I was not at all prepared for my transition from being a resident to an attending. Now that there are work hour restrictions and constant oversight during training, graduating residents seldom get a preview of what it feels like to be at the top of the decision tree.
‘A very terrifying change’
I am an ob-gyn, so for me, this meant that I went from being on call with a handful of other residents and several attendings to being the only physician covering the obstetric and gynecologic patients. I am very lucky to be working in a supportive environment with plenty of people to call, but this was still a very terrifying change for me.
In many ways, the transition from resident to attending amplifies the bad behaviors that we learned in residency to cope with stress. I would respond to stress by eating chocolate, drinking wine and binge-watching reality TV.
I was told by my friends and colleagues that my feelings of inadequacy never really go away, but that I would get better at dealing with them. Not long into the start of my career, I was overwhelmed, anxious, and looking for a way out of medicine.
Increased responsibility, increased anxiety
The journey from medical student to attending is an interesting one. The things that we used to get excited about as students become the biggest burdens when we’re attendings.
I remember happily anticipating my first call shift as a third-year medical student. I was so excited to learn from all the ER admissions and getting to be more involved with patient care in the middle of the night. As an attending, I do not look forward to being on call, and pages from the ER are not something I particularly enjoy.
As our responsibility for the patients increases, our anxiety naturally follows. It would be beneficial to have a way to counteract that anxiety so that we can continue to enjoy our careers for at least as long as we trained for them.
The problem with residency
Burnout has become pervasive in health care. There are books, blogs, podcasts, and physician coaches all trying to decrease the rate of burnout. I can’t help but wonder if the solution for burnout, like that for so many other things, lies in the prevention of it altogether.
Residency is a stressful several years, and it includes poor sleep habits, eating at all hours of the day and night, limited time to exercise and downtime that often involves large amounts of alcohol. When faced with the anxiety of being an attending, we lean on our residency habits to help us through.
This leads to a deterioration in our health and our emotional well-being. It is a cycle that continues and often leads to physician burnout or to the abandonment of medical careers entirely.
Preparing residents to become attendings
It’s time to incorporate strategies to prevent physician burnout into residency programs. We need to teach our young physicians how to appropriately cope with stress. We need to be focusing on mindfulness and metacognition. We need to be preparing residents for life as attendings without sacrificing safety.
Medicine is not going to get easier. Insurance companies are not going to start reimbursing at a better rate. Electronic health records aren’t going anywhere and will never be perfect. It’s time that we take control of our own happiness and teach young physicians how to do the same.