Article    Table of Contents                    Full Text of this article    PDF of this article (PDFs free after 6 months)    Figures/Tables List    Related articles in Annals  Services    Send comment/rapid response letter    Notify a friend about this article    Alert me when this article is cited    Add to Personal Archive    Download to Citation Manager    ACP Search                            Get Permissions  Google Scholar    Search for Related Content  PubMed Articles in PubMed by Author:    Collier, V. U.    Smith, L.    Related Articles in PubMed    PubMed Citation    PubMed

PERSPECTIVE

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

Virginia U. Collier, MD; Jack D. McCue, MD; Allan Markus, MD; and Lawrence Smith, MD

5 March 2002 | Volume 136 Issue 5 | Pages 384-390

Background: Although curricular reforms have attempted to address sources of stress in medical residency, no recent studies have examined the financial or emotional situations of current medicine residents.

Objective: To question medicine residents about financial status, educational debt, moonlighting, and psychological issues.

Design: Survey distributed in a nonrandomized fashion to medicine residents.

Setting: All 415 U.S. medicine residency programs.

Results: According to the questionnaire responses submitted by the 4128 (18%) participating residents, a substantial number of residents had financial and emotional distress that could have interfered with training. The reported educational debt was at least $50 000 for 1657 (42%) of the respondents and at least $100 000 for 737 (19%). The monthly disposable income was $100 or less for 1620 (43%) of the residents, and 637 residents (16%) could not afford safe housing. Among respondents in their 2nd through 5th year of postgraduate training, 2187 (52%) had insufficient funds to purchase books and equipment, and 678 (29%) could not afford the required fees for the American Board of Internal Medicine certifying examination; 2659 (33%) worked as moonlighters, and this percentage increased progressively with increasing educational debt.

Results: Four or five depressive symptoms during residency were reported by 1461 (35%) residents. Eight hundred ninety-nine residents (23%) thought they had become less humanistic over the course of their residency training; 2347 (61%) reported becoming more cynical. Female residents were more likely than male residents to report increased cynicism and multiple depressive symptoms. Increased cynicism and depressive symptoms were associated with increasing educational debt.

Conclusions: Despite recent curricular reforms, an alarming number of current medicine residents report depressive symptoms, increasing cynicism, and decreasing humanism, which were associated with increasing educational debt and a need to moonlight for financial survival. Ongoing curricular reform, legislative relief from early loan repayment, and salary increases may be necessary to address these problems.

Author and Article Information

From Christiana Care Health System, Newark, Delaware; University of California, San Francisco; St. Joseph's Medical Center, Phoenix, Arizona; and Mt. Sinai Medical Center, New York, New York.

Acknowledgments: The Resident Services Committee of the Association of Program Directors in Internal Medicine (APDIM) designed the survey instrument used in this paper. Other than the authors, members were Drs. Preston Cannady Jr., Jonathan Weschler, and Kevin Yingling. Members of the APDIM Council reviewed this manuscript. In addition to making valuable suggestions, the APDIM Council approved the conclusions and recommendations. APDIM provided administrative support. The authors thank Musa Nsreko, MPH, for performing data analysis, Drs. Neil Farber and Kathy Upchurch for reviewing and critiquing the manuscript, and Cindy Chuidian and Michele Rodriguez for providing secretarial assistance.

Requests for Single Reprints: Virginia U. Collier, MD, Department of Medicine, Christiana Care Health System, PO Box 6001, Newark, DE 19718; e-mail, vcollier{at}christianacare.org.

Current Author Addresses: Dr. Collier: Department of Medicine, Christiana Care Health System, PO Box 6001, Newark, DE 19718.

Dr. McCue: Department of Medicine, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143.

Dr. Markus: St. Joseph's Medical Center, 350 West Thomas Road, Box 2071, Phoenix, AZ 85013.

Dr. Smith: Mt. Sinai Hospital and Medical Center, One Gustave L. Levy Place, New York, NY 10029-6574.

