Mounting Evidence and Calls for Structural Reform in Graduate Medical Education

As the healthcare industry grapples with workforce shortages, declining physician wellbeing, and rising attrition, increasing attention is being paid to the structure of medical residency programs and their impact on physician trainees. Residency, long considered the crucible of medical education, is now drawing critical scrutiny for the role it plays in producing high rates of psychological distress and burnout among young doctors.

Multiple peer-reviewed studies have revealed concerning trends. A widely cited meta-analysis in JAMA found that approximately 43% of residents screen positive for symptoms of depression, with similar patterns noted across specialties and institutions. While rigorous training remains an essential component of clinical competence, these findings raise pressing ethical and systemic questions about the conditions under which medical professionals are trained.

At the heart of the concern lies the structure and culture of residency itself. Long work hours, routinely exceeding 80 hours per week, coupled with inconsistent supervision, sleep deprivation, and high patient loads, contribute to a training environment that often prioritizes endurance over education. The Accreditation Council for Graduate Medical Education (ACGME) has made efforts to impose duty hour restrictions and improve wellness initiatives, but critics argue these interventions remain insufficient and inconsistently enforced.

Sarah M. Worthy, CEO of DoorSpace, a healthcare technology company focused on improving organizational infrastructure and physician support systems, is among those calling for deeper reform. “While eliminating residency programs entirely might not be realistic, reforming them is absolutely necessary. The current structure demands grueling hours and relentless stress, creating a system that breeds burnout instead of fostering well-rounded, effective physicians. Not to mention, they’re unnecessarily competitive. We’re asking young doctors to sacrifice their physical and mental health to prove their commitment, but at what cost?” asks Worthy.

The consequences of this system extend beyond trainee wellbeing. Physician burnout has been linked to increased medical errors, lower patient satisfaction, and higher turnover. The current residency format, established in the early 20th century and modeled on a now-outdated paradigm of hierarchical apprenticeship, often fails to integrate modern insights from organizational psychology, adult learning theory, and occupational health.

Furthermore, the intense competitiveness of the residency match process, particularly in specialties such as dermatology, orthopedics, and ophthalmology, has compounded the pressure on students even before they enter training. This environment discourages vulnerability and suppresses help-seeking behaviors, which are critical to addressing early signs of psychological distress.

Efforts to address these issues have been uneven. Some institutions have piloted changes such as shorter shifts, more structured mentoring, and embedded mental health support services. However, these reforms have yet to be widely adopted across the nation’s teaching hospitals, in part due to resistance from legacy stakeholders who themselves trained under the same demanding conditions.

The emerging consensus among researchers, educators, and healthcare leaders is that a reevaluation of residency is not only warranted but overdue. Proposals range from restructuring duty hours with stronger enforcement mechanisms to redefining performance evaluations to emphasize emotional intelligence and communication alongside clinical acumen. Integrating technology to monitor workload, feedback, and wellbeing indicators in real time is also gaining traction as a complementary solution.

Importantly, the conversation is increasingly shifting from whether reform is needed to how best to implement it without compromising clinical exposure or patient care standards. As Worthy notes, “This isn’t about weakening the profession. It’s about modernizing it in a way that retains talent, promotes longevity, and upholds the quality of care our patients deserve.”

As the next generation of physicians prepares to enter residency, the medical education community faces a pivotal opportunity. Reimagining residency not as a test of endurance but as a foundational period of professional development may be key to building a more sustainable and humane physician workforce for the decades ahead.