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Residents Don 'T Just Look Miserable. They Really Are: Editorial
Residents Don 'T Just Look Miserable. They Really Are: Editorial
Residents Don 'T Just Look Miserable. They Really Are: Editorial
0000000000004128
EDITORIAL
Ann Tilton, MD Is the rite of passage of residency and fellowship a pro- The study broadly reflected US neurology trainees
Laurie Gutmann, MD cess of learning and maturing, or an exhausting and based on the strong response rate and the similarity
demoralizing experience that sets the stage for between the group of respondents and nonrespond-
burnout? What factors can influence the start of ents. The modest numbers preclude further segmen-
Correspondence to burnout or help to promote wellness? It has become tation of the respondents into specific subgroups,
Dr. Tilton:
atilto@lsuhsc.edu
abundantly clear that physicians face a crisis not only leaving questions such as whether child neurology res-
of regulatory burdens, but also of a lack of well-being idents have the same degree of burnout as their adult
Neurology 2017;89:12 or burnout. This is especially true for neurologists. counterparts; data of this sort could offer insights,
This does not begin with the graduation certificate given the lower levels of burnout in practicing pedia-
from residency or fellowship, but instead the indica- tricians compared to neurologists.
tors for burnout are very much present early in their High scores on emotional exhaustion or deperson-
trainingduring residency. More than 50% of alization indicated at least one manifestation of burn-
physicians in the United States meet the criteria for out. Sixty-seven percent of trainees had substantial
burnout, a well-recognized threat to the profession. emotional exhaustion and depersonalization; 54%
Burnout disproportionately affects neurologists, and endorsed accompanying low personal accomplish-
in this issue of Neurology, Levin et al.1 reveal that our ment scores. Of note, residents endorsed higher
next generation of colleagues are equally at risk. scores in depersonalization and low personal accom-
Burnout has 3 defined dimensions: emotional plishment than fellows did. Indeed, the fact that only
exhaustion, feeling of cynicism and detachment 57% of the group evaluated would choose to become
(depersonalization), and a sense of being ineffective physicians again raises serious concern. Interestingly,
at work. This ineffectiveness corresponds to feelings 76% would still choose neurology. The fact that
of low personal accomplishment.2 Burnout has exten- fewer residents and fellows1 than practicing neurolo-
sive ramifications in both personal (personal conflict gists4 (57% vs 61.3%) would again choose to become
and health issues) and work-related activities (work- a physician indicates an early career crisis. In search-
related errors, occupational exposures, and even ing for causative factors, worklife balance constitutes
motor vehicular accidents).3 Thus, burnout poses an extremely important aspect of quality of life for
a threat to the safety of both individual physicians this group. Fewer than 1 in 4 felt that they had ade-
and the patients under their care. quate time for their personal lives. In addition, the
National surveys have confirmed the need for majority found supportive services inadequate.
intervention. The current study looked at 938 of So what factors are associated with burnout in the
the 1,823 US fellows and residents in neurology, training group? Various compounding factors can be
receiving an impressive 37.7% response rate.1 It was considered. Generational issues such as an increased
a complementary study to a previously published reliance on technology and a preference for collabora-
report looking at adult neurologists, and developed tive projects and management style with coaching as
in the same format.4 The 57-question survey, based opposed to top-down directives are also suspected as
on previously validated instruments, addressed burn- associated factors in burnout. Moreover, the high-
out and career satisfaction and personal and profes- demand yet fragmented nature of our current health
sional characteristics. The authors delved into care system may play a role in reported burnout. To
characteristics such as emotional exhaustion, deper- the early-career physicians assessed in this survey,
sonalization, and perception of personal accomplish- meaningful factors identified include worklife
ments, along with career and subspecialty choices. In balance, meaning in work, and supportive staff.
addition, the study explored clerical demands as an Worklife balance was a priority for both residents
area particularly problematic for fellows. and fellows. Of note, women and men gave similar
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Neurology is the official journal of the American Academy of Neurology. Published continuously since
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rights reserved. Print ISSN: 0028-3878. Online ISSN: 1526-632X.