- A mid year comparison study of career satisfaction and emotional states between residents and faculty at one academic medical center

No previous study has compared markers of career satisfaction, emotional states, opinions about positive and negative aspects of the "physician experience", compliance with the ACGME duty hour requirements and sleep attainment in both resident physicians and their faculty simultaneously. The survey has been validated to reflect accurately residents' emotions and attitudes about career satisfaction. Although it has not been validated to reflect faculty opinions in these categories, there is little reason to suspect that the instrument would not be applicable to them. The response rates were excellent – nearly 72 percent of residents and 66 percent of faculty. The reliability of the instrument is supported by the fact that all of the narrative comments were consistent with at least one of the 33 choices about positive and negative experiences provided in the survey questions.

The study was intentionally implemented at mid-year, which is the most negative time for residents' in their training experiences. Accordingly, beliefs about career satisfaction, emotional states and about their professional experiences will typically be at their low points at this time. It is thus reassuring that satisfaction with career choice and emotional states were actually positive for both residents and faculty groups, an indication that the professional milieu is positive. The reasons faculty were more positive and less negative than the residents in career satisfaction, emotional states and positive and negative perceptions of the experience, and at the same time more stressed about their jobs are not understood. Obviously more questions have been raised than answered and these data raise abundant opportunities for more research. However, in previous studies published from this institution, we have consistently noted that residents have more positive emotions and attitudes about their professional experiences as they advance in training [9-11]. They recognize their competence and importance, and their anxiety and depression dissipate. Thus, we believe that faculty's more positive attitudes and emotions reflect the changes in the continuum of advancement observed during residency. These findings are also of particular interest because both groups completed the survey after implementation of the ACGME duty hour requirements. There are a number of recent reports that focus on satisfaction and work hours for residents and faculty, and in some, before and after implementation of the duty hour requirements. Unfortunately all focused on single specialties, had small sample sizes, used variable methodologies, and their findings are not consistent [16-18].

One might consider any number of specific changes that make the faculty more positive, divided for convenience into professional and personal characteristics. Professional ones likely include successful completion of training, assumption of supervisory and teaching roles, as well as academic job stability and security. Personal characteristics likely include age, established relationships and clear support systems, improved financial stability, time for other interests, improved efficiencies. Of perhaps these differences amount simply to "generational gaps".

One unanticipated finding of the study relates to reported work hours and sleep for the two groups. It is interesting that the average sleep hours were surprisingly similar for the cohorts. Thus good or bad sleep patterns seem to be shared by both groups, and residents seem to have at least the same opportunities for sleep as do their faculty. While the vast majority of respondents in both groups were nearly compliant with the ACGME duty hour requirements, it is a surprise that the faculty are slightly less compliant than the residents. And, while more residents than faculty reported working up to the maximum allowable 80 hours per week, more than 60% of the faculty who had duty hour assignments of 24 stayed more than 30 hours and did not have 10 hours between shifts. The work hour data for the residents support the fact that the institution is invested in assuring that the ACGME requirements are met. However, the same cannot be said about a commitment to the faculty. The faculty's work hour data raise significant concern about their excesses and thus patients' safety. While these numbers are not large, and represent a relatively small number of faculty, these individuals are likely in units where there are critically ill patients. Neurobiologists have warned institutional and academic leaders that sleep deprivation and its consequences are particularly difficult for older individuals. Sleep deprivation in older individuals may have more significant implications for patient safety than the same degree of sleep deprivation for younger individuals. If this is true, perhaps the ACGME work hour requirements should be applied to faculty who work in its accredited programs.

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