Increased rates of depression, cynicism and low levels of career satisfaction may have direct effects on patient care, report the authors of two studies published in the latest issue of Annals of Internal Medicine.

The first study, by Dr Tait Shanafelt and colleagues from the University of Washington in Seattle, surveyed 115 residents (newly qualified doctors in post-graduate training) of internal medicine using the Maslach Burnout Inventory in addition to five questions specifically designed to assess practices likely to lead to suboptimal patient care.

In total, 76 per cent of respondents were found to be suffering burnout, which was significantly associated with suboptimal patient-care practices that occurred at least once a month.

The second study, conducted by Dr Virginia Collier, from the Christiana Care Health System in Delaware, and colleagues, included residents from all 415 residency programmes in the US. The questionnaires distributed were designed to assess financial and emotional issues associated with medical training.

The researchers found that symptoms of depression were reported by more than one-third of respondents and 61 per cent also admitted becoming increasingly cynical over the course of their residency.

Forty-two per cent of respondents had accrued educational debt of at least $50,000 while 19 per cent had debts of over $100,000. Disposable income was less than $100 for 43 per cent of residents, many could not afford safe housing and over half could not afford books or equipment. Around one-third maintained jobs in addition to their residency positions.

The authors suggest that tuition subsidies and better financial advising could counter the increasing cynicism and depression and the dehumanising effects of educational debt and other aspects of medical training. They stressed that an immediate response was required from the medical community to deal with “the alarming financial and psychological distress” suffered by a significant proportion of residents.

Reference: Shanafelt et al, Annals of Internal Medicine 2002; 136: 358-367 and Collier et al, Annals of Internal Medicine 2002; 136: 384-390