Intern Survival Guide Topic

Don't run on empty.

Burnout's three dimensions, how common it is in residents, what the trials say works, fatigue countermeasures, warning signs, 988 and the Physician Support Line, and where licensure questions stand.

Reviewed October 2026 · verify against current guidelines

Burnout · 1 of 6

Name it precisely.

What burnout is

The WHO's ICD-11 defines burnout as a syndrome resulting from chronic workplace stress that has not been successfully managed. It is classified as an occupational phenomenon, not a medical condition. That framing matters: the cause sits largely in the work.

The three Maslach dimensions

Emotional exhaustionDrained before the shift starts. Nothing left by the end of it.
DepersonalizationCynicism and distance. Patients start to feel like tasks: “the hip in 12.”
Reduced personal accomplishmentThe sense that nothing you do matters, or that you are not good at this.
Burnout is not depression, but they overlap — Burnout is anchored to work. Depression follows you home, onto vacation and into everything else, and it needs an evaluation, not a better schedule.
Burnout · 2 of 6

You are not the only one.

What the data show

Burnout, residents worldwide51.0% pooled across 22,778 residents; 51.6% in North America (Low 2019 meta-analysis).
Burnout, 22-item MBI studies only35.7% across 26 studies and 4,664 residents (Rodrigues 2018). Prevalence depends on how burnout is defined.
US residents, PGY-245.2% reported burnout symptoms; 14.1% reported career-choice regret (Dyrbye 2018, 3,588 residents).
Depression or depressive symptoms28.8% pooled across 17,560 residents. In longitudinal studies, the median absolute rise at the start of residency was 15.8% (Mata 2015).

The estimates vary; the direction does not. It also matters for patients: in a meta-analysis of 170 studies, burnout was associated with twice the odds of patient safety incidents (OR 2.04; 35 studies; Hodkinson, BMJ 2022).

PGY-2 second postgraduate yearMBI Maslach Burnout InventoryOR odds ratio
Burnout · 3 of 6

Fix the system first.

What the trials say

Panagioti (JAMA Intern Med 2017; 19 studies, 1,550 physicians) found interventions produced small reductions in burnout (SMD −0.29). Organization-directed interventions worked better (SMD −0.45) than physician-directed ones (SMD −0.18). West (Lancet 2016; 15 randomized trials and 37 cohort studies) found overall burnout fell from 54% to 44%, and that both individual and organizational strategies produced meaningful reductions.

What your program owes you (ACGME CPR 6.13–6.16)

  • Attention to scheduling, work intensity and work compression.
  • Time to attend medical, mental health and dental appointments, including during work hours.
  • Confidential, affordable mental health assessment, counseling and treatment, with urgent and emergent access 24 hours a day, 7 days a week.
  • Education on recognizing burnout, depression, substance use and suicidal ideation, and access to self-screening tools.
  • Coverage when you cannot work (illness, fatigue, family emergency), without negative consequences.
  • Fatigue-mitigation education, adequate sleep facilities and safe transportation home.

What you control

  • Protect sleep before you protect anything else.
  • Keep one thing that is not medicine on the calendar every week.
  • Debrief hard cases with a co-resident instead of carrying them alone.
  • Get your own PCP and, if you want one, a therapist, before you need them.
  • Take your vacation. All of it.
  • Define “done” for the day and go home when you reach it.
Resilience training does not replace a humane schedule — The evidence favors organizational change. If the system is the problem, say so through your chiefs, program evaluations and the ACGME survey.
SMD standardized mean differenceCPR ACGME Common Program Requirements (well-being was VI.C in earlier versions; now 6.13)PCP primary care physician
Burnout · 4 of 6

Treat fatigue like a vital sign.

Why it matters

In a national cohort of 2,737 interns (Barger, NEJM 2005), driving after a shift of 24 hours or more carried 2.3 times the odds of a crash and 5.9 times the odds of a near miss. Each extended shift scheduled in a month raised the monthly risk of a crash on the commute home by 16.2%.

