Table 3.

Potential strategies to address burnout and depressive symptoms in nephrology training programs

Potential Strategy
Support from program and organizational leadership:
Program directors need to be cognizant of the national and local trends and risk factors for burnout and depressive symptoms among physicians in training.
Programs should emphasize the importance of personal and professional well being at orientation and offer support throughout training.
Prioritizing work-life balance may be achieved by review of work hours, patient load, documentation needs, EMR responsibilities, work environment, call rooms, inpatient and outpatient rotations, and collaborating with fellows in creating work schedules.
Other strategies to enhance work-life integration such as mentoring programs, leadership training, promoting physical health and diet, and offering personal self-care tools to manage work and stress (such as time management, limiting EMR work at home) may be needed in fellowship programs.
Commitment from national organizations such as ASN, NKF, and the American College of Physicians to address physician burnout and emotional distress is highly encouraging.
Assessment:
Periodic assessment of burnout through the MBI or other validated surveys such as the Mini-Z in collaboration with the institution’s graduate medical education office can help identify and track longitudinal trends in well being, while identifying solutions at the personal level, workplace, or training environment based on available resources.
Academic curriculum:
Fellowship curriculum should incorporate sessions on emotional well being, financial planning, clinical expectations and practice, and responsibilities as medical director to allow a smooth transition into the attending role where burnout may be higher.
Training in palliative care and end-of-life discussions in nephrology may reduce burnout and fellows by empowering them with essential communication skills.
Addressing clinical workload:
Interventions—such as having nurse practitioners, nephrology hospitalists, change in overnight call—need to be studied as each strategy may produce different results in a program.
Access to mental health support:
Prompt access to confidential resources such as counselor or psychologist support while fostering a culture of social support and destigmatization is essential to prevent, identify, and treat depressive symptoms early, when present.
Addressing disruptive work environment:
Disruptive work environment needs to be addressed through program directors who serve as a liaison between fellows and hospital administration.
Hospital should adopt zero tolerance for any kind of violence in the workplace and promote confidential reporting in addressing workplace issues, while providing physicians with tools for coping and enhancing resilience.