The transition from medical school to residency is notoriously one of the hardest of our career. As an intern, you work long hours and have an immense amount to learn. It's very common to feel overwhelmed, judged and generally cynical. And now with an entirely uprooted health care landscape from a global pandemic, you may find yourself with many difficult days ahead.
I graduated from UNR Med in 2018 and moved to New York City for my emergency medicine residency. I had no idea what to expect. I constantly felt like a fish out of water my first two years, but gradually I gained traction. Then, at the end of my second year, COVID-19 hit.
My program rotates at three hospitals in the city, but one of our hospitals -- Elmhurst Hospital Center -- was hit particularly hard. It's a county hospital in the borough of Queens, and the patient population is largely made up of people of color, the poor and immigrants.
The news called our hospital "the epicenter of the epicenter." We nearly had an uninterrupted stream of news coverage outside our ER. They constantly filmed our overworked ambulance bay, and reporters repeatedly asked us questions as we left or arrived for a shift. All this for good reason. On the inside of the hospital, we were absolutely overrun with critically ill patients. The scale of death and suffering was rightfully compared to a warzone and is something that we will never forget.
Yes, these were tough days. As residents, we often felt like we were getting the short end of the stick in terms of hours worked, amount of COVID patient contacts, shortage of PPE, lack of hazard pay, etc. However, with the use of some tried and true methods, we were able to combat the burnout that many other residents felt during this time. This advice worked for us, and I pass it on to you in hopes it will work for your intern year in this post-COVID world.
- Build your social support system. First, and most importantly, we leaned on each other. Similar to your medical school classmates, there is no one who will understand you better than your fellow residents, especially those in your same program year. When your service is over census, they are right there with you holding the line. When you have a patient with a bad outcome, they can provide an understanding ear. Having an external source to vent and validate your experience during a stressful period is one of the most beneficial activities you can possibly participate in. The bond you will form with your co-residents will undoubtedly be strong and rich but it takes effort. My advice is to prioritize these relationships early on, even if they feel burdensome at the start. You will be investing in a support system that will continue to return benefits long into your journey.
- Remember the good. Second, we kept a log of good patient outcomes. In most of medicine, we think about our mistakes and difficult cases. This is great from a learning standpoint, but it's terrible for our personal well being. The patient who beats the odds and makes a miraculous recovery is just as important to remember, if not more important . These cases keep you humble, hopeful and optimistic. They provide you stories you can share with others (especially those who work outside of medicine) and they keep you excited to come to work. Therefore, when one of your patients wakes up from a coma, survives neurologically intact from multiple cardiac arrests, or walks out of the ICU after a multiple month stay, remember it and write it down. Store a bank of these experiences and actively tell others about them. It seems simple, but it works, and it requires very little effort.
- Conserve energy. Third, we became very good at prioritizing and telling others "no." Somewhere around the summer of 2020, we realized this was going to be a long and difficult fight. Things like research, inservice exam studying, outside projects, etc, quickly became less important and put on the back burner. This freed a significant amount of time we could use for ourselves, which was very needed due to our increased stress levels. Similarly, residency can be very long and difficult. If you are using all of your energy at the beginning, you may find yourself burnt out at the end of the journey. The idea of saying "no" more often sounds simple, but I can assure you it is very difficult. You will feel a strong urge to say "yes" to all kinds of new and exciting projects. You may see other residents picking up multiple opportunities and the comparison mindset will slowly sneak its way in. As my senior resident told me when I started, "intern year is about survival." Do not be worried if nearly all of your time and attention is consumed by clinical responsibilities because you will be in good company. Soon enough, you will have ample time to explore your passions.
- Be an advocate. Fourth, we learned how to advocate for ourselves. Early on in the pandemic, it was clear that some residents were being taken advantage of. I was lucky that my program treated us very well, however, many other residents around the country were not as fortunate. Some were being told to not call out sick, that they didn't deserve hazard pay, and that voicing discontent was "not becoming of a compassionate and caring physician." This lack of respect and willingness to treat residents poorly is unfortunately common, and not just during a pandemic.
Therefore, it's vitally important to know what is appropriate and what is a clear violation of the rules. Being required to work extra hours, being threatened with retaliation, and being publicly shamed are all violations and should be taken seriously. If resident rights are regularly being violated, then it is our duty to say something. This is a very hard thing for a resident to do because we may risk being labeled the "difficult resident." We worry that nothing will change even if we do file a complaint. However, by not speaking up, we are condoning this behavior and allowing mistreatment to happen to all the future residents coming in behind us. Be firm and know you are doing something most would not have the courage to do.
The American College of Graduate Medical Education (ACGME) and the Association of American Medical Colleges (AAMC) have a variety of resources that outline what constitutes mistreatment. But an even better option is to call or email the Graduate Medical Education (GME) office at your new institution and ask if they have a document outlining their mistreatment policy. If they do, then great, read the document and hold them accountable. If they don't, then ask them to create such a document and take steps to actively distribute it.
Advocating for your patients, yourself, and your profession is a skill that benefits us the earlier we learn it. Medicine is fast moving and forever changing. Government creates new rules and regulations. Hospital systems hire new management who steer in a new direction. Resisting change and not requesting a seat at the discussion table is a one-way road to cynicism and nihilism. Be fluid and learn the ways you can shape, and even create, change in medicine. - Accept the compliment. Lastly, we learned how to receive kind sentiments from others. A couple weeks into the lockdown in New York, people started spontaneously cheering everyday at 7 p.m. for all health care workers. This outpouring of appreciation went on for months, to the point where we questioned if it was ever going to stop. Then we started receiving donations of food, hand drawn pictures of doctors in superhero costumes, and on and on. You would think this would be a pleasant experience for us, but the predominant emotion amongst us residents was actually feeling uncomfortable. This is a complicated emotional reaction that is difficult to simplify, but I personally believe a major reason why we felt uncomfortable is because we don't see ourselves as heroes. We see each other as normal people doing a job just like everyone else. This line of thinking is fed to us early and often in our training. We are told to not get cocky and to not let the power go to our heads. We all fear being called an "arrogant doctor." However, could it be possible that the pendulum has swung too far in the negative direction? What is the harm in simply taking a compliment every once in a while? My advice is to work on this early. Patients are much nicer post-pandemic. You will undoubtedly receive praise many times even when you're just starting. Learn how to accept it and not push it away. You have dedicated yourself to an incredibly noble profession, and it is okay to feel proud of that.
