Starting Out Completely Exhausted

Do you feel burned out by your day-to-day routine? Are you frustrated by an endless avalanche of patients, all vying for your time? Do you wish that you could take more time off work, but it just seems impossible? Perhaps what you need is a new associate. If you have grown a bit weary after a decade or two of patient care, a newly minted ophthalmologist might be just the right prescription for what ails you. Who would be better equipped to take on some of these challenges than a fresh-faced, brand new ophthalmologist?

But don’t get your hopes up. Today’s new ophthalmology residents are dead tired, depressed, and possibly suicidal. According to a study recently published in JAMA Ophthalmology, over two-thirds of the 241 ophthalmology residents who responded to a survey reported that their training programs had faced an issue with depression, burnout, or suicide within the past year.¹ About one-quarter reported being personally involved in a case in which fatigue, burnout, or depression adversely affected the medical outcome or their judgment.

In that same study, only 26.7% of residents reported that their training program had a formal resident wellness program that offered services such as nutritional seminars, exercise classes, and one-on-one counseling.

Residency can be a stressful time—although many would argue that ophthalmology residency is somewhat benign when compared with several other specialties. Still, the challenges of absorbing enormous amounts of new information, learning intricate surgical procedures, and caring for sick patients is undeniably difficult. In the hopes of improving patient safety, a series of restrictions were placed upon resident work hours by the Accreditation Council for Graduate Medical Education (ACGME). Starting in 2003, the workweek was formally capped at 80 hours, with shifts capped at a maximum of 24 consecutive hours.² More recent rules allow shifts of up to 28 hours.³

Despite these protections, some residents have complained that, even though their official hours might be capped at 80 per week, they are still responsible for completing a workload that requires far more hours.⁴ Further complicating the situation is the fact that it is not clear who is actually responsible for monitoring and enforcing these restrictions. Although the reforms were designed to improve patient safety, a systematic review of 27 studies found no difference in patient mortality before and after implementation of the ACGME work restrictions.⁵

Additional help may be on the way for our weary residents. The ACGME recently released a set of guidelines that formally requires accredited ophthalmology residencies to provide activities to promote resident well-being, including confidential counseling, behavioral health resources, and overall wellness education.⁶ These initiatives were all born of good intentions—and perhaps the additional regulatory requirements will succeed where previous ones have failed—but I wonder if we should look elsewhere to alleviate resident dissatisfaction.

A 2016 study found that internal medicine residents spend an average of 5 hours per day on the demoralizing task of filling out required electronic health record (EHR) data fields.⁷ Unfortunately, things don’t seem to get much better after residency; a recent time-motion study of four ambulatory care specialties found that half of all physician time was spent dealing with EHR and regulatory paperwork.⁸ Indeed, many physicians seem to be in open revolt against EHR.^9-11 Dissatisfaction and burnout among physicians both in and out of training seems higher than it needs to be, and the nonclinical scutwork component of the job seems to be a major culprit. Sadly, I see nothing on the horizon to reverse this trend. n

Steven J. Dell, MD | Chief Medical Editor