Of all the fulfilling and purposeful vocations to pursue, we’ve ended up trying to find our footing in the vast and ever-changing maze of medicine. Propelled by some combination of privilege, perseverance, and circumstance, we became doctors — many of us with the noble drive to heal and support other humans through the physical and spiritual struggles of life.
There are many wonderful things that come with being able to call yourself a doctor: opportunities to finally put theory to action, to explore the practice of everything you studied in medical school, to ideally influence patients’ lives for the better — all beautiful experiences. Yet, the learning curve is steep in the first year of residency, and the demands are great. Intern year is an experience unlike any other, where most new physicians are in the trenches together, spending a significant majority of their lives within the confines of the hospital regardless of specialty, before moving on to more outpatient practice versus inpatient time, radiology, dermatology, life in the operating room, etc.
Yet during my intern year, I discovered that the glorified title and privilege of being called “doctor” had a very high price tag and the process of fulfilling my idealized role would not be smooth or pretty. The hierarchical power structure, 28–hour shifts, unenforced work hour limits, absence of traditional labor practices such as overtime or required breaks, etc., are all well-understood expectations and topics of never-ending debate with the ACGME. These structural and institutional challenges are compounded by the enormous emotional, mental, and intellectual toll that intern year can take on a new doctor. Despite the wellness “curricula” adopted by residency programs across the nation, consisting of a lecture here or there, suicide remains “the only cause of death that is higher among doctors than the general population.”
There were many times when I felt overworked, overwhelmed and ill-equipped with the number of tasks to complete for a large census. The number of patients was immense, but that wasn’t all. I felt that I was unable to have conversations with patients that I normally would if I had more time. Personal, emotional, social, familial concerns were no longer touched upon, only the minimum necessary to move down the list. Some would argue that the emotional, mental, and social well-being of a patient is at the crux of overall healing and well-being — yet these are not issues one overworked intern can even begin to address.
At the end of the day, I felt exhausted and drained because my work was not meaningful — it was, in fact, cursory. There were many instances when I felt that I had lost the sense of idealism, empathy, or sensitivity that drove me to want to become a physician. Even with patients dying in the ICU or on the trauma service, all I could do was think about what was expected of me at the time: notes, returning pages, putting in orders. There was no time afterward to get adequate sleep and exercise, much less process, feel, and grieve.
As interns, we are expected to keep running on the hamster wheel with the expectation of getting “through it” without a complaint. Trying to “get through” something is not living, and the fact that most residents view intern year this way suggests that we are facing a system detrimental to the health of physicians-in-training. It is not a system that is set up for thriving and inspiring passion for your profession, but a system that can be easily compared to a military boot camp. Why is this an expected practice? How is it sustainable? Are we causing more harm than good to new physicians? Are we introducing cynicism from the start of training?
There is no question that this is not an effective model for training physicians, nor does it foster the desire for learning or the desire to become invested in the underlying issues that plague patients. Despite the challenges of intern year, I shared significant and beautiful experiences with patients who I got to know in their time of need. As a result, I felt moved to do more and be a better physician for them — regardless of how spread thin I was. I shared in the joy of their accomplishments and grieved with them during the most devastating moments of their lives. As a new doctor, I continue to be humbled by the magnitude of what I have yet to learn in order to better serve future patients.
There is so much more we can do to make this process of becoming a skilled, empathetic, and knowledgeable provider more bearable — even enjoyable. But it really is up to us to speak up and advocate for policy change, create a culture of open communication, and foster non-punitive methods of learning, in addition to allowing space and time for self-care, especially in a way that a resident can easily ask without expecting retribution. Maybe this involves becoming part of the system or leadership and lobbying for resident protection. Ultimately, we are fighting to do good for people in an unjust world and we are only effective when we can be present as a whole and care for ourselves. As Buddhist teacher, Jack Kornfield, states, “If your compassion does not include yourself, it is incomplete,” yet self-compassion and self-care is only possible if we fight to make space for it.
Image credit: clay by Dean Hochman is licensed under CC BY 2.0.
Resident Physician Contributing Writer
Harbor UCLA Medical Center
Saba Malik, MD, MPH is a 3rd year family medicine resident at Harbor UCLA Medical Center. She earned her MD with a distinction in advocacy from Albany Medical College in 2018, prior to which she had completed a masters in public health with a concentration in community health sciences from the UCLA Fielding School of Public Health. She has an undergraduate degree in Neuroscience also from UCLA. She is passionate about health disparities, health justice, holistic and integrative medicine, LGBTQ issues, and improving the health and well being of vulnerable and disadvantaged communities.