Related articles in Annals:

Articles
Burnout and Self-Reported Patient Care in an Internal Medicine Residency Program
Tait D. Shanafelt, Katharine A. Bradley, Joyce E. Wipf, AND Anthony L. Back

Annals 2002 136: 358-367. [ABSTRACT][SUMMARY][Full Text]  

Editorials
Heeding the Plea To Deal with Resident Stress
Jordan J. Cohen

Annals 2002 136: 394-395. [Full Text]  

Letters
Resident Burnout
Ira S. Nash

Annals 2002 137: 698-699. [Full Text]  

This article has been cited by other articles:

				L. B. Dunn, C. Moutier, K. A. Green Hammond, J. Lehrmann, and L. Weiss Roberts Personal Health Care of Residents: Preferences for Care Outside of the Training Institution Acad Psychiatry, February 1, 2008; 32(1): 20 - 30. [Abstract] [Full Text] [PDF]

				A. Louie, J. Coverdale, and L. W. Roberts Balancing the Personal and the Professional: Should and Can We Teach This? Acad Psychiatry, April 1, 2007; 31(2): 129 - 132. [Full Text] [PDF]

				C. P. West, M. M. Huschka, P. J. Novotny, J. A. Sloan, J. C. Kolars, T. M. Habermann, and T. D. Shanafelt Association of perceived medical errors with resident distress and empathy: a prospective longitudinal study. JAMA, September 6, 2006; 296(9): 1071 - 1078. [Abstract] [Full Text] [PDF]

				S. E. Weinberger, L. G. Smith, V. U. Collier, and for the Education Committee of the American Colleg Redesigning Training for Internal Medicine Ann Intern Med, June 20, 2006; 144(12): 927 - 932. [Abstract] [Full Text] [PDF]

				M. J. Kreitzer, L. Zhang, and M. J. Trotter Transformative Professional Development: Outcomes of the Inner Life Renewal Program Complementary Health Practice Review, January 1, 2006; 11(1): 57 - 62. [Abstract] [PDF]

				N. K. Thomas Resident Burnout JAMA, December 15, 2004; 292(23): 2880 - 2889. [Abstract] [Full Text] [PDF]

				J. G. Hoop Hidden Ethical Dilemmas in Psychiatric Residency Training: The Psychiatry Resident as Dual Agent Acad Psychiatry, September 1, 2004; 28(3): 183 - 189. [Abstract] [Full Text] [PDF]

				K. E. Broquet and P. H. Rockey Teaching Residents and Program Directors About Physician Impairment Acad Psychiatry, September 1, 2004; 28(3): 221 - 225. [Abstract] [Full Text] [PDF]

				C. H. Griffith and J. F. Wilson The Loss of Idealism Throughout Internship Eval Health Prof, December 1, 2003; 26(4): 415 - 426. [Abstract] [PDF]

				S. H. Chae Is the Match Illegal? N. Engl. J. Med., January 23, 2003; 348(4): 352 - 356. [Full Text] [PDF]

				S. Shem Fiction as Resistance Ann Intern Med, December 3, 2002; 137(11): 934 - 937. [Full Text] [PDF]

				D. M. Gaba and S. K. Howard Fatigue among Clinicians and the Safety of Patients N. Engl. J. Med., October 17, 2002; 347(16): 1249 - 1255. [Full Text] [PDF]

				I. S. Nash Resident Burnout Ann Intern Med, October 15, 2002; 137(8): 698 - 699. [Full Text] [PDF]

				G. C. Phillips and L. L. Barton Resident Burnout and Patient Care AAP Grand Rounds, June 1, 2002; 7(6): 65 - 66. [Full Text] [PDF]

				J. J. Cohen Heeding the Plea To Deal with Resident Stress Ann Intern Med, March 5, 2002; 136(5): 394 - 395. [Full Text] [PDF]