Nearly one in seven graduate medical education (GME) trainees experience food insecurity, which was associated with burnout and social isolation, according to survey results published December 17 in JAMA Network Open.

In the cross-sectional study, Larissa R. Thomas, MD, MPH, et al., disseminated the survey among 3,408 residents and fellows at four geographically distinct sites within two large academic medical institutions, three in a large metropolitan area (>1 million residents), and one in a small metropolitan area (50,000-249,000 residents). The response rate was 49%.

About half of the respondents who reported their gender were men (735/1,458) and about a quarter of those who indicated parental status reported having children (365/1,402). Of the 1,457 respondents who reported their ethnicity, 45% were White, 21% were Asian and 5% were Black or African American. Additionally, of the 1,551 respondents who reported their age, 34% were ≤30 years, 50% were 31-35 years, 11% were 36-40 years and 4% were >40 years.

Risk for food insecurity was determined by a two-item screening measure based on the U.S. Household Food Security Survey Module where respondents would answer "often true," "sometimes true" or "never true" for their household in the past 12 months for two statements:

1. We worried whether our food would run out before we got money to buy more.
2. The food we bought just didn't last, and we didn't have money to get more.

Burnout was measured using the Maslach Burnout Inventory and social isolation by the Patient Reported Outcomes Measurement Information System.

Results showed that the overall prevalence of food insecurity was 14%, with higher levels in the three large metropolitan locations vs. smaller location (16%, 17% and 21% vs. 4.5%; p<0.001), in postgraduate year one vs. year five or more (17% vs. 10%; p=0.003), and among Black or African American trainees vs. White trainees (22% vs. 8%; p=0.04). There were no statistically significant differences by gender, sexual orientation, parental status or medical specialty. Cardiology was not one of the specialties recorded.

In their analysis, Thomas, et al., suggest a number of possible interventions targeting high food costs, rising cost of living and at-risk groups, including free or reduced-cost food at hospital and clinical sites outside of regular mealtimes, partnerships with local establishments for discounts, information dissemination on low-cost meals and groceries, salaries and benefits commensurate with local cost of living, moving allowances, salary advances or interest-free loans for those transitioning into training, and food bags and other resources at events likely to have a high proportion at risk for food insecurity.

"While the overall cost of living is not within an institution's control, and many health system employees are at risk for [food insecurity], we contend that each institution has a particular responsibility to mitigate [food insecurity] risk for its residents and fellows, who are contractually obligated to relocate and stay for training, spend a disproportionate number of hours and mealtimes at work, and provide an essential backbone of patient care at their sites," write the authors.