Medical residency — the training that new doctors undergo at hospitals or clinics — is infamous for its demanding schedule, high pressure and relatively low pay. Research has shown that residents also have fairly high depression rates.
The new study suggests that long work hours, specifically, take a toll on residents’ mental health.
Researchers found that among more than 17,000 first-year residents across the United States, average scores on a depression scale rose hand-in-hand with the number of hours worked each week.
Of residents surpassing 90 hours on the clock a week, one-third met the criteria for clinical depression.
The findings offer a strong argument for reducing the number of work hours residents average in a week, according to senior researcher Amy Bohnert, a professor at the University of Michigan Medical School.
“I think we found pretty compelling evidence,” she said.
The residents her team studied most commonly worked somewhere between 65 and 80 hours a week, with some putting in more than 90 hours.
As it stands, residents in the United States are supposed to work no more than 80 hours a week. But that can be averaged over four weeks, Bohnert noted. Plus, she said, enforcement around that 80-hour limit can be lacking.
Working such long hours could take a mental health toll for several reasons, Bohnert said. There’s the stress of all that time in a high-pressure environment; the lack of sleep or simple downtime to recover, and having little time for family and relationships, to name a few.
“There are just some parts of being a doctor that are going to be stressful,” Bohnert said. “And you need breaks to allow yourself to recover.”
That’s not to say doctors are unique in that way, she pointed out. Long hours in any stressful job could potentially drain people’s mental well-being.
The findings, published Oct. 20 in the New England Journal of Medicine, are based on 17,082 participants who were first-year residents between 2009 and 2020. They completed a standard questionnaire used to screen for depression shortly before starting residency, then every few months during their first year.
At the start, the average score was between 2 and 3 — indicating minimal depression symptoms — and fewer than 1 in 20 met the criteria for moderate to severe depression.
Over the course of the year, residents’ depression scores typically rose, but much depended on how many hours they worked. Among residents working 40 to 45 hours a week, depression scores rose by just under 2 points, on average. Of those working 90 or more hours, scores increased by more than 5 points, and just over 33% met the threshold for depression.
Dr. Laurel Mayer is a professor of psychiatry at Columbia University Medical Center and directs the campus NYP-House Staff Mental Health Service.
She noted that particularly since the start of the pandemic, there has been a lot of talk about health care workers’ “burnout” — which refers to physical, mental or emotional exhaustion related to work stress.
Burnout, Mayer said, is broadly regarded as a problem that health care systems need to address, whereas depression is viewed as being within the individual.
But, she said, this study suggests that the system can do something about residents’ depression.
“We know this isn’t a problem of resilience,” said Mayer, who wasn’t part of the research. Doctors, including residents, are typically a can-do group who can handle a lot of stress — but everyone has limits.
“I think this is a good time to rethink our training of residents, and what it could look like,” Mayer said.
Of course, residents are there to learn how to care for patients. So work hours cannot be reduced to the point of compromising their education or patient care, Mayer said.
Beyond the issue of long work hours, she said, there is also still stigma around mental health issues — even among health care professionals. And that can be a barrier to residents and other health care workers seeking care, Mayer said.
So along with addressing training, she said, health care systems need to talk openly about mental health and make care accessible — including for doctors working 80 hours a week.