Welcome to in-House, the online peer-reviewed publication for residents & fellows. Please email us at inhouseexec@gmail.com with any questions or concerns.
I am an intern physician currently enrolled in a residency program, writing anonymously for fear of of retribution. I am also chronically injured and disabled. In my time off from work, I’ve had the chance to reflect on being injured in residency, and one particular incident comes to mind.
“I spent the first semester in France where I studied the language.” I was about to say that I spent the second semester in my home country in South America doing research on Chagas disease when he interrupted by saying, “What a waste of time. What did learning French ever help you with?”
Career and specialty choice aside, the debt accrued for physicians is very real. Obtaining accessible and accurate advice on what to do with that debt is, at best, disappointing. My goal for this article is to educate, provide adequate resources that can help alleviate stress, set you — the reader and colleague — up to be financially successful, and hopefully make you “money wise” when it comes to your early career.
Two months ago, I woke up one morning at 5:30 a.m., as usual. I played my gym motivation playlist in the shower, ate oatmeal for breakfast, and headed out the door, as usual. I swore at the car that swerved into the lane in front of me without signaling, as usual. An hour later, I pre-rounded on one of my favorite patients, a man with wide, childlike eyes who had a great deal of difficulty expressing his feelings.
My partner Evan’s third year of residency completed his trajectory toward what is commonly called “burnout.” Two out of the 10 residents in his class left the program. In an already understaffed department, the remaining residents picked up the slack, taking extra call and working longer days. The general misery index among his cohort skyrocketed.
On March 11, an invitation-only meeting will determine the future of the United States Medical Licensing Exam (USMLE) Step 1 exam. The results will profoundly affect how all future American doctors are taught.
Overwhelmed and exhausted, a resident recently came to me to ask, “Can we do something about call?” Defeat and despair had taken over his psyche. He felt unable to cope with the tasks of residency, including the seemingly never-ending demands of fielding consults, pages and patient needs. He imagined that the problem could be solved by taking less overnight call.
Originally, I wasn’t going to enter the fellowship match. I had started my psychiatry residency fully intending to do the four years, then maybe a fellowship. Then, in my second year while sharing dinner with friends who had just certified lists for the general residency match, my plans to go into child and adolescent psychiatry came up.
When I took a job as a residency coordinator in graduate medical education at a local community hospital, I made myself a promise: I will not date a resident. They’re too busy, we work together, and we have nothing in common.
The recent ruminations of Drs. Katsufrakis and Chaudhry in the form of an invited commentary in Academic Medicine, entitled “Improving Residency Selection Requires Close Study and Better Understanding of Stakeholder Needs,” has garnered a significant amount of attention on Twitter. Drs. Katsufrakis and Chaudhry’s commentary was in response to a well-written and well-reasoned article by a group of medical students published in the same journal recommending the USMLE Step 1 transition from a numeric score to pass/fail.
Now that you, the reader, have become house staff, the time has come to change your mindset from one of competition to one of collaboration with your peers. The path that leads to achieving the MD or DO degree is one of often single-minded pursuit of academic victory. The competition has been fierce.
One of the trickier things to learn as a young doctor is how to navigate boundaries between patient, doctor, family and friends. Medical school teaches us that it is unethical to treat yourself or your close family due to a lack of objectivity that can affect judgement. It is fairly obvious why doing otherwise can create poor medical care due to blind spots created by subjectivity, hope, selective listening, personal agendas, and bias for a certain approach to treatment.
Attending Physician Guest Writer
Geisel School of Medicine at Dartmouth
Dr. Ronan is an associate professor of neurology and medicine at the Geisel School of Medicine and is the program director of the Dartmouth-Hitchcock Neurology Residency.
Practical Wellness: Perspectives from a Program Director
A program director's perspectives on practical wellness in residency and how graduate medical education leadership can facilitate housestaff resiliency and self-advocacy.
