Are residents happy and well paid?

Highlights from Medscape Resident Happiness and Compensation Reports

By #LifeofaMedStudent

Every year, Medscape does a great job of looking at the compensation, lifestyle, and happiness of physicians – including residents. These are free and fairly easy to access (you do have to create a login). But, I find many either don’t know or don’t bother to look. Thus, in this post, we will look at a few of the highlights that I think are important to pass along! Medscape interviewed 1500+ US residents in over 25 specialties and this is what they found…

Happiness and Lifestyle

The last year has seen a lot of focus on social media of the mental health of medical students and residents. Depression symptoms, already known to be common in medical students, were also found at high rates in residents. Almost half responded that they feel depressed “always/most the time” (10%) or “sometimes” (35%). A concerning 10% answered “yes” to “have you ever considered suicide?” Likewise, the issue of asking for help continues to be a problem, with 67% “strongly/somewhat agree” that there was still a stigma against seeking help for mental health. The averages above tended to be slightly worse for women than men in medicine. We clearly still have a long way to go to improve physician wellness and mental health care.

Some of the reasons for these numbers were also clear from the surveys. The two biggest challenges of residency were listed as “work-life balance” and “time pressures/demands on time.” 19% of residents replied they were too tired to function well because of long shifts “always/most the time” and another 48% felt this way “sometimes.” Half of residents sometimes “doubt their ability to be a good doctor” with another 20% having these feelings “always/most the time.”

When it came to social wellness the numbers were not much better. 37% answered “rarely or never” to the question of having enough time for a social life. 36% answered “rarely or never” for “enough time for personal health/wellness.”

Coping Strategies and Avoiding Burnout

When asking what residents do to avoid burnout, a common theme emerged. 66% said that more manageable work hours/call schedule would help – the highest response recorded. Not surprisingly, 4 out of the next 5 most common responses were also related to the work environment. These included: Reasonable patient loads (39%), Flexibility in Schedule (38%), Positive Attitudes in Colleagues (36%), and Adequate support staff (34%).

If asked to work so much, the other way to avoid burnout was compensation. 42% replied sufficient compensation to avoid financial stress was key to preventing burnout.

Coping strategies for stress and burnout varied greatly, some more healthy of responses than others. Luckily, the number one response was exercise (38%). The next response was Movies, TV, and Video games (23%), followed by Socialize (12%), Pets (9%), Hobbies (5%), Sports (4%), Music/Art (4%), Sleeping (4%), Eating and drinking (4%).

Somewhat surprisingly, spirituality was only identified as a coping mechanism by 2% of respondents.

The above answers together I think paint a picture of residents who value work-life balance more than ever and are currently still desiring improvement on the life side of the equation.

My personal experience is that this varies greatly from specialty to specialty and institution to institution. It would have been nice to see a breakdown by specialty in this regard. My own specialty, anesthesia, tends to be more favorable to life balance, but I certainly know of locations where that is NOT the case. Likewise, more demanding surgical specialties are may not be the typical “all work, no play” expectation at every institution.

Compensation and Debt

The other “Resident” report to come out of Medscape this summer was the Salary and Debt Report. The good news is salaries continued to go up, now at an average of $57,200 for all residents. This is improved from $56,500 in 2016 and $55,400 in 2015. There is still a bit of a gap from highest to lowest paying specialties – hematology being the highest ($69k average) while family medicine being the lowest ($54k average).

Salary improves each year of training, with the Post Grad Year 5 (PGY-5) average coming in at $61,400. Starting PGY-1 or intern salary clocked in at about $53k. These are both improvements over the last few years. For personal comparison, my PGY-1 salary in 2013 (as a transitional year resident) was just under $50,000.

Amazingly, despite the fact that salaries are generally equal for all of a particular specialty at an institution, there is still a bit of a gender wage gap. The male all resident average salary was reported as $57,400 compared to the women average being $56,700. I can only guess that this is a result of the differing pay of certain specialties (seen above) and the predilection for genders to enter these specialties with varying levels of interest.

Not surprisingly, 83% of residents felt their compensation “doesn’t reflect the number of hours worked” and 65% stated that the compensation doesn’t reflect the required level of skill. 60% felt that they should be making between 10-50% more than are currently paid.

Personally, I agree with this sentiment. I feel that resident salary would be fairer if the averages were much closer to the $100,000 mark. Many residents will moonlight for additional compensation, putting extra stress on them mentally and physically – just to have a greater sense of financial stability. The choice to add extra hours to an already grueling residency is surely a sign of the need for compensation improvement.

Student loan debt is a major component of financial health and the numbers continue to suggest this is a growing burden. A whopping 45% of residents now have student loan debt of greater than $200,000. 18% of those are >$300,000.

With numbers like that it is not surprising that many residents use future income potential in their specialty choice. 38% stated future income was “extremely/very influential” and another 53% stated it was “somewhat/only slightly influential.” Only 9% of residents stated that future income was not at all influential in their specialty choice. This could, unfortunately, continue to place an unproportionate strain on primary care specialties to attract residents.

Overall

Not all is bad news or unhappiness out of these reports, however. Despite the clear areas for improvement noted above, overall satisfaction with the residency and training experience remains high. Only 19% of respondents found that their training included “more hours than needed” while a robust 79% found their total hours “sufficient.” Similarly, 78% found their overall learning experience “very/somewhat satisfied,” while only 9% were “very/somewhat dissatisfied.”

Attending interactions with residents also scored high. 89% described their relationships with attending as “good/very good” and 81% reported as “very/somewhat satisfied” with the attending physicians’ treatment toward residents.

In conclusion, I believe that despite common resident unhappiness with often inadequate work-life balance and lack of fair compensation…. as residents we do see that we are generally being well-trained. And the Medscape report would agree! 89% listed “the clinical knowledge and experience I’m getting” as the most rewarding part of the job.

Maybe our growing skillset and the satisfaction of becoming more and more independent is what keeps us coming back to work each day… and for many of us, the thing that keeps burn out away.

Below are the two Medscape articles from which the above data was obtained:

Residents Lifestyle and Happiness Report 2017

Residents Salary and Debt Report 2017

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