A long overdue post, on how I survived residency training.
For those unfamiliar with residency, it is the period of 3-7 years (depending on the specialty) after medical school where you practice medicine as a junior doctor, overseen by supervisors. You must graduate residency before you can practice medicine independently on your own as a full-fledged physician.
Regular labor laws somehow do not apply to residency jobs – you get a fixed salary of about $50k per year and are expected to work sometimes 80-100 hours per week, including 24-hour shifts where you’d be lucky to catch half an hour of sleep.
Residency has been accurately likened to military training. It pushes you to your physical, mental, and emotional limits.
They suggest breaking residency up into bite-sized chunks, only looking at what is in front of you – the day’s work, the rotation you’re on, next week’s schedule. It’s absolutely overwhelming otherwise.
I made that mistake with my first residency program, in obstetrics and gynecology (OB/GYN). About 2 years in, I was so scared of what lay ahead – nearly 50 more 24-hour shifts, 4 more months of exclusive night shifts, the Oral Boards (being grilled by a panel of other physicians on almost every patient I ever had, and having to explain and defend all my medical decisions), and most of all, the leadership role I would need to assume as a senior resident, to command a room and make possibly life-or-death decisions for my patients. I had so much self-doubt that I couldn’t see myself even potentially making it to the end.
Many people are able to push through at this point by remembering why they went into this field in the first place. When I desperately grasped for that lifeline, I realized I didn’t have even that. Medicine wasn’t my one true calling, a career I would have chosen again and again if I could rewind time.
I had pushed my other passions of art, writing, and teaching aside for a job I felt was noble, both in serving the world “more concretely” and showing appreciation for my parents who had raised me and sacrificed so much for me.
I had made a decision out of fear, due to not believing in myself enough that I could make a living following my heart. Of course I wanted to help women, and I did love certain parts of medicine, but they were too few and far between for the traditional role of full-time doctor to be a good fit overall.
But not wanting to leave without exploring everything I could, I decided to try out another residency program, in a different field. Family medicine and OB/GYN both allowed me to help women in an office-based setting, but they were different enough that I thought it was worth exploring.
Unfortunately when it became clear that the problem was full-time clinical medicine itself and not just the specialty, I felt stuck at a crossroads.
I ultimately decided to finish what I had started, even if it would end up being nothing more than bragging rights about a piece of paper/graduation certificate.
There were so many layers to it. I wanted to prove I wasn’t running away just because it was hard. The fearful, anxious part of me wanted it as a backup option if everything else I tried failed (I know that’s unlikely, but there’s a certain comfort to having more options).
Also, I wanted all the years I had put in already to mean something concrete (the sunk cost fallacy of psychology…I do NOT recommend giving into this!!) I could not accept that the lessons I had learned and the experiences I had had were enough to justify the time and effort I had spent.
I succeeded! But I had to employ some tricks to get me there, ones that I hope I can share to help others as well!
This post will be about Psychological Tips and Tricks. A post will soon follow on Practical Tips.
1) Take each day as it comes, and celebrate completion of every day, or even, each patient you see.
I knew people who marked a calendar or counted down the exact days until residency graduation. Make sure to treat yourself after a particularly hard day or encounter. Don’t be afraid to ask for coverage for a breather. Think of how much more productive and helpful you will be as a well-rested doctor, rather than a frazzled, overwhelmed, exhausted one.
2) Think of everything from the patient’s point of view.
Think of how much this visit with you means to them and how much you’re helping them. Even if they are snappy or treat you badly, remind yourself that it’s not about you, that there’s likely something stressful going on in their lives that you don’t know about. And their behavior is a reflection of who they are, not on you.
Always be kind and courteous and take the higher road so you can look back on yourself with pride that you did everything you could on your end to try to help them and improve their day.
3) Think of those who would kill to be in your shoes.
During my abroad rotation in Japan, I met many people who were incredibly envious of my position in an American residency program and the opportunities that came with it (the US residency certificate is more recognized internationally than other countries’).
I left with a newfound appreciation of my job. I’ve also met people who could not pass an important exam, did not Match, or could not finish medical school due to health reasons. The more people I met, the more grateful I became to have all that I do.
4) Look back on your journey and how far you’ve already come.
I know so many people who had studied so hard and tried to get even into medical school, and it reminded me of how far I had come and all that I had sacrificed and accomplished to be where I was. Though I was far from the end and couldn’t see the “light at the end of the tunnel,” looking backwards affirmed and boosted my confidence that I had and was making progress.
