Food Insecurity in Medical Residents and Fellows

Mahan et al 1 report on food insecurity among resident physicians and clinical fellows at a large academic health system using the 10-item US Department of Agriculture (USDA) Adult Food Security Survey Module. 2 This cross-sectional study adds to growing literature suggesting that food insecurity affects a meaningful proportion of graduate medical education trainees, particularly during the earliest stages of residency.Although exact prevalence reported in any single study should be interpreted cautiously, the central message is difficult to dismiss: some physicians in training struggle to reliably afford food, particularly at the transition from undergraduate medical training to residency, and programs should regard that as a wellness and systems problem.This study extends prior work by Thomas et al, 3 who identified food insecurity in 13.7% of resident or fellow physicians across 4 geographically diverse sites and demonstrated associations with burnout or social isolation.By using the 10-item USDA survey instrument vs a 2-question screener, Mahan et al 1 provide a detailed picture of how food insecurity is experienced by trainees.Food insecurity is not simply a binary measure of deprivation; it can include anxiety about running out of food, compromises in dietary quality, and reductions in intake because of financial constraints.A more comprehensive instrument helps move the conversation beyond whether food insecurity exists to how it manifests during training.However, the prevalence of food insecurity reported in this study appears strikingly high.The authors found 30.5% of respondents screened positive for food insecurity, more than double the 13.7% prevalence reported in the US population 4 and the 13.7% prevalence observed by Thomas.3 Such findings should prompt both concern and caution.Concern, because even if the true prevalence is lower than reported, food insecurity among physicians in training is troubling.Caution, because a single-site study with a low response rate (165 of 600 [28%]) is vulnerable to response bias, and those most affected by financial stress may have been more likely to participate.The denominator (600) and response rate may also not be appropriate for a 3-year cross-sectional analysis because the trainee population changed every year, and some individuals were eligible for multiple years while other trainees left or entered the system.The confidence interval as reported is not likely to account for the self-selection mechanism and likely requires additional quality and nonresponse analysis.The prevalence of food insecurity is also higher than those reported by Shanab et al 5 across 8 undergraduate medical schools at 21.2% (institutional prevalence ranged from 16.0% to 31.9%).The authors appropriately acknowledge these limitations.Still, readers should be careful not to overgeneralize.The study's most compelling contribution is not the overall prevalence, but rather the repeated observation that consistent with prior studies, food insecurity appears to be concentrated among postgraduate year 1 (PGY-1) trainees (45.3% in PGY-1, 23.4% in PGY-2 to PGY-4 or higher).The transition from medical school to residency is a uniquely precarious financial period.Graduates face relocation costs, delays in receiving their first paycheck, licensing or examination fees, the end of student-oriented financial supports, and the start of federal student loan repayment periods, all while beginning a demanding job, often in a new location.Even trainees with stable long-term earning potential may experience acute short-term financial strain.The timing of the USDA survey window, however, complicates interpretation.Because respondents were asked to report on food insecurity during the prior 12 months, a positive screen among PGY-1 residents may reflect experiences from the fourth year of medical school rather than + Related articleAuthor affiliations and article information are listed at the end of this article.Open Access.This is an open access article distributed under the terms of the CC-BY-NC-