November 9, 2020

As Residents Face Pandemic Burnout, Siegel and Team Look for Solutions

REDUCING THE STRAIN: A faculty-student DBOS team is developing strategies to help medical residents. (Photo credit: AAMC/

A growing mental health crisis has been reported since the beginning of the COVID-19 pandemic, and there’s no sign of its stopping. A recent Boston University study notes that depression rates have tripled since quarantine began earlier this year.

As we enter the winter months, there’s more concern that these rates will get even worse with the increased isolation caused by the weather, the holiday season, and a divisive political election season. But that new study also misses one group that is getting hit especially hard by the pandemic: medical residents.

What’s happening to this particular group of doctors? Are residents more vulnerable to depression in these challenging times?

Yes, says a research team led by Jason Siegel, a professor in the Division of Behavioral and Organizational Science.

That team is seeking solutions to help them with a research project under way in partnership with the Hospital Corporation of America (HCA), an organization that operates some 186 hospitals and thousands of other care sites in the U.S. and abroad.

Siegel and his student research team are seeking to develop strategies that hospitals can use to minimize stress and depression for this especially hard-hit segment of doctors.

The Medical Profession’s Workhorses

Aside from nurses, medical residents are one of the profession’s workhorses: They face long hours and grueling schedules that can deprive them of sleep, affect their diets, and limit normal healthy social interactions (Gray’s Anatomy makes all of this seem far more glamorous than it really is).

“Before COVID-19, residents were already struggling,” Siegel explained. “They’re a very resilient group, but you can’t take them for granted, especially now. Taking better steps to ensure their health and well-being is beneficial not only for them, either. It’s obviously important because of their patients.”

Creating hospital interventions and other strategies to lower stress levels for residents.

What causes burnout among many medical residents?

In pre-pandemic times, Siegel noted that there are many reasons for burnout among medical residents. These include long work hours, limited levels of autonomy, a lack of certainty about the future, and the perception that personal needs should be put aside.

To work under those kinds of conditions was hard before, but now “during COVID-19 it’s become even harder and they’re feeling more worn down,” he said.

Finding value and meaning in one’s work is critical. Without that, Siegel said, what happens to a person “is an unfortunate chain of events. Burnout can lead to depression, and that depression can lead to even deeper depression. It’s also possible they’ll be less likely to seek help for themselves or go the extra mile for patients.”

So the team’s HCA study is meant to highlight the plight of residents in this especially stressful time and to work with hospital systems to take as humane an approach to handling them as possible—especially the number of hours they’re logging—and to help them keep their psychological capital as intact as possible.

A Team With Diverse Skills, Experience

The genesis of the project was a partnership between Gregory Guldner, a doctor and program director of Riverside Community Hospital/University of California Riverside, and DBOS graduate student Anne Brafford, who worked with Guldner on a project for one of Siegel’s classes.

The CGU research team includes doctoral students (from left) Anne Brafford, Brendon Ellis, Stephanie Ramirez, and Gabrielle Riazi.

Siegel credits their work together (which resulted in two previous smaller HCA contracts) for resulting in a new contract and partnership that has enlisted Siegel and his students (including Brafford). That team includes Gabrielle Riazi, Brendon Ellis, and Stephanie Ramirez. Without the initial work conducted by Guldner and Brafford, as well as the support from HCA, Siegel said this project would not exist.

Brafford, who was a lawyer and author of a book about lawyers and wellbeing before enrolling at CGU, is about to write her dissertation; Ellis is close to beginning his dissertation work; Riazi is a second year psychology doctoral student who’s also completing her MPH; and Ramirez is starting her second year in a dual public health and psychology master’s and plans to go to medical school.

“It’s never too soon to plunge into field work. That’s what I tell all of my students,” Siegel said. “You shouldn’t have to wait until after graduation to conduct important, helpful work that’s going to improve someone’s life.”

Research results

The team conducted a survey of medical residents (most from the U.S. with some participants from abroad) and received data from 366 respondents. The average age of survey participants was 31, and the survey looked at a range of factors that contribute to their sustained experiences of stress.

Some of these factors are not surprising: Residents reported that an increased workload and work schedule directly translated into a much greater degree of burnout. The team’s current survey fits into a larger effort that is also recording levels of resident stress pre-pandemic.

Over time, Siegel said, the team’s plan is to look at the differences in these sets of data and and come up with a set of recommendations and wellness interventions that hospitals can use to protect the health of their residents. The team’s work also includes co-authoring a forthcoming paper about their research results.

Siegel said they’re pleased to be working on this with HCA, which “cares greatly not only about their patients but their medical professionals, too.”

“No one’s immune to stress, not even doctors,” he added. “It’s very critical to protect their well-being because it has widespread consequences. Not only does their ability to take care of themselves decline, it can impact the quality of the care that they’re providing, too.”