5) Adopt a “growth mindset.”
Meaning, be forgiving of yourself when you make mistakes or don’t know something, because it’s almost always because you don’t have the experience required yet. It takes about 10,000 hours to become an expert in anything!
You will get there if you put in more time and effort, it’s not a question. Don’t fall prey to the “fixed mindset” which thinks of yourself with rigid, finite boundaries for knowledge and talent (the “you either have it/know it, or you don’t” mentality).
6) Reach out, know that you are never alone.
Along this vein, so many people feel like an imposter during medical training (called Imposter Syndrome) because they think they’re so far behind their peers, when in fact many others feel this way too!!
If anyone seems to be an expert or not struggle at all, they are likely lying to themselves or you. We are told to “fake it till you make it,” so people rarely admit their weaknesses or open up about their struggles.
The medical knowledge and skills pool is HUGE, almost infinite, ever-growing and expanding, so don’t be so hard on yourself and expect yourself to know everything.
Remember that you are never alone! Try to reach out to colleagues to talk about your experiences and feelings. There is truly no way to describe how comforting it is to know that others share in what you feel.
7) Try to adopt the “Progress, not Perfection” attitude.
The majority of people in the medical field are type A perfectionistic over-achievers, including myself. We’ve had to work extremely hard to stay afloat, and have high expectations of ourselves.
This can unfortunately be damaging in residency when the volume of work and patients we need to see dramatically increase compared to med school that we can’t write such long, beautiful, eloquent notes about each patient encounter.
I’ve known many colleagues who burn the midnight oil writing notes far beyond work hours, sometimes even falling asleep from exhaustion.
If a note sounds awkward or choppy, but it conveys the appropriate medical information, try to let it go. Use universally-accepted shorthands and abbreviations when you can, because you already have so so much to write.
Also, think about when you are reviewing a patient’s chart – is it easier for you to read a shorter, concise note from a previous provider, or a long, detailed one?
8) Seek higher levels of help, if you need it.
Medical training is unfortunately abusive. They may say it’s your fault for being too weak or not “resilient” enough to “properly manage this burnout,” but it is WAY more than just an individual problem.
The medical training system violates human rights, and it’s only natural that all this wears on you and affects all aspects of your health. OVER ONE-THIRD of medical trainees suffer depression, anxiety, or some other mental health disorder.
If you are suffering, and talking to your family, friends, and colleagues is not enough support, PLEASE DON’T BE AFRAID TO REACH OUT FOR MORE HELP!!! There are Chaplain services, counselors, therapists, psychiatrists…so many people who are there for you and want the best for you.
There is unfortunately such a stigma attached to mental health issues, and you don’t know how someone will react, or if you will be disciplined, suspended, or forced to do random drug testing.
This is why so many medical workers stay silent, leading to worsening of their health and sometimes the worst outcome – suicide. Dr. Pamela Wible is a huge advocate for mental health among healthcare workers, and has counted over 1400 physician suicides since 1858.
I was too afraid to speak up due to my Asian upbringing of “mental illness is not real. Why can’t you just snap out of it? You need to suck it up and push onwards, always.” My family didn’t understand. Some of my friends didn’t, either. But I was afraid to tell my Program Director or any of my colleagues how I felt because I didn’t want them to have to take extra shifts to cover for me while I went to appointments, or lose faith in me/stop trusting me at work.
It wasn’t until my anxiety, self-doubt, low self-esteem and Imposter Syndrome got so bad and caused me to break down crying during work, that I decided I could no longer try to handle this all on my own.
I remember feeling so trapped and kept wishing I could get out, yet couldn’t bear the thought of just quitting and what it would mean to my family and how they would react.
It seemed a much easier and less embarrassing way to leave to just say get into a car accident (as so many sleep-deprived, exhausted and overworked residents do!!!) or have a mishap while skydiving.
Realizing that I didn’t value my life and was being so careless and nonchalant with my own health was really a turning point for me. Thankfully, I got the help I needed, and got back to feeling myself again.
I don’t want anyone else to get to as low a point as I did or worse, or stay stuck there. There is always a way to change your life and make things better.
Some people I knew took a leave of absence. Some quit entirely. Others got help and pushed on, or returned after a leave.
Do whatever you need to do, that’s best for you. Your health is a priority. Don’t feel guilty; you are ultimately doing what’s best for everyone by being the best version of yourself you can be.
If you found this helpful, please share with other trainees in tough programs or field! I’m also here for you if you ever want to chat.