This story is hard to tell.
It was an overnight shift, well into my internship. I was asleep in a call room when the beeper went off. Seconds later, my resident was on the phone, telling me a patient was coming up from the ED. I probably said “great” or “thank you” or whatever good interns were supposed to say when called with an admission. But inside, I was cranky, achy, frustrated, disappointed, and tired.
Minutes later, the resident called back with an update. The patient had died. “What a relief,” I thought. Not “how sad.” Not “what happened?” I didn’t care. It didn’t matter who the patient was nor what brought them to the hospital. I didn’t consider the family, let alone their grief. I had no feelings at all as I shut the light and crawled back under the covers. I only wanted to be left alone for a while before rounds.
Decades later, I’m pained by my attitude, which was so unlike the physician I wanted to be. Physical and emotional exhaustion had stolen my empathy and moral imagination. Outwardly, I was sweet and caring- kind to patients and generous with colleagues. I never lost my cool nor shirked responsibility. But inside, I was different. To this day, I don’t know how many of my co-interns were hiding darker thoughts, beyond the handful who displayed them openly. Everyone else seemed fine.
The thing about burnout is that it’s often hidden, even to those experiencing it, even today as we discuss it openly. According to PubMed, 1421 articles were published last year with “burnout” in the title. The focus on this topic helped me recognize what I was struggling with as an intern. Now that I’m a program director, the attention to burnout sensitizes me to the reality that many trainees are struggling, even if we can’t see it, even if they’re quiet about it.
A few days ago, we got the results of our annual ACGME resident and faculty wellbeing survey. One of the benefits of the survey is that it’s anonymous, which makes it easy for respondents to report what they’re really thinking. The ACGME prohibits publishing the results publicly, but here’s what I can share:
- Nearly half of our residents report feeling emotionally drained at work.
- More than two thirds say that after work, they need more time than in the past to relax.
- Nearly two thirds report feeling worn out and weary after work.
Faculty responses were similar and, notably, residents and faculty reported these struggles despite having an extremely positive view of the program. The implications for burnout are obvious.
Some stressors, like the pandemic, are beyond our capacity to control. Others, like overnight call and the 80-hour work week, will require a transformation in the way we train residents in this country. But that still leaves plenty of opportunity for us to promote wellbeing. For example, we must:
- Create humane schedules (among the Chiefs’ top priorities)
- Foster agency by encouraging residents to advocate for themselves
- Cultivate meaning at work
- Nurture our residency community
- Advocate for administrative support
- Ensure time for residents to eat, sleep, exercise, and socialize
- Provide opportunities for self-care (get a checkup, have your teeth cleaned, see a therapist, etc.)
- Openly acknowledge our stresses and challenges
- Maintain an accepting, inclusive workplace
In summary, resident and faculty wellness must be prioritized.
I’m doing better now than when I was a resident- not perfect, but better. I’m finally able to recognize when my work and wellbeing are out of sync, when I don’t feel like the caring, compassionate physician I aspire to be. This inevitably happens when I’m working too many hours, not sleeping, not exercising, and spending too little time with my family. When I recognize this, or someone points it out to me, then I know it’s time to stop answering emails, get on my bike, and hang out with Heide and the girls. The solution may be different for you, but I encourage each of you to do your own internal inventory, commit to caring for yourself, and let me and the rest of program leadership know what we can do to help.
Wishing you all a restful Sunday. I’m going out for a long bike ride on the Farmington Canal.
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