July 1 marked a monumental day for all first-year residents, also known as interns, across the country. All freshly minted medical graduates began the rite of passage of what purports to be the most challenging year in medical training. No longer medical students, interns suddenly must take up the mantle of responsibility and make real-life medical decisions. This transitional time is riddled with anxiety and stress. Two years ago, two interns working at reputable hospitals in New York committed suicide a week into their residency training.
Among all professional groups, physicians are at the highest risk of suicide. It has been estimated that an average of 400 physicians’ lives are lost to suicide annually. Not surprisingly, the increase in suicide among medical trainees parallels the high rate of physician burnout. In a recent interview with MedPage, U.S. Surgeon General Vivek Murty expressed grave concerns about rising levels of physician burnout at a time when there is higher demand than ever to train more physicians.
As a fourth-year resident in my final year of training, I have experienced firsthand the factors that stymie emotional well-being: lack of positive affirmation and support, overtly aggressive work environments, excessive workloads in a rigidly hierarchical culture and the disillusionment of working within broken health systems. Faced with these hurdles, health and wellness in residency training are a constant struggle. In a recent widely publicized study, the rate of depression among medical residents was observed to be three times the rate among the general public.
In efforts to address this worrisome trend of burnout among trainees, Zina Meriden, a senior resident in the Johns Hopkins Department of Psychiatry and Behavioral Sciences, designed an educational video module to educate residents and fellows about signs and symptoms of depression. The video is currently in beta testing among a focus group of Johns Hopkins trainees and will soon be released to all trainees as a potential intervention tool to address burnout.
Against this backdrop and reflecting back on my intern year three years ago, I share the following pearls garnered over the course of my residency training:
- Practice self-care. Self-care is the gateway to sound care for others. Not caring for yourself puts you and your patients at risk for errors and potentially fatal medical decisions. Practically, this means that at the end of each day, do one thing that is purely for you, not for work, friends or anyone else.
- Pursue self-knowledge. Understand and know your strengths. Residency brings more challenges than medical school. However, don’t let perfection weigh you down. As an intern, strive toward mastery in your training, but understand mastery of medicine is a lifelong pursuit. Don’t let the medical system’s incessant obsession with grades distract you from what is important. Develop those soft skills that will endear you to your patients and colleagues. Residency is the perfect time to reflect and mold yourself into the kind of physician you want to be.
- Don’t be afraid to ask for help. Asking for help is a sign of strength and courage, and recognition of your own limitations. Take advantage of your institution’s free, confidential counseling and mental health services program, and seek help if you have feelings of helplessness, hopelessness, incompetence, or lack of joy and fulfillment at work. If your institution does not provide any of these services, talk to more senior residents and colleagues for advice on resources available in the area.
- Find a support network outside of work. Whether it is family, friends, or social or religious groups, your support network will provide you with an outsider’s perspective and solidarity in your vulnerable moments.
- Keep up with your hobbies. This will allow you to do things that bring you sustenance and energizing refreshment away from a stressful work environment.
- Maintain a healthy schedule. Get a full night’s rest and exercise regularly. A well-rested mind is a mind primed for excellence.
- Go on vacation. Do not sacrifice your vacation time in residency training. Vacation time with family and loved ones is an essential aspect of stress relief and self-care.
The road to becoming a caring physician is long and arduous. Self-care is a time-tested secret to surviving the intern year and the best safeguard against burnout.
- Stuck in Despair
Why do physician trainees experience depression and suicide at rates much higher than the general public? And how can they get the help they need?
- Depression in Grad School: What You Need to Know.
- Student Wellness Initiative Promotes Self-Care
- How to Relieve Stress: A 5-Step Plan to Feeling Good
Stress may be a part of life, but it doesn’t have to get the best of you. Follow these everyday ways to stay calm, happy and healthy, from a Johns Hopkins expert on managing stress.
- Visit our Health Library to learn more about depression and suicide.