Lucas A. Salg, MD

 in the department of psychiatry at the University of Colorado School of Medicine in 

The incessant demands of medical residency are well documented, as are the effects of its constant stressors that compromise well-being and lead to 

. Many residents are aware of burnout in the periphery as they trudge along. The looming specter of emotional and physical exhaustion; the very real possibility of losing empathy; the “death-by-1000-cuts” effect of vicarious trauma-these persist early in the career of a physician and often take hold well into one’s career.

So what are we doing about it? Programs vary in the amount of time required of residents to learn the practice of psychotherapy, but actively encouraging residents to seek their own therapy-for either professional growth or personal wellness-seems to be very much a thing of the past.

Though charged with promoting the health of others, doctors tend to be poor stewards of our own wellness. Amid such discussions and revelations about the health of physicians are the discussions we have with the next generation of doctors. Though medical school applications are rising, and the number of graduating medical students is growing, half of doctors in practice say they would not recommend medicine as a career to their children and over a quarter would not choose to be a physician if they had their career to do over again.

Though charged with promoting the health of others, doctors tend to be poor stewards of our own wellness.

While the factors at play are complex, the dramatic proportion of 

 who would choose a different career or discourage others from pursuing medicine speaks volumes about the mental health and satisfaction within our profession.

Physicians work long hours, live stressful lives, make difficult decisions, and feel squeezed to see more patients in less time for less money. To some, a sick day can jeopardize their clinic. For others, they work longer hours than their own providers. In the past, some psychiatric training programs either required, or strongly recommended, personal psychotherapy for their residents.

In general, rates of psychiatric residents in therapy have 

 indicated that in the 1950s, as many as two-thirds of residents sought personal therapy.

 These days, few residents pursue individual therapy. A 

 showed that training directors believed therapy to be useful, but that less than 33% of residents actually sought it out.

It is not hard to speculate about the reasons why. One of the 

 indicated shortage of time and money as primary forces involved.

 From anecdotal as well as personal experience, giving away precious free time to therapy may feel trivial in comparison to some of the injustices suffered by patients. Free time is also hard to come by when there is so much work to be done on the unit or in the clinic.

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Training directors, especially those with a psychotherapeutic interest, might value the experience in a vacuum, but giving residents time to pursue therapy requires logistical planning that affects both patients and other residents. Additionally, an interested resident must comb through a list of therapists who take Graduate Medical Education insurance, and from there, whittle an already limited list down to those actually accepting new patients.

Despite all the roadblocks one could expect, residents should not give up on seeking personal therapy. Some programs have implemented resident wellness programs that offer counseling with encouraging results.

 in which residents are aware of the available services 

Ultimately, residents may must advocate for themselves to make time for therapy. For those with an interest in psychotherapy, it is certainly relevant to experience the view from the patient’s chair and to learn from those doctors who are more experienced than they are.

Perhaps most importantly, therapy provides residents with the ability to cope with the stress of residency and with the opportunity to seek wellness. This in turn benefits patients, who receive care from a resident who has not lost his or her drive. If physicians truly strive to “do no harm,” they owe it to their patients to be well enough physically and emotionally to give patients their best efforts.

1. The Physician’s Foundation (2016, September 21). 2016 Survey of America’s Physicians: Practice Patterns & Perspectives. September 21, 2016. 

http://www.physiciansfoundation.org/uploads/default/Biennial_Physician_Survey_2016.pdf

The role of personal therapy in psychiatric residency training: a survey of psychiatry training directors

Personal psychotherapy during residency training: a survey of psychiatric residents

Use and characterization of personal psychotherapy by psychiatry residents

“If you build it they will come”: attitudes of medical residents and fellow about seeking services in a resident wellness program

6. Moutier C, Norcross W, Jong P, et al. 

The suicide prevention and depression awareness program at the University of California, San Diego School of Medicine

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The looming specter of emotional and physical exhaustion in residency often takes hold well into a physician's career. So what are we doing about it?

Lucas A. Salg, MD

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