Residents and fellows have staying power. They work extremely long hours—often without taking the time to sleep or eat. They are constantly surrounded by trauma and illness. They sacrifice time spent with friends and family to perfect their craft and pursue a dream. Becoming a physician is not for the faint of heart—and it is no wonder that resident depression, anxiety, and suicide rates have increased over time.
A Mayo Clinic study showed a strong correlation between burnout and depression, with 31% of residents screening positive for depression and 51% reporting a history of depression during residency. It is clear that rates of depression are higher in medical students and residents (15% to 30%) than in the general population. Some surveys have found that roughly 10 percent of medical students have reported having thoughts of killing themselves within the past year, which compares to 3.7 percent of the general U.S. population.
Complicating matters? Because of the significant demands on their time, residents and fellows are less likely to receive mental health treatment than members of the general population.
In years prior, there were no limits to the number of hours residents work. However, the ACGME, the governing body overseeing medical and surgical residency programs, has taken measures through the years to stunt the burnout epidemic. In 2003, with adjustments in 2011, the council imposed an 80-hour cap on the number of hours a resident can work per week, with 16 consecutive hours also serving as a limit for first-year residents (24 hours for a second- and third-year residents).
To accompany these regulations, there are additional measures your organization can take to curb resident and fellow burnout.
1. Hold Special Stress-Mitigating Staff Events
Appreciation can go a long way in the medical industry. At Pennsylvania Hospital in Philadelphia, a hospital committee runs a yearly event called Paws for Pennsy (P4P), where cats and dogs are brought in for staff to enjoy.
“This definitely helps,” said Stephen Tsoukas, a medical resident at the hospital. “Hospitals are stressful. Some cases are sad. This brightens up your day.”
The UNC School of Medicine takes a similar route, hosting annual social events and activities to diminish burnout. These events include picnics, welcome and goodbye dinners, and participation in softball and kickball leagues.
2. Be Aware: Recognize Symptoms and Take Action
Residents are trained to detect signs of depression or substance abuse among patients. According to Morganna L. Freeman, DO, FACP, chair of ACP’s Council of Resident/Fellow Members and chief oncology fellow at the H. Lee Moffitt Cancer Center in Tampa, Fla., this should be practiced with peers, as well.
“Our skillset as clinicians in paying attention not only to what patients say but what they don’t say or how they interact with you is something you can easily carry over to how you interact with colleagues. … We have to look out for each other,” she said.
When Dr. Freeman saw a resident exhibiting signs of depression or anxiety, she waited until rounds were over, pulled him or her aside, offered to take the next admission, and suggested a coffee break.
3. Make Communication (and well-being check-ins) Mandatory
Residents should feel comfortable speaking about their struggles. However, the current residency/fellowship climate often discourages this, leaving physicians feeling uncomfortable about sharing their failures or struggles with superiors.
A former resident’s suicide inspired Stanford’s Department of Surgery to form a wellness program that promotes psychological and physical well-being for new surgeons. A focus of the Balance in Life program includes mandatory group therapy with Lisa Post, PhD, Clinical Associate Professor of Psychiatry and Behavioral Sciences. Post is also available for one-on-one counseling if the participants deem it necessary.
Balance in Life has implemented stress-mitigating staff events on the campus lawn, mentoring partnerships between junior and senior residents, and healthy snack-stocked fridges since its inception in 2011.
Odds are that individuals in intense residency and fellowship programs will experience some sort of burnout throughout their journey. By normalizing these feelings and behaviors—and offering outlets for communication and counsel—leading academic healthcare centers throughout the country can help to mitigate this long-standing challenge. Innovative resources, respite opportunities, and organized appreciation events will go a long way in improving the mental health and clarity of hard-working residents and physicians.
