One patient down. Nine more to go.
My attending politely closed the door behind him and walked back to his computer to chart his patient. His pen crossed off a line from the list that he pulled from his pocket. His schedule was listed in 15-minute intervals.
As we got to the workroom, he sat down, and under his breath, I heard him sigh. It was barely ten o’clock in the morning. Was he already exhausted? He looked at me, and without me saying a word, he said, “You know, medicine took my twenties.” And continued on with his work.
A shiver spiraled throughout my spine. “He’s barely in his early 30s, and that is what he thinks of medicine already?” my curiosity piqued. I waited for him to follow up, but only silence lingered in the fresh cold air. I could see wrinkles of fatigue and regret on his face.
Is this what it feels like once you become an attending? Is this how I want to look back at my own twenties? Do most physicians have the same sentiment, or is he just an outlier?
Our commitment to medical training in the United States takes a long pattern of educational endeavors: some science affiliated major in college for four years, medical school for another four years, three to seven years of residency, and lastly followed by one to two years of fellowship if one chooses. Tally all those numbers, and the total can hover around a minimum of 11 years before you start noticing some meaningful compensation for all the hard work. These accumulated years come at a hefty cost, though. There are countless mental, emotional, and intellectual obstacles throughout residency. Medicine is not a Usain Bolt sprint; it’s a Kipchoge marathon. And for these reasons, it takes resilience and perseverance to reach the end in this longstanding and worthwhile medical training.
Not long ago, in a conversation with an attending, she added to it, “There is this idea in medicine that if you are not exhausted, you aren’t working hard enough.” What does this say about our current model of medical training? Is there an unwritten assumption that long hours of work lead to better results for the patient and greater satisfaction for the resident or attending?
While residencies implement a minimum set of requirements for their trainees to become competent in their respective fields, they shouldn’t be worked to the point of burnout. I remember a friend of mine recounting how intern year led her to depression and the feeling of burnout not even six months in. And I am sure she is not alone. According to a Medscape report, one of the biggest challenges residents face is dealing with time pressure and demands on time. Over 75 percent of the people polled looked into work schedules and hours when looking at their first job.
But there is a change in this tide of practice. Leaders in our field are starting to listen to what we are voicing. Some residency programs offer mental day awareness, and others offer services including counseling and therapy to alleviate the many stressors that affect residents. Mental health is a dialogue that we need to openly discuss without stigmatization. It is has become a necessity across medical school training, residency training, and attending status.
There is a lot more we can do. We must help those physicians who are at the brink of burnout, depression, and high stress. I do not think my supervisor’s life was wasted in his twenties. Those years honed his clinical skills, expanded his knowledge, and molded an analytical and critical physician. Residency can be exciting and very much rewarding.
As is often the case, old practices age rapidly in an evolving culture. We must be proactive in caring for our physicians as much as we desire to care for our patients. If not, burnout will soon catch up to those we need and love most.
Is this what we truly want?
Ricardo Chujutalli is a physician. Adrian Agudelo is an emergency medicine resident.
Image credit: Shutterstock.com
