title: Burnout and internal medicine resident work-hour restrictions.
abstract: BACKGROUND
  Burnout is very common in internal medicine residents. Effective July 2003, all residents were restricted to work less than an average of 80 hours per week and no more than 30 hours of continuous duty for patient care and educational obligations. We evaluated rates of burnout in internal medicine residents before and after the implementation of the new work-hour restriction.
  
  
  METHODS
  University of Colorado Health Science Center internal medicine residents were surveyed in May 2003 and May 2004. The survey contained the Maslach Burnout Inventory, organized into 3 subscales (ie, emotional exhaustion, depersonalization, and personal accomplishment); the Primary Care Evaluation of Mental Disorders depression screen; and self-reported quality of care and education.
  
  
  RESULTS
  The response rate was 87% (121 of 139 residents) and 74% (106 of 143 residents) in 2003 and 2004, respectively. Self-reported hours worked decreased from a mean of 74.6 to 67.1 (P = .003). In 2004, 13% fewer residents experienced high emotional exhaustion (42% vs 29%; P = .03). There was a trend toward fewer residents with high depersonalization (61% vs 55%; P = .13) and fewer residents with a positive depression screen (51% vs 41%; P = .11). Personal accomplishment did not change. The assessment of self-reported quality of care did not significantly change from 2003 to 2004. Residents reported attending fewer educational conferences per month (18.99 vs 15.56; P = .01). Overall residency satisfaction decreased 6 mm on a 100-mm visual analogue score (P = .02).
  
  
  CONCLUSIONS
  Burnout continues to be a major problem. Reducing hours may be the first step to reduce burnout but may also affect education and quality of care.
authors.affiliation: Division of General Internal Medicine, Department of Internal Medicine, University of Colorado Health Science Center, Aurora, CO, USA. Ravi.Gopal@med.va.gov
authors.forename: Ravi
authors.initials: R
authors.lastname: Gopal
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Glasheen
authors.forename: Tom J
authors.initials: TJ
authors.lastname: Miyoshi
authors.forename: Allan V
authors.initials: AV
authors.lastname: Prochazka
mesh_terms: D000328:Adult; D002055:Burnout, Professional / Q000523:psychology*; D003120:Colorado; D005260:Female; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency; D007588:Job Satisfaction; D008137:Longitudinal Studies; D008297:Male; D010561:Personnel Staffing and Scheduling; D010820:Physicians / Q000523:psychology; D011446:Prospective Studies; D011787:Quality of Health Care; D011795:Surveys and Questionnaires; D014940:Work Schedule Tolerance