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Association of Clinical Specialty With Symptoms of Burnout and Career Choice Regret Among US Resident Physicians

Educational Objective
To understand risk factors for burnout and career choice regret among US resident physicians.
1 Credit CME
Key Points

Question  Do rates of burnout and career choice regret among resident physicians vary by clinical specialty?

Findings  In this prospective cohort study of 3588 second-year resident physicians with follow-up since medical school, reported symptoms of burnout occurred in 45.2% of participants and career choice regret in 14.1%. However, there were wide ranges of prevalence by clinical specialty (29.6%-63.8% for burnout symptoms and 7.4%-32.7% for career choice regret).

Meaning  Symptoms of burnout and career choice regret were prevalent among US resident physicians.

Abstract

Importance  Burnout among physicians is common and has been associated with medical errors and lapses in professionalism. It is unknown whether rates for symptoms of burnout among resident physicians vary by clinical specialty and if individual factors measured during medical school relate to the risk of burnout and career choice regret during residency.

Objective  To explore factors associated with symptoms of burnout and career choice regret during residency.

Design, Setting, and Participants  Prospective cohort study of 4732 US resident physicians. First-year medical students were enrolled between October 2010 and January 2011 and completed the baseline questionnaire. Participants were invited to respond to 2 questionnaires; one during year 4 of medical school (January-March 2014) and the other during the second year of residency (spring of 2016). The last follow-up was on July 31, 2016.

Exposures  Clinical specialty, demographic characteristics, educational debt, US Medical Licensing Examination Step 1 score, and reported levels of anxiety, empathy, and social support during medical school.

Main Outcomes and Measures  Prevalence during second year of residency of reported symptoms of burnout measured by 2 single-item measures (adapted from the Maslach Burnout Inventory) and an additional item that evaluated career choice regret (defined as whether, if able to revisit career choice, the resident would choose to become a physician again).

Results  Among 4696 resident physicians, 3588 (76.4%) completed the questionnaire during the second year of residency (median age, 29 [interquartile range, 28.0-31.0] years in 2016; 1822 [50.9%] were women). Symptoms of burnout were reported by 1615 of 3574 resident physicians (45.2%; 95% CI, 43.6% to 46.8%). Career choice regret was reported by 502 of 3571 resident physicians (14.1%; 95% CI, 12.9% to 15.2%). In a multivariable analysis, training in urology, neurology, emergency medicine, ophthalmology, and general surgery were associated with higher relative risks (RRs) of reported symptoms of burnout (range of RRs, 1.23 to 1.48) relative to training in internal medicine. Characteristics associated with higher risk of reported symptoms of burnout included female sex (RR, 1.19 [95% CI, 1.09 to 1.29]; risk difference [RD], 7.6% [95% CI, 3.8% to 11.3%]) and higher reported levels of anxiety during medical school (RR, 1.08 per 1-point increase [95% CI, 1.06 to 1.10]; RD, 1.7% per 1-point increase [95% CI, 1.5% to 1.9%]). A higher reported level of empathy during medical school was associated with a lower risk of reported symptoms of burnout during residency (RR, 0.99 per 1-point increase [95% CI, 0.99 to 1.00]; RD, −0.5% per 1-point increase [95% CI, −0.5% to −0.2%]). Reported symptoms of burnout (RR, 3.46 [95% CI, 2.83 to 4.23]; RD, 15.2% [95% CI, 12.8% to 17.5%]) and clinical specialty (range of RRs, 1.60 to 2.96) were both significantly associated with career choice regret.

Conclusions and Relevance  Among US resident physicians, symptoms of burnout and career choice regret were prevalent, but varied substantially by clinical specialty. Further research is needed to better understand these differences and to address these issues.

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Article Information

Corresponding Author: Liselotte N. Dyrbye, MD, MHPE, Department of Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (dyrbye.liselotte@mayo.edu).

Accepted for Publication: August 6, 2018.

Retraction and Replacement: This article was retracted and replaced on March 26, 2019, to fix data errors that occurred during statistical analysis in the Abstract, Results section, and Tables 2, 3, and 4 (see Supplement 3 for the retracted article with errors highlighted and Supplement 4 for the replacement aticle with corrections highlighted).

Author Contributions: Dr Herrin and Mr Satele had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Dyrbye, Burke, Hardeman, Yeazel, Dovidio, Phelan, van Ryn.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Dyrbye, Hardeman, Dovidio, Satele.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Herrrin, Phelan, Satele.

Obtained funding: Dovidio, van Ryn.

Administrative, technical, or material support: Dyrbye.

Supervision: Dyrbye.

Conflict of Interest Disclosures: The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Drs Dyrbye and Shanafelt reported receiving royalties from CWS Inc for the Well-Being Index licensed by the Mayo Clinic. No other disclosures were reported.

Funding/Support: This study was supported by grant R01HL085631 from the National Heart, Lung, and Blood Institute. Dr Hardeman was further supported by grant 3R01HL085631-S2 from the National Heart, Lung, and Blood Institute through a research supplement to promote diversity in health-related research. This work also was supported by the Mayo Clinic Department of Medicine Program on Physician Well-Being.

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Data Sharing Statement: See Supplement 2.

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