Medical residents have it rough. Their hours are long, their wages low, and many have debts from their schooling amounting to tens of thousands of dollars. Now the results of a new study indicate that these stresses can have serious consequences for doctors and patients alike. According to the findings, published today in the Annals of Internal Medicine, a high degree of burnout exists among residents, many of whom report providing sub-optimal patient care at least once a month.

Tait D. Shanafelt, now at the Mayo Clinic in Rochester, Minn., and colleagues mailed surveys aimed at assessing burnout to the 151 eligible residents in the University of Washington Affiliated Hospitals Internal Medicine Residency program in February 2001. Analyses of the 115 completed surveys revealed that 76 percent of the responding residents suffer from burnout, which the authors characterize as "a syndrome of emotional exhaustion, depersonalization and perceived low personal accomplishment." These residents, they found, were two to three times more likely than their non-burned-out counterparts to report giving sub-optimal patient care--such as discharging patients early to reduce their workload, or making medical errors--monthly or weekly. More than half of the burned-out residents said they were not happy with their career choice.

The results of a survey of residents in all 415 internal medicine residency programs in the U.S. provided additional insight. Virginia Collier of the Christiana Care Health System in Newark, Del., and colleagues announce in the same issue that 42 percent of 4,128 participants in that survey had educational debt of at least 50,000 dollars; 35 percent reported experiencing four or five symptoms of depression during residency; 61 percent reported becoming more cynical.

Collier's team acknowledges that the results of their survey probably do not represent a statistically accurate sampling. But "even if we assume that only discontented, maladjusted, or financially distressed residents returned the survey," they write, "the absolute number of internal medicine residents reporting significant problems must serve as a serious alert to all concerned with our medical educational system and demands remediation."