Medical Residency Burnout: How to Avoid It
According to the Maslach Burnout Inventory, there are three specific components in assessing burnout: emotional exhaustion, depersonalization, and a lack of a sense of personal accomplishment. About 40% of medical students, residents, and attending physicians experience these symptoms of burnout. Considering the prevalence of burnout among medical professionals, how do you avoid burning out in residency? Here are a few pieces of advice from my own experience that can help you better understand, manage, and minimize your risk of residency burnout.
Why is residency burnout so common?
Residents may be especially prone to burnout. They often work long hours, with disproportionately low financial compensation. Even with ACGME protections meant to limit excessive work hours, some programs have been rumored to violate the 80-hour weekly limit. There are also unfortunate situations where residents find themselves in malignant programs that actively silence resident concerns or duty hour violations.
Furthermore, with residency occupying the middle of your journey through medicine, you may already feel a little burnt out from medical school. Entering residency, you’re suddenly saddled with more responsibility for direct patient care. Since you’re still learning, the amount of stress skyrockets while your ability to handle complicated medical situations is slower to catch up. Residency ranges anywhere from three to seven years, so it can be hard to see the proverbial light at the end of the tunnel.
How do your minimize your risk of residency burnout?
Burnout in medicine is a complex issue that affects many and is influenced by systemic factors. While there may be contributors that aren’t easy for you to control, you can still benefit from a few key tips to prevent residency burnout.
1. Lean on your support system
It takes a village. Many of your colleagues who are in the trenches with you understand what you’re going through. Upperclassmen who have gone through the same training and have made it to the other side understand what you’re going through. It isn’t always possible to have a strong support system of like-minded individuals in your residency program, especially if you find yourself in a program that is actively contributing to burnout. I was lucky enough to be able to confide in my coresidents when going through residency. We were there for each other when life got hard and helped each other with advice and encouragement, or even cross-coverage.
If that’s not your situation, maintain your relationships with people in your medical school class, your family, your spouse, or nonmedical friends. Reach out to mentors and friends in medicine who aren’t affiliated with your program. They may not be able to cover a shift, but having a listening and understanding ear can make you feel heard and valued.
2. Cultivate hobbies and interests outside of medicine
Practicing medicine can be draining. Maintaining passions outside of medicine can restore enthusiasm for life. Even something as simple as reading a few pages of a book that has nothing to do with medicine can be a refreshing experience when it feels like you live and breathe medicine. Don’t forget that you have an identity outside of being a doctor, and that’s a good thing! Maybe you won’t get to paint or play the violin as often as you did before, but every bit that you can fit into your schedule counts. It’s worth the time commitment because it can sustain you through residency.
3. Make health a priority
When the going gets tough, it can be tempting to eat poorly, neglect sleep, or stop exercising. You need to take care of yourself, because if you don’t, it becomes harder to take care of others. I found that when I stopped exercising during hard rotations, I ended up more fatigued and less energized than when I fit in a short workout before or after work.
4. Use your vacation and time off
It can be tempting to save your important life errands for a “vacation week,” or to spend it resting, and there are certainly times when that needs to happen. However, don’t spend every allotted vacation during residency doing that. It sounds ridiculous, but you almost need to schedule fun into your life. Forcing yourself into a change of scenery during your rare time off, even if it means spending a few days lazing around the closest beach, or traveling to see family or friends, can offer a change in perspective.
After spending a few of my vacations stuck at home during COVID-19, compared to the vacations when I got to travel to a new place, I noticed a huge difference in how I felt after coming back to work. If I did nothing, it felt like time passed me by and I didn’t even have any time off.
5. Look for a program that values your needs
This may be a little late if you’re already in residency, but it’s an important factor to address. The interview process when selecting a residency is just as much for you to evaluate the programs as it is for the programs to evaluate you. Observe how the residents talk to each other and how they talk about their work experiences. Try to assess the culture. A program might be prestigious and desirable, but is that the right program for your needs and values? Be realistic with yourself, are you going to be happy there? When selecting a residency program, focusing on fit versus focusing on traditional measures of success is going to do more towards preventing burnout in the long run.