Countermeasures

Strategic napsShort naps of 15–30 minutes with an alarm. Waking after about 20 or about 90 minutes leaves less grogginess than waking at an hour.
Sleep inertiaGrogginess after waking usually fades within about 30 minutes, longer when you are sleep-deprived. Do not make a high-stakes decision the moment you wake.
CaffeineUse it judiciously. It takes about 30 minutes to work, so caffeine taken just before a short nap may help you wake more alert.
Before and after callIncrease sleep before and after call, and keep a consistent routine on days off.
Day sleep after nightsBlackout curtains, earplugs or white noise, phone silenced, the same wind-down every time.
Getting homeToo tired to drive? Use the call room or a ride. Your program must provide sleep facilities and safe transport options (CPR 6.16).
Post-call is not a driving condition — Nodding at red lights is a warning, not a joke. Sleep first or get a ride.
Burnout · 5 of 6

Know the signs. Use the numbers.

Suicide warning signs (NIMH)

  • Talking about wanting to die, great guilt or shame, or being a burden to others.
  • Feeling empty, hopeless, trapped or having no reason to live; extremely sad, anxious, agitated or full of rage; unbearable emotional or physical pain.
  • Making a plan or researching ways to die.
  • Withdrawing from friends, saying goodbye, giving away important items, or making a will.
  • Taking dangerous risks, extreme mood swings, eating or sleeping more or less, using drugs or alcohol more often.

In a co-resident, or in yourself

Get help now, especially if the change is new or worsening. Ask directly and privately: “Are you thinking about suicide?” If they have a plan, intent or access to means, do not leave them alone: call or text 988, call 911, or walk them to the emergency department. Then tell the chief resident or program director. Means safety matters: clinicians have ready access to medications, and reducing that access during a crisis is part of keeping someone safe. Imminent risk overrides a co-resident's request to keep it confidential.

Where to get help

Immediate dangerCall 911 or go to the nearest emergency department.
988 Suicide & Crisis LifelineCall 988 or text 988, or chat at 988lifeline.org. Available 24/7/365; free and confidential. Veterans: dial 988, then press 1, or text 838255.
Physician Support Line1-888-409-0141. Monday–Friday except federal holidays, 8:00 AM–11:00 PM ET. Free, confidential and anonymous; staffed by volunteer psychiatrists; for physicians and medical students; no appointment; any issue, not just a crisis.
Your programThe ACGME requires confidential, 24/7 urgent mental health access for residents (CPR 6.13.e). Save the number in your phone now.
If you are thinking about suicide right now — Call or text 988, or call 911. You do not have to be sure it is a crisis to call.
Burnout · 6 of 6

Getting care should not cost your license.

Why this changed

Dr. Lorna Breen, an emergency physician, died by suicide on April 26, 2020, after severe exhaustion during the early COVID-19 pandemic. She feared that getting mental health care would cost her the career she loved. The Dr. Lorna Breen Foundation now leads a national campaign to remove intrusive mental health questions from licensing and credentialing applications.

Where things stand, October 2026

FSMB policy (April 2018)If a board asks about mental health at all, it should ask only about current impairment, not diagnosis or past treatment; any look-back should be 2 years or less; mental and physical health should be asked the same way. Boards should consider “safe haven” non-reporting for applicants in treatment or in good standing with a physician health program.
Wellbeing First ChampionsAs of September 25, 2026, 46 medical licensing boards, 1,087 hospitals and 3,306 other care facilities were verified as free of intrusive mental health questions. The state-by-state map is at drlornabreen.org/wfcc.
Federal lawThe Dr. Lorna Breen Health Care Provider Protection Act became law March 18, 2022 (P.L. 117-105). It was reauthorized in the Consolidated Appropriations Act, 2026, signed February 3, 2026, and extended through September 2030.

Practical steps

  • Check your state board's map entry and your hospital's credentialing form before you assume the worst.
  • Read the exact question: the time window, and whether it asks about current impairment or past diagnosis.
  • Unsure how to answer? Ask your state physician health program or a lawyer, not the group chat.
  • Get the care either way. Untreated illness is the bigger risk to your patients and your career.
FSMB Federation of State Medical BoardsP.L. Public Law

Educational reference only — not medical advice. Verify against local protocol. If you are in crisis, call or text 988.

