We have read with great interest the article by Afonso et al. in the January 2024 issue of Anesthesiology.  Focusing on attending anesthesiologists, the authors found that burnout has become more prevalent in the postpandemic area. As resident physicians, we want to add how this pressing issue substantially affects trainees.

The article cites several studies that demonstrate increased burnout among trainees and younger physicians, explaining that this phenomenon is likely secondary to less-developed “coping mechanisms” and “low levels of personal accomplishments” without acknowledging other well-known causes of trainee burnout. A previous article in Anesthesiology identified even before the pandemic that a lack of institutional and social support, work–life balance, and manageable workload markedly affects resident burnout.  The COVID-19 pandemic and its aftermath only exacerbated the challenges trainees face. Alfonso et al. identified “staffing shortages” and “lack of support at work” as the strongest risk factors for burnout, and trainees are especially implicated in these problems.

The shortage of anesthesiologists and other physicians is anticipated to only increase over time.  Institutions are under more pressure to utilize residents as a major part of their workforce productivity. The inherently conflicting role of residents as students and employees is strained as hospitals become reliant on operating room productivity to meet the hospital’s bottom line. We have seen a corresponding increase in residency programs and positions in order to meet this need.  As a more cost-effective alternative to advanced practice providers, resident physicians often serve as the first-line staff members to fill work hours.  Institutions prioritize their mission to the education and well-being of residents with great consideration of the financial cost.

Although improved over the past few decades, residents have the highest work hours with comparatively lower hourly pay and flexibility. Salaries, benefits, and support for residents have not been commensurate with the demands for efficiency, productivity, and costs of modern life. Unable to leave their work environment conditions, trainees have resorted to change from the bottom up, exemplified in recent unionizing efforts across the country at major academic centers.  Under intense pressure to meet competing demands of their institution and trainees, program leadership are at a great risk of burnout themselves. 

We write this letter not only to shed light on the challenges faced by resident physicians but also to urge the consideration of trainees while thinking about burnout and well-being of attending anesthesiologists. Although not all current attending anesthesiologists work in an academic setting or with residents, all attendings were trainees at some point. Training is a crucial and seminal period of any physician’s journey, and it is imperative that we work toward solving these problems in burnout from the bottom to the top. By doing so, we can improve the culture and fulfillment in medicine of all members of our specialty.