Low quality of life reported among internal medicine residents

West C. JAMA. 2011;306:952-960.

Issue: October 2011

Internal medicine residents commonly experience suboptimal quality of life, dissatisfaction with work life and burnout symptoms of emotional exhaustion and depersonalization, according to a study.

Researchers used data collected from 16,394 participants who took the 2008 and 2009 Internal Medicine In-Training Examination (IM-ITE) and the 2008 IM-ITE survey to measure well-being and evaluate relationships with demographics, educational debt and medical knowledge of internal medicine residents. Questions concerning quality of life (QOL), satisfaction with work-life balance and burnout were asked in 2008, and overall QOL was measured by a single-item linear analogue self-assessment, according to the study.

Researchers found that low QOL, emotional exhaustion and educational debt were associated with lower IM-ITE scores. IM-ITE scores for postgraduate students in their first year increased by a mean of 4.1 points (99% CI, 3.9-4.3) by their second year, and by 2.6 points (99% CI, 2.4-2.8) by their third year. Overall, 14.8% (99% CI, 14.1-15.6) of participants classified QOL as being “as bad as it can be” or “somewhat bad.” Participants with high levels of debt were found to have lower QOL and satisfaction with work-life balance scores. Of all participants, 32.9% (99% CI, 31.9-33.8) reported being somewhat or very dissatisfied with their work-life balance. At least one symptom of burnout was present in 51.5% (99% CI, 50.5-52.5) of residents, and symptoms were associated with higher debt (OR=1.72; 99% CI, 1.49-1.99). Burnout was less frequent among international medical graduates vs. US medical graduates (OR=0.70; 99% CI, 0.63-0.77). Emotional exhaustion symptoms were reported weekly by 45.8% of patients (99% CI, 44.8-46.8), but these symptoms decreased as patients’ year of training increased. Symptoms of depersonalization were also reported weekly in 28.9% of patients (99% CI, 27.9-29.8), but the symptoms increased after the first year of postgraduate. When it came to educational debt, researchers found emotional exhaustion and depersonalization increased as educational debt increased.

“Regardless of the explanation, internal medicine residents with greater degrees of emotional exhaustion and debt, and lower QOL levels, consistently scored less well on the IM-ITE and did not recover to the level of their colleagues over the course of their training,” researchers wrote. “Additional studies are needed to better understand these relationships and their effect on clinical competency. In particular, as debt relief programs are developed for physicians in training and in practice, their effect on both well-being and patient safety should be assessed.”

Disclosure: Dr. West reports no relevant financial disclosures.

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