Key results

This study identified a high prevalence of self-reported burnout among UK resident doctors and medical students, with more than half of respondents in both groups affected. The associated economic burden is substantial, with burnout-related absenteeism estimated to cost up to £287.43 million annually. These findings are concerning, as they suggest that psychological strain may emerge early in medical training. ^{Reference Prendergast, Cardoso Pinto, Harvey and Muir25} Both residents and students reported considerable financial pressures, relocation difficulties and challenges maintaining work–life balance, all of which likely compound overall psychological distress. Similar trends have been observed across the European Union, where the WHO Mental Health Survey reported high levels of psychological distress among healthcare professionals, exacerbated by adverse working conditions and occupational stress that undermine mental health and well-being. ²⁶ Collectively, these findings indicate that burnout in this population may reflect the cumulative impact of multiple psychosocial stressors rather than a single, isolated phenomenon.

Generalisability

Resident doctors and medical students face distinct stressors that heighten their vulnerability to burnout, including demanding clinical workloads, academic pressures and financial strain. The high prevalence observed in this cohort is likely multifactorial, reflecting the interplay between clinical demands and wider psychosocial and economic factors. These findings reinforce that burnout is a complex, context-dependent phenomenon shaped by individual circumstances and multiple stressors rather than a discrete construct.

Burnout prevalence in our cohort was markedly higher than recent USA estimates from the American Medical Association (34.5% in residents) (Supplemental Reference 1), suggesting important cross-national differences in training environments, training length and systemic pressures that may drive burnout. The current UK resident recruitment climate may further amplify existing stressors, contributing to the higher potential burnout observed compared with countries such as the USA. Heightened competition for postgraduate training intensifies these pressures, compelling early-career doctors and medical students to pursue research, audits and leadership roles during limited personal time to enhance their applications. ²⁷ Competition in postgraduate training may shape burnout trajectories between students and residents. Medical students may experience early anticipatory stress when striving to remain competitive, potentially sacrificing self-care, which can carry forward or worsen in foundation training, as additional clinical, academic and financial pressures emerge. ^{Reference Lin, Woolery-Lloyd, Young and Kenya18,Reference Hall, Johnson, Watt, Tsipa, O’Connor and Harris19} Residents face sustained clinical demands, speciality examinations, lengthy training pathways and uncertainty around securing subsequent training posts, all of which, combined with financial responsibilities, further compound stress and may carry over into higher specialty training.

Higher burnout among residents in medical specialties may reflect heavy service demands and perceived deficiencies in training and support. The Royal College of Physicians 2025 survey found low satisfaction with medical training and widespread perceptions of unfair recruitment and excessive service provision in medicine (Supplemental Reference 2). These factors likely contribute to burnout through emotional exhaustion and reduced professional fulfilment, highlighting the need for targeted specialty-level training and workforce reforms. This culture of competitiveness coupled with inadequate training may compromise mental and physical health, reduce opportunities for rest and recovery, and may contribute to burnout. Financial pressures from attending courses and conferences, as well as from obtaining additional qualifications, can strain personal finances and disrupt work–life balance. ^{Reference Jerjes and Majeed28,Reference Stroman, Weil, Butler and McDonald29} Burnout in this context may therefore represent the cumulative impact of multiple stressors extending beyond the workplace. Importantly, previous research has linked burnout to a heightened intention among clinicians to leave the profession. ^{Reference Ligibel, Goularte, Berliner, Bird, Brazeau and Rowe30}

Collectively, these overlapping influences underscore the need to interpret burnout within a broader framework of well-being, recognising that self-reported symptoms may arise from interconnected academic, relocation, financial and lifestyle-related pressures. Lifestyle factors such as regular physical activity, adequate sleep and balanced nutrition were associated with lower burnout and improved work–life balance, consistent with existing evidence on the protective role of health-promoting behaviours. Although lifestyle factors such as exercise, sleep and nutrition are often bidirectional as these factors can both contribute to, but also result from, burnout. ^{Reference Cecil, McHale, Hart and Laidlaw31,Reference Taylor, Scott and Owen32} Accommodating these behaviours during medical training, alongside institutional initiatives providing targeted financial, psychological and social support, may help prevent burnout, support those already affected and improve retention. Recognising burnout as a dynamic process rather than a fixed outcome highlights the importance of comprehensive, system-level strategies to support the well-being of resident doctors and medical students. ^{Reference Madigan and Curran33}