Sources

Verify against current guidelines and local protocol before acting.

  1. World Health Organization. Burn-out an “occupational phenomenon”: International Classification of Diseases (ICD-11). May 28, 2019.
  2. Low ZX, Yeo KA, Sharma VK, et al. Prevalence of burnout in medical and surgical residents: a meta-analysis. Int J Environ Res Public Health 2019;16(9):1479. doi:10.3390/ijerph16091479.
  3. Rodrigues H, Cobucci R, Oliveira A, et al. Burnout syndrome among medical residents: a systematic review and meta-analysis. PLoS One 2018;13(11):e0206840. doi:10.1371/journal.pone.0206840.
  4. Dyrbye LN, Burke SE, Hardeman RR, et al. Association of clinical specialty with symptoms of burnout and career choice regret among US resident physicians. JAMA 2018;320(11):1114-30. doi:10.1001/jama.2018.12615.
  5. Mata DA, Ramos MA, Bansal N, et al. Prevalence of depression and depressive symptoms among resident physicians: a systematic review and meta-analysis. JAMA 2015;314(22):2373-83. doi:10.1001/jama.2015.15845.
  6. Hodkinson A, Zhou A, Johnson J, et al. Associations of physician burnout with career engagement and quality of patient care: systematic review and meta-analysis. BMJ 2022;378:e070442. doi:10.1136/bmj-2022-070442.
  7. Panagioti M, Panagopoulou E, Bower P, et al. Controlled interventions to reduce burnout in physicians: a systematic review and meta-analysis. JAMA Intern Med 2017;177(2):195-205. doi:10.1001/jamainternmed.2016.7674.
  8. West CP, Dyrbye LN, Erwin PJ, Shanafelt TD. Interventions to prevent and reduce physician burnout: a systematic review and meta-analysis. Lancet 2016;388(10057):2272-81. doi:10.1016/S0140-6736(16)31279-X.
  9. Accreditation Council for Graduate Medical Education. ACGME Common Program Requirements (Residency), effective July 1, 2026. Sections 6.13–6.16 (well-being, fatigue mitigation).
  10. Barger LK, Cade BE, Ayas NT, et al. Extended work shifts and the risk of motor vehicle crashes among interns. N Engl J Med 2005;352(2):125-34. doi:10.1056/NEJMoa041401.
  11. CDC/NIOSH. Training for Nurses on Shift Work and Long Work Hours, Module 7: Napping, an Important Fatigue Countermeasure (sleep inertia; nap duration). https://archive.cdc.gov/www_cdc_gov/niosh/work-hour-training-for-nurses/longhours/mod7/05.html
  12. National Institute of Mental Health. Warning Signs of Suicide. nimh.nih.gov.
  13. 988 Suicide & Crisis Lifeline. 988lifeline.org (call or text 988; chat; available 24/7/365; free and confidential). Veterans Crisis Line: dial 988 then press 1, or text 838255 (veteranscrisisline.net).
  14. Physician Support Line. physiciansupportline.com: 1-888-409-0141, Monday–Friday except federal holidays, 8:00 AM–11:00 PM ET; free, confidential, staffed by volunteer psychiatrists (checked October 18, 2026).
  15. Federation of State Medical Boards. Physician Wellness and Burnout: Report and Recommendations of the Workgroup on Physician Wellness and Burnout. Adopted as policy April 2018. J Med Regul 2018;104(2):37.
  16. Dr. Lorna Breen Foundation. About Dr. Lorna Breen; Wellbeing First Champion Challenge (drlornabreen.org/wfcc; counts as of September 25, 2026).
  17. Dr. Lorna Breen Health Care Provider Protection Act, Public Law 117-105, March 18, 2022. Reauthorization in the Consolidated Appropriations Act, 2026 (H.R. 7148), signed February 3, 2026 (American Society of Anesthesiologists, Washington Alert, February 2026).