It is 6 PM on a Sunday, and at this very moment, somewhere a resident is sitting in a cramped hospital call room preparing to receive sign-out from fellow residents. He or she may be looking forward to the night ahead or perhaps dreading it. The resident wonders if this dread will permeate his or her chosen career. They wonder if they will find happiness in this mind-field or pain. So many of us are experts in this feeling. The unsure place between competence and terror becomes a familiar companion. Developing the mind of a sound physician was not our only job. We were there to teach while we were training, see all, document everything, report to everyone, and smile through it all. We marched forward knowing we were becoming shining examples for those after us but how did we lose our wonder along the way? Burnout is not only an affliction of the attending physician. It creeps in long before we sign our first contract. It is insidious and dangerous to our creativity and resilience. There are factors that we cannot control but let us explore some reasons why resident burnout is a reality.

1. Crippling Debt

While many find satisfaction in the noble effort to be of service to others, the debt monster lurking in the corner can dampen feelings of triumph. Debt is a reality for many medical students. Not many were saving for medical school in high school. Upon medical school entrance, the thought of attaining the goal of becoming a doctor can supersede all other considerations. "If I can just make it to the finish line everything will be all right," we tell ourselves. It is often in residency when we realize the actual weight of our interest accruing debt that we think twice. We are forced to ask ourselves if this journey is worth the trouble. The truth of our financial dilemma lingers in our minds as we forge new versions of ourselves. We must become competent clinicians no matter the cost. We swallow being cheap labor because we know we must train, but we soon realize that the low pay lasts long after we get the hang of covering our attending's service. During our training programs, we are captive to our salaries unless we obtain additional sources of income. In hindsight, many of us would have spent more time investigating passive income and ways to leverage the M.D. immediately after graduation.

2. Workplace Politics

Residents who report to the hospital at 5 AM do so because they want to do the best job they can, not to struggle to have their voice heard. Remember that clinicians in training have to contend with hospital politics from every direction. There are also residency politics and rotation politics that are in constant flux. With multiple rotations in different places, it can be dizzying to find common ground in each place and command respect. Where there are people there are rivalries, and unfortunately for many young doctors, this can be a big turn off. The job of being responsible for the lives of others is weighty enough. Adding negativity and politics can sour an otherwise rewarding experience. Staying above the fray is sometimes challenging but is worth the effort. We should teach residents to communicate graciously with support staff and executives alike. We should also seek to make residents feel supported through conflict. Conflict can result when a clinician pursues a treatment plan that is in the best interest of the patient, and we should support our residents whenever we can.

3. Workload

In our community, we often confuse the habit of giving a resident a heavy workload and the importance of a resident being hard-working. The emphasis on duty hour restriction is an example of our recognition that we can over reach in our expectations of trainees who also happen to be human beings. Countless notes, orders, consultations, family meetings, and phone calls cluttered our days. Many of the tasks were appropriately delegated, but a vast quantity did not require a doctor's personal touch. The administrative burdens faced by medical residents are hefty to put it lightly. It starts to sink in that this will be the expectation moving forward. Students know that they will have to adjust to a new job with unique administrative hassles in the future. Eager to please and yet vulnerable, clinicians in training can inadvertently overextend themselves in order to be helpful. A little (okay a lot) of scut work as a resident builds character, but there is a fine line between administrative work that enhances learning and work that diminishes the learning experience.

4. Fear-based learning

All clinical teaching scenarios will certainly not play out like a scene from Barney, but unnecessary bullying should be rooted out whenever possible. Genuinely committed teachers know when to be stern and are always in pursuit of the best training methods. We can become less effective and inappropriate when the focus shifts from the skill we are teaching to our feelings about the lack of a skill in a resident. While it is concerning when a resident is not performing at a suitable level, the focus should always be in elevating the student instead of tearing them down. All who are in a position of power to train clinicians have an ethical obligation to keep their emotions in check and appeal to more positive instincts. We can teach and build each other up. We can choose to pursue fairmindedness whenever we are teaching. Terrified students are less likely to be innovative or resilient. No one ever told said they wished their doctor was more like a robot.

While this is only the tip of the iceberg, it is a window into the world of the resident. Retaining an energetic and innovative healthcare workforce starts before training ends. We should continue to strive to create environments that engender a sense of safety and empowerment. Ultimately we want our best to see medicine as a sustainable career and not a heavy burden.

Mirza W, Mirza AM, Saleem MS, et al. Well-being Assessment of Medical Professionals in Progressive Levels of Training: Derived from the WHO-5 Well-being Index. Cureus. 2018;10(12):e3790. Published 2018 Dec 28. doi:10.7759/cureus.3790
Bari A, Kamran R, Haroon F, Bano I. Burnout among pediatric residents and junior consultants working at a tertiary care hospital. Pak J Med Sci. 2019;35(1):45–49. doi:10.12669/pjms.35.1.43

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