Interpretation

Our findings highlight that many resident doctors and medical students, particularly those experiencing burnout, were unaware of existing well-being support services. This finding highlights a potential communication and accessibility gap between institutions and individuals, suggesting that visibility of resources is equally important as their availability. Increasing awareness and accessibility of these services is therefore essential to ensure that at-risk individuals can seek timely support before burnout progresses to more severe psychological distress. One proposed solution, developed through an iterative co-design process by a multidisciplinary team comprising psychiatrists, general practitioners, surgical specialists, medical students and resident doctors, is a ‘stepped-support’ and ‘traffic light’ framework that provides evidence-based guidance on preventing burnout and links burnout severity to appropriate levels of support for resident doctors and medical students, as shown in Figs 1 and 2 below, respectively (Supplementary Methods). Starting from self-guided resources and escalating to professional counselling or crisis services, these posters could be standardised nationally or adapted locally before being incorporated into local hospitals’ or universities’ well-being initiatives and inductions. Their effectiveness could be validated through local and national quality improvement programmes, using pre- and post-implementation measures of awareness, help-seeking confidence, service utilisation/referrals and burnout scores to assess impact and inform iterative refinement. Efforts to increase awareness are undoubtedly laudable, although they may prove to be futile unless similar efforts are made to dismantle barriers and reject mental health-related stigma within medical school and residency. Without such active cultural change, resident doctors and medical students living with burnout are at risk of suffering in silence despite the availability of effective interventions.

Fig. 1

Illustrative poster incorporating a ‘traffic light’ framework that provides evidence-based key burnout support services available to UK resident doctors. RCPCH, Royal College of Paediatrics and Child Health; RCR, Royal College of Radiologists; RCPath, Royal College of Pathologists; RCS, Royal College of Surgeons; RCEM, Royal College of Emergency Medicine; RCOG, Royal College of Obstetricians and Gynaecologists; RCP, Royal College of Physicians; RCOphth, Royal College of Ophthalmologists; RCPsych, Royal College of Psychiatrists; RCoA, Royal College of Anaesthetists; A&E, Accident and Emergency Department; BMA, British Medical Association.

Fig. 2

Illustrative poster incorporating a ‘stepped-support’ framework that provides evidence-based self-care advice and key burnout support services available to UK medical students.

A focused approach to identifying the key stressors affecting resident doctors and medical students is essential to guide targeted and effective interventions. Financial strain remains a major concern, heightened by rising living costs and ongoing industrial action over pay erosion and workforce pressures. ³⁴ Recent announcements of further strikes by the British Medical Association underscore the persistent financial and occupational uncertainty that contributes to psychological distress among doctors and students. ³⁵ Interestingly, the lower financial stress reported by Scottish residents may relate to the recent pay discussions and improved industrial relations with the Scottish Government (Supplemental Reference 3). Recent pay restoration in Scotland and reduced strike action may have mitigated financial stress among residents, whereas ongoing disputes in England, with associated salary sacrifice, may exacerbate financial strain. These findings suggest that constructive workforce negotiations and pay stability may have measurable effects on trainee well-being. Supervisors and educators should remain aware of these non-clinical external pressures and offer appropriate guidance and support, and should be aware of local services that can help support residents and students (Figs 1 and 2). Furthermore, the progressive loss of autonomy throughout medical training, including limited control over training location and career trajectory, potentially increases vulnerability to burnout. ^{Reference Cook, Tandanu, Rehman, Whiteman, Osunronbi and Mukhtar8,27,36} Frequent relocations and geographical instability can disrupt social networks and erode a sense of security, contributing to burnout and related stress. These risks should be recognised early in training, with mechanisms in place to identify individuals requiring additional support and to provide timely interventions during rotations.

At a policy level, early identification and support for resident doctors and medical students experiencing burnout aligns with the NHS Long-Term Workforce Plan’s emphasis on sustaining a healthy, resilient workforce. ³⁷ Addressing burnout early in medical education represents an opportunity to improve retention and performance, reduce psychological morbidity, and mitigate future attrition within the NHS. The considerable economic implications of burnout among resident doctors should not be overlooked. In our analysis, burnout among resident doctors was estimated to cost the UK £251 million annually through absenteeism. Even when applying the lower prevalence rates reported by the General Medical Council’s workforce survey, and without accounting for absenteeism among the wider healthcare workforce, the estimated annual cost remains £215 million. ²¹ This cost falls within the broader context of work-related stress in the UK, estimated at £28 billion each year. Safeguarding the NHS workforce’s well-being, therefore, represents not only a professional responsibility, but also an economic imperative. Investing in staff well-being has been shown to generate significant returns, with each pound spent on mental health producing an estimated 4.7-fold increase in productivity. ³⁸ In the current NHS climate, these potential gains represent an important opportunity to strengthen both staff well-being and patient care. Furthermore, these findings highlight the need to review training standards, particularly in high-burnout specialties such as medicine, and for Royal Colleges to implement targeted strategies to improve training quality and recruitment. In parallel, constructive engagement between resident doctors and government is required to address financial pressures that may otherwise compound burnout and threaten workforce retention.

