Residents have a crucial role in the hospital in addition to being the future physician workforce. Burnout in physicians is a threat not just to their personal well-being and patient care but also to the future of the health system in a country. Therefore, in the last years, significant efforts to reduce the feeling of burnout and increase the satisfaction rates from residency have been implimented.6–8
In this current study, we found that the mean satisfaction rate from residency was 7.4 out of 10. Most of the residents felt burnout due to the high workload. There was a correlation between high satisfaction rates and low conflicts with colleagues. In accordance, the most influencing factors that affect residency training is the atmosphere in the department.
A mean satisfaction rate from the residency of 7.4 means that most of the residents are overall satisfied with their training programs however that room for improvement exists. Anesthesiologists, psychiatrists and ophthalmologists were the most satisfied residents while orthopedics, general surgeons and plastic surgeons were the least. Those findings are surprising as plastic surgery, general surgery and orthopedics surgery are considered very popular and competitive specialties. 11,12 One would think that this may rise from the long hours that surgeons work. However, we did not find any correlation between satisfaction rates to monthly working hours and numbers of overnight shifts. Furthermore, we found a correlation between low satisfaction rates and residents medical problems as well as personal relationship difficulties, which been reported in the past.13,14
The mean monthly working hours, in this study, was 176.11 (44 hours per week) and 3.5 overnight shifts per month. In the past few years in Israel, the reduction of working hours of residents has been a major debate, as long working hours have been considered a major cause of stress on resident physicians 15,16 However, in this study we did not find any correlation between working hours and satisfaction rates as well as feelings of burnout. This result implies that residents' perception of working hours can be more significant than actual total working hours. Probably senior residents who are familiar with the different medical situations and maybe even want to stay more in the hospital as they want to gain experience may not see long working hours as a burden while junior residents who are unfamiliar and inexperienced with different medical conditions, see those long hours working as a burden. These findings together with other studies in the past literature 15,16 may suggest that simply reducing work hours may be insufficient to reduce burnout, and it may be essential to focus on the types of stress felt by each resident and specialties.
We found that the burnout feeling is mainly due to high workload and poor work–family life balance. Due to the shortage in doctors as well as shortage in health teams in Israel, the clinical and bureaucratic workload on the residents is pretty high.17 Furthermore, responsibilities outside of the hospital including active participation in research, answering emails, or studying further consumes limited time resident physicians may have.
Residents in Israel usually start their residency when they are in their early or late 30th, so during the residency they usually have a spouse and small children. Therefore, continuing to work at home, probably increases their fatigue feeling as well as impaired their work–family balance. Efforts should be done to decrease workload in hospitals and to implement policies to improve work– family life balance like no answering emails on weekends, protected hours for research and studying, etc.
Low frequency of conflicts with collea medial staff gues (residents, nurses and para-medical staff) as well as low frequency of experiencing intimidation and harassment by bosses was found to be correlated with higher satisfaction rates. Moreover, when the residents, in this survey, needed to choose 5 most important factors that influence their residency, the three most chosen factors were the relationships with colleagues and the training. This is similar to reports from around the world that found that support from co-workers has a buffering effect on depressive symptoms and burnout.18,19 Therefore, health system managers should focus mainly on improving working- relationship in departments, improving residency programs and reducing abuse and harassment. Formal and informal curriculum and workshops for all members of the healthcare system should be performed in order to improve this.
Limitations of this study include that the given survey was sent after two years following the COVID-19 pandemic, which significantly impacted the health system, the work life and family life were different from regular times. Therefore, we send this survey one year following the last lockdown in Israel. In addition, as with any survey, our study struggles with response bias, or example, compliance may have been affected by burnt-out residents apathetic to filling out surveys, or alternatively are overly inclined to fill out the survey. However, still a high response level was achieved from different specialties.