To all the new interns, residents, and fellows,
I am very pleased to welcome you all to a new academic year at the esteemed institution at which you find yourself, perhaps somewhat unexpectedly, thanks to the Match. Late June is always somewhat bittersweet, but it is a simultaneously exciting time in the academic year. June means a graduating student or resident just survived another year of rigorous training. June, as it bleeds into July, also heralds the reopening of the terrifying great chasm of the unknown, yet-to-be experienced medical adventures right in front of you. The wise, looked-up-to chiefs leave us behind to go to “real jobs.” The newbies move up anxiously to take more senior roles and responsibilities. Training programs across the country gather together to celebrate survival and major accomplishments, jobs well-done, important learning and development. In the most honest ceremonies, we acknowledge the hard work and suffering that accompanies the annual journey.
At resident and fellow graduation, I like to exert program director privilege to say a few words to our graduates and incoming residents:
Yes, this past year was a really tough year. Was it the worst year ever? Doubtful, but it was challenging nonetheless. Each year is a bit different, and I have no idea what the next will bring. Because of teamwork, collaboration and kindness to each other, the residents in the program have emerged once again from what at times, though hopefully not often, can seem like a dark tunnel of despair. They have achieved something monumental, and I feel confident that there is sunlight ahead as we start a new academic year.
In late June, the summer solstice keeps the sun out until late in the evening, the flowers are blooming and enthusiasm for new experiences and challenges are filling the air. It is a good time to be here. The word on the street is to never go to the hospital as a patient in July, but I actually find that morale and enthusiasm for the work are at its annual height in July. The argument is that the new physicians lack critical skills, but in reality, supervision is the highest and most comprehensive in the summer. July is a happy time at a teaching hospital.
Program directors, residents, medical students, long-time physicians and newly minted attendings continue to discuss the hot-button issue of burnout. Highly publicized reports claim that 50 percent of physicians report at least one symptom of burnout. This critical issue in American health care reached the opinion pages of The New York Times recently when Dr. Danielle Ofri published her lament that physicians were being near-fatally abused by corporate health care. In response to that conversation, I would like to give some suggestions for our new trainees to use as they enter this next phase of their careers.
My first piece of advice is to stay above the chaos. Martin Luther King Jr. wrote in 1957, “Life’s most persistent and urgent question is, ‘What you are doing for others?’” Choosing to become a physician is fundamentally a decision to serve something greater than oneself. The symptoms of burnout (cynicism, depersonalization, disconnectedness) will get in the way and distract you from that bedrock concept. It will, therefore, be important to keep yourself physically and emotionally healthy in whatever manner suits you to prevent those insidiously damaging symptoms. I caution you that the chatter about physician “wellness” might inadvertently steer health care providers to devalue the interconnectedness, interbeing, and service to others which fulfills the meaning in our career lives. Don’t try to wait until your own personal emotional needs are met before connecting with your patients. No singular physician will be spared personal suffering, and as physicians, we cannot wait for our lives to be perfect before we serve others. That said, the culture in medicine has changed, and it is acceptable to ask for help dealing with stress in whatever form it takes. In order to be effective in treating others, reach out to others for your own support.
Martin Luther King Jr also asked, “What is your life’s blueprint?” This is an exhortation to consider and construct a life that will fulfill you individually and offer your gifts to the benefit of the world. Residency and training, in general, will present structures, rules and requirements that may seem to contradict the blueprint. If your plan is sincere, though, the learning and the work will bear fruit. Work the personal plan, and keep sight of the bigger goal.
As a program director, my desires for a trainee starting our program are as follows:
First, I want you to believe in yourself. I don’t want you to fall into a trap of letting others define you. You can make a difference in the world with the knowledge and skills you already possess. You will be even more effective as you incrementally master the skills you have decided to pursue by undertaking training in this field. Let your mentors guide you and seek wisdom wherever you can find it.
Second, I want you to show up on time, make the effort, and do the work. Be present and engage with those who come to you for help. This is not a lot to ask, but in a busy world filled with demands and stress, this expectation can feel unachievable.
Lastly, I want you to practice compassion. This means that the empathy that you as a resident or fellow feel when you interact with patients, families or colleagues is met with action. Advocate for those whose voice is weak or unheard, for those in pain, or for those who have little hope. Bring that patient a glass of water. Do the small jobs that show respect to others. Help out without grumbling. Compassion is turning care into action, and as physicians, compassion is our job.
In summary, the excitement is palpable in July when a new crop of trainees hits the ground running. It can feel overwhelming and discombobulating, but the headiness of the moment will fade. Competency will begin to replace the greenness of summer.
Above all, enjoy this month as a new resident or fellow.
A program director’s perspectives on practical wellness in residency and how graduate medical education leadership can facilitate housestaff resiliency and self-advocacy.