Elsevier

Clinics in Dermatology

Volume 39, Issue 6, November–December 2021, Pages 1025-1031
Clinics in Dermatology

Preserving wellness in dermatology residents

https://doi.org/10.1016/j.clindermatol.2021.02.001Get rights and content

Abstract

Although a dermatology residency is associated with a favorable lifestyle, nearly one in three budding dermatologists meet the criteria for burnout. The competitive nature of dermatology residency selection may confer a predisposition to burnout. Contributing factors during residency include a high-volume clinical experience and frequent use of electronic health records. Women may face particular pressures in managing work-life balance when starting a family during dermatology residency. In addition to preventing burnout before residency, fears of professional repercussions should be alleviated to ensure resident well-being. We have focusedW focus on the causes of burnout among dermatology residents and suggest solutions to promote wellness.

Section snippets

Recognizing and defining burnout

Herbert Freudenberger (1926-1999, a German-born American psychologist, first brought the concept of burnout to the attention of physicians in the 1970s.7 A 2012 study reported that burnout clinical manifestations are significantly more prevalent in practicing physicians compared with high school graduates and individuals with professional or doctoral degrees other than a doctor of medicine (MD) or doctor of osteopathic medicine (DO).8

The three following contributing factors can be qualitatively

Burnout prevalence and specialty choice regret among dermatology residents

A large 2018 study used an adapted version of the MBI to determine the rates of burnout among residents across 20 medical specialties. The mean prevalence of burnout of the 20 specialties sampled was 45.2% (n = 3,588). The prevalence of burnout among dermatology residents was found to be 29.6% (n = 71), the lowest rate of burnout among all specialties. Another indicator of burnout in physicians is dissatisfaction with career choice. The mean percentage of residents that regretted their choice

Factors contributing to burnout

The factors that contribute to burnout are many and not always predictable. Most can be tied to recent evolutions in the health care system.17 Program directors should address the specific causes that may disproportionately affect dermatology residents, including stressful family life issues related to the administrative burden in high-volume dermatology practices and a higher proportion of women in dermatology.18 In addition, dermatology residents may be burned out before they ever arrive in

The stresses of preparing for a career in dermatology

The competitive nature of the dermatology application process is clear. With sustained and substantial pressure to achieve at the highest level throughout college and medical school, dermatology residents may be at risk for burnout before they begin their residency.

The process of securing a residency position in dermatology is becoming more competitive with each academic year. In addition to high grades, the average United States Medical Licensing Examination Step 1 and Step 2 scores of senior

Work-life balance

A second contributing factor leading to stress in dermatology residents is the need to balance work and family life at a time when they may wish to start a family, a decision already delayed by medical school. Women make up 62.2% of the dermatology resident workforce, and limitations on maternity leave represent a serious concern.22,23 The current American Board of Dermatology guidelines limit leave of absence during residency to 6 weeks in any given year or to 14 weeks over 3 years.24

Electronic health records

The electronic health record (EHR) was implemented to enhance the quality of patient care, reduce paperwork costs, and improve physicians’ efficiency. Unfortunately, many physicians have found that EHRs create new issues in the workplace owing to an increased documentation burden.27 In fact, a 2018 survey of academic dermatologists found that the most commonly reported cause of burnout—identified by 22% of responders—was excessive time spent documenting EHRs.28 This is perceived to be an

Combating burnout in dermatology residency

The primary responsibility of maintaining the wellness of trainees ultimately falls on the residency program director. Program directors may believe that asking about wellness may seem difficult or intrusive, but in a 2018 survey of residents, 82% reported that they were in favor of their program directors regularly asking about wellness regardless of job performance. The survey also reported that lack of time, lack of knowledge of mechanisms for seeking help, and concerns about appearing weak

Addressing fear of professional repercussions

Along with these common barriers, fear of derailing their career for seeking help is a factor that may prevent residents from coming forward.34 A survey in 2008 revealed that 37% of state medical boards reported dealing “differently” with physicians receiving psychiatric care versus medical care. Medical residents also reported that revocation or restriction of license, probation, or treatment programs were possible consequences of physician impairment.35 The stigma surrounding mental health in

Stemming pre-residency burnout

The issue of medical student burnout cannot be ignored when attempting to confront resident burnout. Measures must be taken to educate medical students about physician burnout including personal and professional implications, prevention, identification, and options for seeking help. Being perfect in the world of medicine is not a realistic goal, and those with perfectionist traits are more likely to burn out.38 Therefore, helping medical students come to terms with making mistakes or asking for

Special focus on women in dermatology

Burnout in women dermatologists may be reduced by improved maternity leave policies that are clearly outlined. Leave can be separated into two phases—childbearing leave and family leave. Childbearing leave is defined as the leave of absence taken by the mother leading up to the birth of the child. Family leave is the time taken by the mother, father, or caregiver after the child is born. A review of maternity leave policies for academic faculty at 12 US medical institutions with high National

Confronting EHR issues in dermatology residency

Battling the long work hours and sense of powerlessness associated with EHR requires both optimization of EHR operations and team-based care. Optimization may include the use of smart phrases to prepopulate data. Team-based care initiatives permit dermatology residents to have nursing support and scribes in their continuity clinics in the same way this support is being afforded to faculty. In addition, an optimal number of patients should be scheduled to contribute to productivity while

General efforts to preserve wellness in dermatology residents

Several studies have focused on the preservation of physician wellness as the antidote to burnout.46, 47, 48 Merriam-Webster defines wellness as “the quality or state of being in good health especially as an actively sought goal.”49 Pursuing wellness is an active process that is already being utilized to combat the burnout epidemic. Because burnout arises from a combination of personal stress and work-related factors, combatting burnout on both fronts could be the key to overcoming it.

One

Conclusions

The incidence of burnout may be increasing in the field of dermatology owing to a stressful family life and a struggle for work-life balance, the administrative burden in high-volume dermatology practices, and the overall competitive nature of preparing for and sustaining a career in dermatology. Three factors that contribute to physician burnout that can be qualitatively measured include degrees of expressed emotion, depersonalization, and lack of personal accomplishment.10

Curricula in medical

Declaration of Competing Interest

None.

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