Organizational interventions needed to address trainee physician stress, burnout

Trainee physicians were at high risk for burnout and stress, which supports the need for mitigation-focused organizational interventions, according to results of a systematic review and meta-analysis published in JAMA Network Open.

“High burnout and stress levels have been found in trainee physicians working in the U.S., Australia and Canada,” Anli Yue Zhou, MBChB, MA, MSc, of the division of population health at University of Manchester in the U.K., and colleagues wrote. “Surveys on trainee physicians suggest that 50% were experiencing burnout symptoms and 80% were experiencing high stress. Burnout in trainee physicians can have profound effects on personal well-being, career prospects, and relationships and may jeopardize patient care.

“The well-being of trainee physicians is a benchmark for the sustainability of health care systems,” they added. “Better understanding of factors that underpin feelings of stress and burnout in trainee physicians has important implications.”

Results of previous studies suggested factors related to the workplace, including work-life conflict and workload, and factors unrelated to the workplace were linked to burnout; however, because of variations in presentation and methods of results, researchers have encountered difficulty comparing the findings between published studies and exploring the reasons for inconsistent results.

In the current study, Zhou and colleagues sought to estimate the association between burnout/stress and various stressors among trainee physicians. They searched four databases from inception through April 30, 2019, using the search terms trainee, foundation year, registrar, resident and intern, and they included 48 studies that reported associations between stressors and burnout/stress among this population. The association between burnout/stress and workplace- or non-workplace-related factors served as the main outcome.

Data were available for 36,266 individuals, and the mean age was 29 years. Results showed trainee physician work demands were linked to an approximate three-fold increased risk for burnout/stress (OR = 2.84; 95% CI, 2.26-3.59), followed by patient care concerns (OR = 2.35; 95% CI, 1.58-3.5), poor work environment (OR = 2.06; 95% CI, 1.57-2.7) and poor work-life balance (OR = 1.93; 95% CI, 1.53-2.44). Other factors associated with increased risk for burnout/stress included perceived/reported poor physical or mental health (OR = 2.41; 95% CI, 1.76-3.31), female sex (OR = 1.34; 95% CI, 1.2-1.5), financial worries (OR = 1.35; 95% CI, 1.07-1.72) and low self-efficacy (OR = 2.13; 95% CI, 1.31-3.46). The researchers reported no significant associations for younger age or a more junior grade.

“The findings of this study suggest that burnout/stress in trainee physicians is predominantly associated with workplace-related factors, such as work demands and poor work environment, rather than nonmodifiable and non–workplace-related factors,” Zhou and colleagues wrote. “Multilevel organizational interventions targeting poor work environment and work demands have the potential to mitigate burnout and stress among trainee physicians.”

In a related editorial, Dave W. Lu, MD, MS, of the department of emergency medicine at University of Washington School of Medicine, highlighted the need for synergy between individual- and organization-level interventions to address these needs among trainee physicians.

“While there is a role for individual interventions, without concurrent systems- and organization-based actions, such interventions are not sufficient,” Lu wrote. “There remains a dearth of large-scale and rigorous studies of burnout interventions for trainees and other clinicians. As the landscape of medicine changes in the face of political, economic and social challenges, issues surrounding burnout and occupational stress are not going away. Robust, evidence-based recommendations to promote the professional well-being of trainees and other health care professionals are essential.”