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Welcome to “Ask the Program Director,” a column from MedPage Today where your most pressing questions about residency — from the application process to life as a resident — are asked and answered. Want to submit a question? Comment below or email perspectives@medpagetoday.com.
Dear residency program director,
How should I prioritize self-care during training? I’m a first-year resident and even though I’m 7 months in at this point, I’m still struggling with the demanding hours. In-patient rotations are the toughest, and with spending 90 or more hours a week in the hospital, I feel like I have little time to do much more than eat and sleep. I feel like I’m neglecting my non-healthcare friends and family, and some of the hobbies I used to enjoy. I’m wondering if there’s a “right” approach to self-care to ensure that free time is used to recharge and not be more draining than it should.
Dear resident,
Thank you for submitting such an important question, given the high rates of burnout among clinicians throughout the country. We often hear about burnout among attending physicians, but as you’re quickly learning, burnout and mental health issues are just as relevant and real for trainees and medical students.
First of all, please know you are not alone and professional help is available if you need it. There is absolutely no shame in seeking help. Many residents struggle with the demanding hours of training and have difficulty finding time for many of their hobbies or spending time with loved ones.
In general, my best advice for improving well-being during residency is to be intentional with your tasks and time.
No matter how little time you have away from the hospital, you must set aside time to embrace your joys or modes of relaxation — this should be non-negotiable time that should never be compromised. This may mean blocking off time for exercise, reading a book, going to the movies, doing yoga, or just relaxing on the couch. Whatever the activity (or lack there of!), it should be treated as an appointment with yourself to enjoy hobbies and activities outside of work. This could be just 20 minutes a day. But when done regularly, that time adds up to 2 hours and 20 minutes of self-care time per week — with important benefits for your well-being.
Just as important as being intentional about time management is learning to say “no,” which is a skill I have only recently learned but wish I adopted earlier in my residency training. As medical professionals, we are often ambitious and like to take on many tasks; on the flip-side, we may be hesitant to decline opportunities, particularly when asked by supervisors or role models. However, sometimes it is important to take a step back and decline engagements, particularly when time is so limited.
Making the most of the small amount of free time you have is also essential. If you commute to the hospital, consider living within walking distance (if possible) or a short commute away, and use the saved time for a hobby or activity you love doing. Not only does this time saved add up, but also, the extra walking promotes cardiovascular health and well-being.
On that note, maintaining physical health and well-being should be a priority. This means prioritizing sleep (which you already seem to be doing), staying hydrated while at work, exercising when you can, and preparing energizing, nutritious meals at home when possible to avoid relying on unhealthy snacks at the hospital.
Finally, learn to recognize the signs of burnout. It is usually characterized by emotional exhaustion, a low sense of accomplishment at work, and not enjoying activities you once enjoyed. If you’re feeling this way, reach out to your program director or trusted mentors, or call the Physician Support Line to get the support you deserve.
As a residency program director myself, I must add that working 90 hours a week could be a violation of the Accreditation Council for Graduate Medical Education (ACGME) duty hours. Residents should only be working 80 hours per week, averaged over 4 weeks. However, I do understand this is not always practiced in all residency programs across the country. If you feel this has become a pervasive problem, you should consider speaking to your program director or your graduate medical education office at the hospital. At the end of the day, program directors want the best version of their residents to show up to work in order to optimize patient care, and tired sleep-deprived residents will not serve the hospital or program very well.
I hope you now feel better equipped with some strategies to improve your well-being.
Are you a medical student or resident? Please comment below or email us at perspectives@medpagetoday.com with other questions you’d like to have answered by a residency program director.