Balancing Residency Culture: How to Stay Levelheaded

It’s no doubt that residency is an important part of the medical journey to becoming a hospitalist. There is no replacement for the hands-on training a doctor will receive during their residency at a teaching hospital prior to obtaining their board certification. Most hospitalists complete a three-year residency and continue practicing as internists, and some receive board certification in other areas like pulmonology, intensive care medicine, and nephrology, to name a few. Although the undertaking of a residency program can be very rewarding, it can also be extremely arduous and overwhelming for a large percentage of doctors.

Several years ago, the Journal of the American Medical Association published a meta-analysis of the Prevalence of Depression and Depressive Symptoms Among Resident Physicians. According to the analysis,

“data was extracted from 31 cross-sectional studies (9447 individuals) and 23 longitudinal studies (8113 individuals). Three studies used clinical interviews and 51 used self-report instruments. The summary estimate of the prevalence of depression or depressive symptoms among resident physicians was 28.8%, ranging from 20.9% to 43.2% depending on the instrument used, and increased with each calendar year.” (1)

Examining these statistics can be alarming, especially for those looking to become a hospitalist. However, by actionably taking precautions, doctors can try to reduce the likelihood of experiencing depressive thoughts and feeling inundated during their residency.

Keep reading to learn more about the top three factors that can contribute to depression as a resident, and practical step to improve the outcome.

Work-life Balance

Working overnight shifts and upwards of 80 hours a week can take a major toll on even the most composed person. Being overworked can lead to sleep deprivation and impaired cognitive function. Additionally, by spending all waking hours working, it can be difficult to create and maintain healthy social relationships. This can lead to a sense of loneliness, and an even deeper depressive state. To help combat this, residents should talk to their program directors to try to work out a schedule that works. On days off, residents should spend away from their work environment, and find ways to rest their minds and bodies with activities such as yoga or meditation. It can also be helpful to find creative ways to sneak in naps, deep breathing exercises, and/or quiet time for reading, prayer, or listening to calming music throughout the workday.

Financial Burdens

A lot of doctors in a residency program have upwards $200,000 in student loan debt. This financial burden can place a lot of added stress on residents, making it hard to live within their means. Residents can help face their budgetary anxieties by creating a strategy that includes setting realistic goals for paying down debt and sticking to that plan no matter what. There are also professional organizations like the National Foundation for Credit Counseling that offer resources for free to individuals who need credit and student loan guidance.

Patient Suffering

For many, this will be the first time directly dealing with patient illnesses, and a lot of them. Residents may experience traumatization after facing situations involving serious complications and death among the patient population they are serving. Grief from constant loss can make it difficult to maintain a positive outlook. Because residents should be very careful not to internalize the anguish they may experience, they should seek help from external resources like grief support and counseling. Additionally, by attending virtual seminars or listening to podcasts on personal and mental wellness, they will realize they are not alone. Lastly, they should not be ashamed to bring these feelings up to their superiors. Having an open dialogue can lead to strong mentorship bonds that ultimately will help with healing.

Although residents can take many steps to decreasing their risk for developing depressive thoughts on the job, ultimately it is up to the organization to provide their staff with an environment that fosters creativity, open communication, and teamwork. By providing support, supplemental education opportunities, and positive feedback, residents are much more likely to succeed.

If you are in crisis or think you may have an emergency, call your doctor or 911 immediately. If you’re having suicidal thoughts, call 1-800-273-TALK (8255) to talk to a skilled, trained counselor at a crisis center in your area at any time (National Suicide Prevention Lifeline). If you are located outside the United States, call your local emergency line immediately.

Learn More About Advanced Care Hospitalists (ACH)

ACH is a Lakeland-based hospitalist group providing comprehensive patient care in community hospitals across Central Florida. Our providers are highly skilled, board-certified internal medicine specialists who are available around-the-clock to meet the care needs of patients from hospital admission through discharge. Post-discharge from the hospital, we continue overseeing patient care for 30 days.

We’ve found that continued care coordination ensures more accurate medication reconciliation, improved compliance with discharge plans, better scheduling of follow-up visits, and fewer hospital readmissions. Our providers do everything in their power to make sure our patients receive the compassionate and comprehensive care they need to promote healing and prevent a second hospital admission.

For more information about our services and our practice, please contact Advanced Care Hospitalists at 863-816-5884 or fill out a contact form online.

Resources

1. Mata DA, Ramos MA, Bansal N, Khan R, Guille C, Di Angelantonio E, Sen S. Prevalence of Depression and Depressive Symptoms Among Resident Physicians: A Systematic Review and Meta-analysis. JAMA. 2015 Dec 8;314(22):2373-83. doi: 10.1001/jama.2015.15845. PMID: 26647259; PMCID: PMC4866499.