Burnout in Military Emergency Medicine Resident Physicians: A Cross-Sectional Study With Comparisons to Other Physician Groups

INTRODUCTION: Physician burnout is of growing concern in the medical community and in emergency medicine (EM) in particular. It is unclear whether higher levels of burnout are associated with poorer academic or clinical performance. EM residency in military environments compared to civilian residencies has unique considerations related to additional military-specific training and operational requirements, which may contribute to burnout. The prevalence and effects of burnout on military EM resident physicians have not been investigated. METHODS: In this institutional review board-approved cross-sectional study, the prevalence of burnout and its effect on academic performance of 30 EM residents in a single 4-year military EM training program was examined. The primary instrument utilized to assess for burnout was the Maslach Burnout Inventory Health Services Survey (MBI-HSS). The primary definition of burnout utilized was a high score in both emotional exhaustion (EE) and depersonalization (DP), and a low score in personal achievement (PA). Additionally, at risk for burnout was defined as moderate or high scores in both EE and DP and low scores in PA. A secondary definition of burnout utilized was any high score in EE or DP, or a low score in PA. The findings in this cohort were compared with published reports of burnout in civilian EM resident and attending physicians as well as military orthopedic physicians. The annual American Board of Emergency Medicine In-Training Exam (ABEM-ITE) percentile ranks for each volunteer in that same academic year were collected as a measure of academic achievement. RESULTS: Thirty of the 40 eligible resident physicians consented to participate in this research project (75%). All 30 completed the MBI-HSS and ABEM-ITE. Burnout, using the primary definition, was found in 10% of residents with an additional 13% at risk for burnout. Using the secondary definition of burnout, 73% of residents demonstrated burnout. The prevalence of burnout as measured by the MBI-HSS was similar to that reported in civilian EM resident and practicing physician groups but 2.7 times the burnout rates found in a military orthopedic resident group. We found no relationship between any individual burnout measure in the MBI-HSS and the annual ABEM-ITE percentile scores. CONCLUSION: In a small study of military EM resident physicians, level of burnout as measured by the MBI-HSS is similar to other EM populations including civilian residents and practicing physicians, though it was much higher than that of military orthopedic residents. No relationship between presence or absence of burnout and academic performance as measured by the ABEM-ITE was found.