Stressors, emotional exhaustion and aversion to patients in residents and chief residents - what can be done?

QUESTIONS UNDER STUDY: The goal of the study was to identify (1) specific stressors in the work of residents and chief residents (R and CR) and their consequences, and (2) possibilities for improvement. METHODS: Written questionnaire of 80 physicians at a Swiss public primary and secondary referral center and teaching hospital surveying stressors and resources in the working conditions as well as associated subjective strains. Selective observation of work activities of 14 representative R and CR. RESULTS: Stressors: R and CR reported a deficit in 6 out of 10 expectations regarding their work (greatest deficits: lack of time off, lack of future career prospects and of clear management). The deficits for the R/CR group differed in part highly significantly from deficits reported by directing physicians and medical directors. Work intensity was experienced as high or too high in 72% of R and 67% of CR. Strains: 41% of R and 43% of CR met criteria for emotional exhaustion, and 34% of R and 14% of CR reached critical values for aversion to patients. These strains correlated significantly with the stressors "overburdened through heavy workload", "subjective work intensity", "inadequate leisure time", and "lack of a right to a say in important matters" (all p between <0.001 and <0.01). CONCLUSIONS: Work-related emotional exhaustion and aversion to patients reached a critical mass in R and CR and was underestimated by both physicians and hospital management. The significant correlations between stressors and strains point to the main areas for improvement: reduction in work intensity and workload, change in style of leadership and management, development of new work models.