6. Take time for yourself each day
Taking 10 minutes out of the day to sit in silence and “just be” can make a world of difference. For me, I made a purposeful effort to shut out the noise before going to sleep at night. For 10 minutes, I would listen to a guided meditation app, or just relax and not think about any of the things I needed to do tomorrow, letting my mind recenter and ground itself and just be still. This often made falling asleep a little easier too.
7. Treat yourself
Don’t go crazy and buy yourself whatever you want. But sometimes, a little “treat” can go a long way. During difficult rotations, I paid an extra $10 a day to park at the hospital a few days out of the week. That was my “treat,” and the 20-30 minutes I didn’t have to waste waiting for the bus at the end of a workday felt so worth it to me.
Sometimes, you feel too exhausted to cook and need to order takeout. Free time is in short supply during residency. Occasionally, spending your residency money on something that will make your life a little more convenient can be the best way to spend that money.
Of course, don’t be too excessive. My advice is to find one thing that makes the biggest difference and splurge a little towards that. For some, that can mean weekly grocery delivery, a dog walking service, or a cleaning service.
8. Learn to say “no” both personally and professionally
Medical education is not a sprint—it’s a marathon. During residency, it’s especially common to “hit a wall.” There’s just no way you can do every single thing that’s asked of you and expect to make it to the finish line without some long-term damage.
I apply this principle to things that don’t involve my primary work responsibilities, but may be professionally related. If I’m offered a research project but already feel overwhelmed with my work schedule, I may decline to commit myself to the project at that time. If your neighbor asks you to dog-sit for a week when you’ve got call and long workdays, it’s perfectly appropriate to politely decline. Saying “no” is hard and can feel awkward, but there are times when you need to for the sake of your own well-being, and your own well-being is important.
9. Reflect on your impact
Part of burnout, as mentioned above, is feeling emotionally exhausted, disconnected, or even numb to the work that we do. There’s so much happening in your day-to-day life and not enough time to process everything. Some days, you’re putting out one fire after another, without any time to debrief before moving on to the next task. It can feel like an onslaught that weighs you down, and you’re not quite sure why you feel that way.
I find it useful to reflect on one lowlight and one highlight from every workday. That way, you acknowledge the bad, while recognizing the good. Remember that patient who hugged and thanked you when discharging? Thinking back on it, it can feel good to feel like you’re making a difference. Maybe you performed a procedure well and didn’t have to be reminded of any of the steps. Don’t forget to celebrate your victories.
10. Give your program feedback
Burnout isn’t necessarily an individual issue. The structure of residency is inherently difficult, and last time I checked, medical professionals are still human. If you’re feeling the burn, there’s a chance your colleagues feel that way, too.
There are usually ways a residency program can improve conditions for residents. If you feel your program leadership might be receptive to this, it may be worth letting them know which aspects of the program may be a “burnout risk.” Filling out ACGME surveys or getting involved in residency councils can also be a step toward making changes that will benefit everyone. Some institutions have ombudsmen for which cases of harassment or bullying can be anonymously reported, as well. Speak up for yourself and for each other.
What if you’re already burning out?
If you feel yourself already experiencing symptoms of burnout, it’s important to tell someone you trust and get some help. You may ultimately benefit from the help of a professional therapist. Don’t keep it to yourself, as this may exacerbate feelings of isolation. Don’t ignore it, because it can get worse and lead to other serious issues such as depression. Remember you’re not alone, and burning out does not mean you’re “not resilient enough.”
Look for community and read about the experiences of other physicians who have shared their stories—what has worked for them? I’ve known of situations where a resident suffering burnout transferred to a different program or even a different specialty and found themselves much happier. I’ve also known residents who received professional counseling and were able to make it through their program.
Feeling symptoms of burnout does not mean all hope is lost. Acknowledging and addressing your symptoms are necessary first steps to prevent burnout from progressing any further.
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