The conversation about Indian residency burnout usually starts with hours. 80–100 hours a week. 36-hour shifts. Six days a week with one day off, sometimes none. These numbers are real, and they are the visible part of the iceberg.

The published burnout rate among Indian medical residents, across cohorts and specialties, is 40–60% depending on the institution and the measurement instrument. Studies from AIIMS Delhi (Singh et al., Indian J Med Res, 2018), JIPMER (Saini et al., Industrial Psychiatry Journal, 2017), and PGIMER (Grover et al., Indian J Psychol Med, 2018) converge on roughly the same range.

What the hours-focused conversation misses is the interruption-density contribution. A resident on a 36-hour shift in a low-load department burns out at a different rate than a resident on a 36-hour shift in a high-load department, even with identical hours. The mediating variable is the number of decisions made per hour and the cognitive cost of each.

The published work on this in non-medical contexts (Mark et al. on knowledge workers, various papers) suggests that the cognitive recovery cost of frequent task-switching may be as significant as the absolute hours. Applied to residency, this is the explanation for why two residents in the same programme, on the same rotation, on the same hours, have different burnout trajectories.

The implication is uncomfortable. Reducing resident hours alone may not reduce burnout to the degree the public conversation expects. What might reduce burnout is reducing the number of decisions a resident has to make per hour, by automating the trivial ones — which dose of paracetamol, what's the standard ABG follow-up timing, what's the typical handover note for a stable post-op.

This is not a substitute for the longer conversation about hours, pay, and structural reform of residency in India. It is, however, the conversation that the existing tools can have now — by removing the trivial cognitive load from the resident's day. The hard cognitive load — the clinical reasoning, the patient conversation, the team coordination — is what the resident is there to do.

The burnout number Indian residency doesn't talk about is the cognitive load per hour. We should.