100 Hour Work Weeks
Residency training is supposed to be hard, right? Everyone knows that working 100 hours a week, without regular sleep, exercise, or normal dietary habits, is just part of the job. So you shouldn’t be complaining. After all, residency is just three, five, seven or ten years of your life. It will all be worth it in the end when you make a billion dollars a year.
I think this is the logic that I am faced with every time I tell friends or family that residency is challenging. Seeing a consult at 2 am and then going to work at 6 am is the expected norm because after graduation, I will be handsomely compensated for the hours I put in.
However, there are some obvious flaws to this thought process, especially considering some of the serious problems facing residents and other healthcare providers.
For physicians in particular, a few studies link these problems to the onset of residency training. One study, for example, showed that the rate of moderate depression among first-year residents increased from 4.3% to 29.8%, with a strong correlation to sleep deprivation. While at the beginning of the year only 4.3% of residents said they experienced burnout (likely from medical school), at the end of the intern year a staggering 55.3% had some symptoms of burnout.
What is Burnout?
Maslach et al, creators of the Maslach Burnout Inventory tool, define burnout as having three components.
Emotional exhaustion: when overwhelming work depletes energy
Depersonalization and cynicism: when individuals detach from work
Feelings of inefficacy: when a lack of personal achievement is perceived
Personally, I can say that I have experienced all three of these during the course of my residency training. It is easy to see how one or all three of these components could lead to compromised patient care.
What about the idea that everything will be better after residency? Is there any evidence to suggest that this is true? Unfortunately, the studies are not encouraging.
Rates of depression, for example, never return to pre-residency levels. It is hard to believe rates of anxiety or substance abuse decrease significantly either, primarily because healthcare providers have a hard time seeking help. One major impeding factor is time. I know from personal experience that setting time aside for a doctor’s appointment is very challenging. There is some cruel irony in the fact that healthcare providers cannot receive healthcare.
The other impeding factor is the underlying stigma against those who need help. Most of those who go into the medical field are smart, driven and determined. These are not the individuals who would willingly admit personal struggles. Even when they are willing to seek counsel, it is not clear what resources are available.
I fall into the latter camp. I want to discuss my feelings and thoughts about residency, but I have no idea how I should go about doing this. I have tried to talk to my attendings, but honestly I do not feel they are equipped or trained in the needed capacity. Sure, outside counseling services exist, but are expensive and not covered with my current hospital health plan.
Do any of you face similar problems?
This blog is partially a points and miles website. But as I have mentioned before, it is also an outlet to sort through the messy topic of provider burnout. Hopefully, we call all find some answers together.
I am in the process of building a well-being page, and if you have any helpful resources I would love to know about them.
In the meantime, here is a conversation with Dr. Elisabeth Poorman on the topic of resident depression. I know it will beneficial for everyone.