future.


  2. Cedfeldt, A. S., English, C., El Youssef, R., Gilhooly, J., & Girard, D. E. (2009). Institute of Medicine Committee Report on Resident Duty Hours: A View From a Trench. Journal of Graduate Medical Education, 1(2), 178–180. 
  3. Ludmerer, K. M. (2009). Resident Burnout: Working Hours or Working Conditions? Journal of Graduate Medical Education, 1(2), 169–171.
  4. Fernandez Nievas, I. F., & Thaver, D. (2015). Work–Life Balance: A Different Scale for Doctors. Frontiers in Pediatrics, 3, 115.

Explore the Well-Being Index Demo

Join 600+ organizations already using the Well-Being Index. Invented by Mayo Clinic, the Well-Being Index:

  • Anonymously measures 6 dimensions of distress and well-being in just 9 questions. 
  • Allows participants to compare their results to peers’ and national averages.
  • Provides customized resources based on an individual’s results designed to reduce distress. 
  • Includes the ability to track well-being over time.

The Well-Being Index is available in multiple plans to ensure organizations of all sizes can utilize the tool.

Access the Well-Being Index Demo