Exploring residents’ well-being factors on the Multilevel Model of Healthcare Professional (HCP): Insight from the nationwide cross-sectional survey
This nationwide cross-sectional study in South Korea applied a Multilevel Model of Healthcare Professional Well-Being to reveal that resident well-being is significantly heterogeneous across postgraduate years and specialty tracks, with junior residents and those in essential specialties facing more adverse organizational conditions and individual stressors despite similar burnout levels.
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Medical residents occupy a unique and demanding space in the healthcare world. They are simultaneously students, learning the intricate details of their chosen specialties, and fully licensed physicians responsible for the lives and safety of patients. This dual role often creates a high-pressure environment where the need to learn clashes with the need to provide continuous care. For years, researchers and hospital administrators have worried that this pressure harms the mental health of these young doctors, leading to exhaustion and errors. To understand this, many have focused on a single measure: burnout, a state of emotional and physical depletion. However, a growing understanding suggests that well-being is not just the absence of burnout. It is a complex picture built from many layers, including a person's own health, their relationships with colleagues, the structure of their training program, the policies of their hospital, and the broader rules of the healthcare system. If we look only at whether a doctor feels burned out, we might miss the deeper, structural issues that shape their daily lives and their future in medicine.
In South Korea, a team of researchers set out to map this complex picture before a major crisis unfolded in the country's medical workforce. They turned to a massive survey conducted in 2020 by the Korean Medical Association, which captured the experiences of thousands of doctors just before the 2024 controversy over medical school expansion caused widespread resignations. The researchers focused specifically on 650 residents, those in their first four years of specialty training. Instead of asking a simple question about stress, they applied a detailed framework that sorts well-being into five distinct levels: the individual, the interpersonal, the training program, the organization, and the system. Two medical educators carefully reviewed hundreds of survey questions to ensure each one fit into the correct level, and a panel of experts confirmed that these questions truly reflected the reality of a resident's life. This rigorous process allowed them to build a clear, multi-layered view of what it was like to be a resident in Korea at that time.
The study revealed that the experience of being a resident was not uniform; it changed significantly depending on how long a doctor had been in training and what specialty they were pursuing. The most striking differences appeared in the organizational conditions, the rules and schedules set by the hospitals. Junior residents, those in their first and second years, worked much longer hours than their senior counterparts. A first-year resident worked an average of 61.44 hours on a typical weekday, while a fourth-year resident worked 50.28 hours. The gap was even wider on weekends and public holidays, where junior residents worked nearly three times as many hours as senior residents. Consequently, junior residents had fewer days off, slept less, and rated their own health and life satisfaction lower than those further along in their training. They also reported higher levels of perceived stress. Interestingly, despite these harsher conditions, the study found no significant difference in burnout or emotional labor between junior and senior residents. This suggests that looking only at burnout would have hidden the severe disparities in working conditions that younger doctors faced.
The divide was even more pronounced when comparing different types of medical specialties. The researchers grouped specialties into two categories: "essential" fields like internal medicine, surgery, and pediatrics, which are critical to the healthcare system but often face staffing shortages, and "non-essential" fields. Residents in essential specialties faced a much heavier burden. They worked longer hours on weekdays, weekends, and holidays, and had significantly fewer days off throughout the year compared to those in non-essential tracks. On average, residents in essential specialties spent 81.4 percent of their time on direct clinical care, whereas those in non-essential specialties spent 68.9 percent. This heavy clinical load came at a cost. Essential specialty residents reported lower satisfaction with their workload, less time for leisure, shorter sleep, and higher stress. They also felt they had fewer opportunities to read medical journals, attend conferences, or engage in the educational activities that are vital for their growth. They were less satisfied with the overall healthcare system and the availability of medical resources. Yet, just as with the year-in-training comparison, the study found no significant difference in burnout scores between these two groups.
These findings paint a picture of a system where the most critical doctors are working the hardest, with the least support for their personal well-being and professional development. The researchers emphasize that the lack of difference in burnout scores does not mean that well-being is the same across all groups. Instead, it highlights that well-being is shaped by many factors, and a single measure like burnout cannot capture the full story. The study suggests that the structural conditions of training—how many hours one works, how much time is left for learning, and how many days off one gets—are powerful drivers of a resident's experience. The data, collected before the 2024 workforce crisis, shows that these structural inequities were already deeply embedded in the system. The researchers conclude that to truly understand and improve the lives of medical residents, we must look beyond individual resilience and address the organizational and systemic conditions that define their daily reality. Without these changes, the path to becoming a specialist remains disproportionately difficult for those serving in the most essential roles.
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