Stress in Medical Residency: Status Quo After a Decade of Reform?

Abstract

Surveys going back to the 1970s demonstrated more frequent depression, anger, and hostility in residents than in the general population, presumably reflecting chronic sleep deprivation and fatigue. Attempts were subsequently made to identify, manage, and lower the level of resident stress. At present, duty hours are closely regulated and program directors are obliged to monitor stress levels. New sources of stress continue to emerge, however, examples being unstable financial conditions at some academic medical centers, increased personal debt, and lower confidence in the ability to get work after completing residency. The investigators questioned residents at all 415 U.S. medicine residency programs about their financial status, educational dept, moonlighting practices, and psychological issues. The 4128 survey respondents represented a response rate of 18%. At least 42% of responding residents reported educational debt of $50,000 or more, and 19% owes at least $100,000. Monthly disposable income was $100 or less for 43% of respondents; 16% could not afford safe housing. More than half the respondents in the second through fifth years of postgraduate training could not buy books and equipment, and 29% could not afford to take the American Board of Internal Medicine certifying examination. One third of residents, especially those with a higher debt, reported moonlighting. About half the residents reported changes in appetite, 61% had mood swings, and 45% reported depressed mood. Nearly one fourth of the residents felt that they had become less humanistic during their training, and 61% reported becoming more cynical. Depressive symptoms and cynicism correlated with increasing debt. More than one in four female residents experienced pressure from faculty to delay pregnancy. Female residents with children reported less depression than those without and less frequently reported increased cynicism. It seems that many medical residents continue to experience financial and emotional distress that could interfere with training, despite efforts to limit stress. Disturbingly, feelings of cynicism and a perception of becoming less humanistic are reported frequently. Possible ways of resolving these problems include relief from early repayment and increased salaries. Special efforts are needed to relieve stress in female medical residents.