I am completely and utterly terrified by residency. Most medical students I know have the same fears though few openly express them. Being a fourth-year medical student, I am soon to embark on a journey that so many others have taken before me. The imminent adventure brings reflection on my innate desire for a balanced life and engenders the realization that this inclination does not align itself well with my future as a resident. It is not that I mind hard work, complex studies, or pressure. Nobody gets this far in medical school without enduring those aspects. Rather, it’s the tangential challenges of residency that occupy my thoughts and fears: sleep-deprivation, burnout, maintaining my mental and physical health, limited time and resources, and nourishing important relationships.
My medical school regularly lectures on substance abuse, divorce rates, depression, and suicide in medicine. It’s incredible that the deluge of negativity doesn’t turn us ghost white and cause one after another to stand up from our seats and start sprinting to the nearest exit. We are informed of the most recent haunting statistics and various meta-analyses on physicians in training: the prevalence of depression or depressive symptoms among resident physicians is “28.8%, ranging from 20.9% to 43.2%…and increased with time, (1)” and that “the suicide rate among male physicians is 1.41 times higher than the general male population. And among female physicians, the relative risk is even more pronounced — 2.27 times greater than the general female population (2).”
Shortly after our blood pressure has risen ten points at the thought of becoming one of these horrifying statistics, they have us practice deep breathing exercises. The lecturer encourages all 220 of my classmates to shut our eyes, breathe in through our noses for 4 seconds, hold for 7 seconds, and out through our mouths for 8 seconds. She teaches us this small pearl of sanity as if it somehow it will prevent us from becoming one of the aforementioned statistics. You can almost hear your neighbor scoffing internally at the exercise. The truth is, that while it is important for each and every one of us to practice self-care and wellness on our own, a major part of the problem is at the systems/organization level. It is disturbingly clear that there is a need for more protections and resources for our residents.
Residents’ time and work is not valued. You witness it in the grueling hours they work, the wages they are paid, and the limited resources they have available to them. They appear to become stuck in a revolving wheel of tradition and each year they tell themselves, “oh well, next year must be better.” Unfortunately, the next year of residency comes and it is rarely better and generally not easier, but often hard in a different way. A wise pediatric intern once told me that interns/residents are like “rabbits forever chasing the carrot on a stick.” There is no doubt in my mind that we can do better when it comes to systematic changes in residency programs to increase wellness and decrease burnout.
Pioneering advancements in resident wellness are best exemplified by programs like “Balance in Life” developed at Stanford University School of Medicine. The program was created after mourning the tragic suicide of a recent graduate from the school’s general surgery program. Their well-being curriculum addressed four domains: professional, physical, psychological and social. The program fosters wellness by providing resident mentorship and leadership training, stocking resident environments with healthy foods and snacks, confidential counseling as an integral part of training, and the hosting of social gatherings and events with fellow residents (3). These were all minor changes that made a major impact on resident wellness. Programs similar to the above, along with other benefits including a resident exercise room, should be standardized across all programs in order to meet accreditation. If you cannot supply the resources and tools to keep your residents physically and mentally well, then you are not fit to have a residency program.
In the near future, my fellow medical students and I will be placed in the same position as our predecessors. I cannot see any of my colleagues, friends, and family in medicine becoming a statistic, but I am smart enough to know that everyone before me thought the same, and that this pattern will continue without serious change taking place. So, I’m afraid for the day when July 1st is tomorrow. Afraid of losing who I am and why I love medicine. Afraid of becoming a statistical casualty of the healthcare machine, exhaustion and indifference.
I lament the day the happy-go-lucky classmate succumbs to substance abuse as a coping mechanism against chronic stress or the adorable medical school couple falls out of love because they lack the time to nourish their relationship. Above all, I dread the day I discover my classmate that always struggled more than most decided to take their life. However, I am hopeful that change has already begun. I am confident this generation of doctors understands the necessity of wellness to combat burnout, depression, and suicide more than any of those who came before us. I look forward to the newfound focus on wellness transforming residency into a step in our journey that we can anticipate with anxious excitement, not fear.
Jake Goldman is a 4th year medical student at UT Health San Antonio applying into Family Medicine, passionate about physician wellness and compassionate care for all patients.
- Nacht, J. (2016). Prevalence of Depression and Depressive Symptoms Among Resident Physicians: A Systematic Review and Meta-analysis. The Journal of Emergency Medicine,50(5), 805. doi:10.1016/j.jemermed.2016.03.012
- Talbott, J. (2006). Suicide Rates Among Physicians: A Quantitative and Gender Assessment (Meta-Analysis). Yearbook of Psychiatry and Applied Mental Health,2006, 155–156. doi:10.1016/s0084–3970(08)70149-x
- Salles, A., Liebert, C. A., & Greco, R. S. (2015). Promoting Balance in the Lives of Resident Physicians. JAMA Surgery,150(7), 607. doi:10.1001/jamasurg.2015.0257