The following manuscript was submitted to the May 2018 Mental Health theme issue.
One evening, overwhelmed by burnout, I drafted a letter of resignation to my program director and saved it on my computer. The next morning, I deleted the email without sending it.
Just six months later, at the end of my second year of family medicine residency, I stood outside the ACGME offices, ready to attend my first meeting as the resident representative to the Review Committee of Family Medicine. Gazing at the well-known logo emblazoned on their heavy doors, I felt intimidated and small, my imposter syndrome helpfully pointing out all my inadequacies for the task I was about to take on. All of the newness, the excitement of the long white coat, the pride at calling myself “doctor,” had long worn off.
I held my burnout close to me, ashamed of how I felt. I didn’t tell anyone, even my loving and supportive husband, how distressed I really was. Like almost all of my colleagues, my mental and emotional wellbeing fluctuated from rotation to rotation, influenced by the kindness of my attending, the helpfulness of my senior resident, the amount of sleep I got each night, how often I saw my husband.
The life and work of a resident lends itself very well to burnout. We work long hours caring for patients who are very ill. We constantly cope with feelings of failure and inadequacy. We make mistakes. We spend much of our time looking at a computer and less and less time connecting with our patients and team members. Perhaps the most challenging part, for me, was the feeling of being a tiny, inconsequential cog in a large machine. I felt like I had no power to control many things in my work and day-to-day life.
As part of my position as the resident representative on the Review Committee for Family Medicine, I was also a member of the Council of Review Committee Residents (CRCR). This is a group of 29 resident physicians from different specialties who get together twice per year to discuss issues that are important to us. Entering my first CRCR meeting, I remember wondering if this two-day meeting would be impactful in any way. Would I be spending nights away from my family for no reason?
I quickly realized there was no need for skepticism.
Each meeting, Dr. Nasca, the current president of the ACGME, sits with us for over an hour and engages in a thoughtful dialog about whatever is on our minds. We have talked candidly about sexism and racism in graduate medical education, about the rights of women to pump breast milk at work, the rights of new mothers and fathers to take a parental leave to care for their newborn, and the high burnout rates among residents and fellows.
After that first meeting, I remember feeling buoyed by the energy and passion in that room, but bothered by lingering thoughts that, so often, talk does not necessarily always lead to action. Did the ACGME really want to help us? Despite these voices of doubt in the back of my mind, I left each meeting feeling lighter. Even though I was still a small cog in a big machine, I felt as though the machine was listening to what I thought and what I needed.
During my short time in the ACGME, I have witnessed the Common Program Requirement revision and the Back to Bedside movement, and have seen the ACGME advocate for resident well-being in unprecedented ways. I know that there have been thousands of voices crying out for the changes that have been made. I know that there are still thousands of voices calling for the further changes that will need to occur. But the knowledge that I was in the room where these conversations happened, that I know Dr. Nasca heard my thoughts and cared about what I had to say, empowered me as nothing has empowered me before.
My new sense of empowerment and connection was the antidote to my burnout. Although I still, of course, have challenging days and challenging patients, I no longer feel as though I am rudderless, being buffeted along by the waves of graduate medical education (GME). By choosing to engage with the GME community, I owned my position in its vast collective. Because of this, I have continued to seek leadership positions in my program and institution — no longer doubting that my opinions, and the opinions of those I represent, matter.
As a family physician, I spend my days trying to empower and motivate my patients to take control of chaotic situations to improve their health. They struggle to remember appointments while working three jobs. They can’t remember to take their medications while managing a tumultuous home situation. Often all that it takes is one step in the right direction to help them to see that they have much more authority over their own lives than they thought. If residency has taught me one thing, it is that we are not all that dissimilar from our patients. We too can take small steps to address the shortcomings in GME and increase our sense of control over our own environments.
I know that the problems facing the GME community are large and can seem insurmountable. I know that no single person can fix all that is broken. But I strongly believe that, by each resident engaging with their programs, their institutions, their specialty organizations, and the ACGME, we can begin to improve things together.
And we just might help our own well-being in the process.