From a practicality point of view, low-cost awareness interventions such as the stepped-support framework are highly feasible and scalable, whereas higher-impact reforms addressing workload, training quality, and financial pressures require coordinated policy action and sustained engagement from educators, Royal Colleges, NHS management and government. However, implementation may be constrained by entrenched cultural barriers within medical training, including stigma surrounding mental health and reluctance to seek support, highlighting the need for parallel cultural and structural change.

Strengths and limitations

The questionnaire was rigorously developed, informed by a systematic literature review, consultation with medical students and a Delphi cycle. This methodological approach aimed to ensure content validity and contextual relevance for the UK resident doctor and medical student population. Furthermore, the large sample size provided sufficient power to detect meaningful associations in understanding the complex determinants of burnout, including demographic, geographical and lifestyle factors. Several limitations should be noted. The sample size, although significant, does not fully represent all resident doctors or medical students in the respective region, and should be interpreted with caution. The use of self-reported data introduces potential bias, and the absence of a validated burnout scale limits cross-study comparability. Burnout prevalence was assessed using a binary self-report measure that aligns with a contextual definition reflecting the lived experiences of UK trainees, but differs from established questionnaires such as the Oldenburg and Copenhagen Burnout Inventories, which focus on exhaustion and disengagement and may underestimate burnout risk in medical populations. ^{39,Reference Tipa, Tudose and Pucarea40} Although these instruments assess general domains of exhaustion and disengagement, they are not specific to the medical context and may underestimate burnout risk within these populations. However, within the preset survey, a definition of burnout was provided that captured the ICD-11 key symptoms relating to burnout including exhaustion, depersonalisation and reduced personal efficacy, and this was the definition applied throughout the survey and study. ¹ Furthermore, lifestyle factors such as exercise, nutrition and sleep likely have a bidirectional relationship with burnout. These behaviours may contribute to the development or exacerbation of burnout; however, they may also deteriorate as a consequence of burnout-related stress, fatigue and reduced capacity for self-care. As a result, the cross-sectional nature of this study limits the ability to determine the directionality or causality of the observed associations. Data were collected over a defined 3-month period (February to April 2025), which may not fully capture potential seasonal variation in burnout; however, this approach is consistent with prior national workforce surveys that similarly employ short, cross-sectional sampling windows. ^21,34,35 Moreover, the survey did not collect further responses on reasons for leaving medicine, nor did we capture respondents’ status as UK or international students, limiting our ability to explore these factors in relation to burnout. The economic analysis also has inherent methodological limitations. Salary estimates were based on average NHS nodal pay points rather than a grade-weighted distribution, which may not represent the different grade levels of resident doctors and contract types in the system. Absenteeism estimates were drawn from national data on stress- and mental health-related disorders, and used as a proxy for burnout-related absenteeism. In contrast, reliable data on presenteeism were unavailable, which likely led to an underestimate of the economic burden. The human capital framework assumes that each lost day represents a full day of foregone output and does not account for labour substitution or organisational adaptation, which may introduce upward biases in the cost estimate.

In conclusion, this study highlights the high prevalence and multifactorial nature of burnout among UK resident doctors and medical students. Limited awareness of available well-being services suggests ongoing barriers to access and communication that require institutional attention. Burnout in this population likely reflects a combination of psychosocial and systemic stress, including financial strain, relocation challenges and poor work–life balance, rather than occupational factors alone. If unaddressed, these pressures may worsen mental health, reduce workforce retention and compromise patient care.

Improving the visibility and accessibility of well-being services, alongside financial and relocation support, can help mitigate stress and promote well-being. A coordinated, multi-level strategy focused on early identification and prevention of burnout throughout medical training is critical to sustaining the resilience of the UK healthcare workforce.