A MESSAGE TO CIR MEMBERS EVERYWHERE:
If a patient presented to us in need of treatment, exhausted and overwhelmed, we would not prescribe them a good night of rest and a 30-day supply of resilience. Unalleviated chronic stress, when combined with overwork, financial struggles or a lack of support, is a recipe for disaster.
Our colleagues at St Luke’s/Mt. Sinai have watched tragedy unfold twice – on January 18, 2018 when a 28-year-old Interventional Nephrology fellow jumped to their death from the residential tower just outside the hospital and in the summer of 2016 when a resident took their own life from the same rooftop.
When tragedy repeats itself, it becomes imperative for us to take a long, hard look at the underlying issues that we face. We need to be talking about these events, with each other and with the public; being silent on these issues is not an option. Because of long hours, high patient volume, academic demands, work compression, and irrational systems that negatively impact both patients and providers, residency is very stressful. We urgently need to examine the greater context which young doctors are navigating and the effects chronic stress have on all aspects of physician health.
If you are having difficulty with these events, or if you are overwhelmed or have thoughts of self-harm or suicide, it is critically important to talk about it. You are not alone. We are here to provide support. Depending on your hospital, you may qualify for mental health benefits and services for you and your family. Please visit your hospital page. If you’re unsure about what resources are available to you, contact the firstname.lastname@example.org.
In popular culture, resident physicians are portrayed as members of an elite, superhuman minority. These brilliant, fictional young doctors save lives by finding cures to rare diseases, performing unprecedented surgical interventions, and overcoming every impediment imaginable to perform medical miracles- all in a day’s work.
In real life, we aren’t superhuman. Interns, residents, and fellows are finite human beings who work in one of the most stressful professions imaginable. Whether an MD or DO, independent of our medical school’s location; no matter where we matched, male medical doctors are two times more likely to commit suicide and female medical doctors are four times more likely to commit suicide as those in the general population. These numbers should shock us.
As scientists, we have a tendency to focus on empirical evidence which shows indicators that an individual resident physician is at risk of suicide. Concurrently, we review data on interventions and draw conclusions about best practices for prevention and treatment. CIR’s own nationwide survey of over 700 residents showed that:
- 10% of 4th year medical students and 1st year residents report having suicidal thoughts
- 28% of residents have fallen asleep at the wheel post-call
- 62% of residents have felt so burned out that it has affected their work
- 40% have felt bullied on the job
“Resilience” is the new buzzword. We are constantly being told that we need to “cultivate resilience” but we already have this so-called “resilience.” Without it, we would not have made it through the extensive post-graduate career that being in medicine requires.
The majority of us feel overwhelmed, and that we could jeopardize our careers by seeking support or taking a day off. We do not wish to be labelled as someone who “can’t cut it,” or “doesn’t have what it takes.” Some take issue with the descriptive, “fear of being stigmatized,” but almost all of us consistently manifest measurable and statistically significant work-related anxiety. As individuals and a union it is our responsibility to ensure that our hospital administrations makes resident well-being a priority and not rely on the supposed “resilience” of physicians to get us through any and everything.
When a healing profession becomes emotionally demoralizing, on top of being mentally and physically draining, it’s time to address the those issues. That time was years ago, but there was an enormous amount of denial on the part of those in a position of authority, accrediting bodies included, in past years. We need a systematic transformation now.
Last year, the ACGME published a report on duty hours that sparked controversial debate among healthcare providers around what’s safe for patients. As we look at the data above, it is clear that thinking of suicide and falling asleep while driving is not safe. We need to recognize that our fight for well-being is about much more than just the number of consecutive hours that we work. Like our patients, we need time off from work to rest. We need to be compensated adequately in order to meet our basic needs. We need mental healthcare and resources to help us deal with the more difficult aspects of our jobs. We need safe hospitals with adequate security. In short, we need a healthy work-life balance, a supportive work environment, and sustainable workloads.
These recommendations aren’t theoretical. Through our union, we’re able to negotiate and create systems that ensure we are treated with dignity and respect. Our position is one that we fight for at every single chapter and every hospital where we have members. Interns, residents and fellows who are not members of CIR are even less equipped to advocate for themselves and each other without fear of reprisal or stigma. We must make it okay for accountability to be enforced on all levels. If residents report duty hours violations, they need to be taken seriously. Furthermore, residents need to feel that they work in an environment where they can tell the truth about violations that take place in their hospitals, but unfortunately most residents don’t feel empowered to speak up.
In order to address systemic issues and truly transform the nature of physician training, we understand that change must be measurable and actionable. It’s why our union has committed to partnering with our hospital administrators to identify key areas in our programs that can be improved. It’s why we made the commitment last year to dedicate our time and resources to growing our well-being campaign and creating a culture of residency centered on respect and dignity in the workplace.
We still have a long way to go. Our vision is one where residency is an experience that creates great physicians. It is one where resident physicians, ancillary staff and hospital administrators work together to address institutional and cultural challenges that come between patient care and resident physician well-being. We know what that looks like – decent hours, decent pay, adequate time at the bedside, protected time to advance our knowledge to be able to provide the most up to date care for our patients and time off from work so that we can give our best selves to patients.
It’s daunting to address the power structures that prevent change while still succeeding in residency. But we must address it together. Our patients hold residents and other healthcare providers accountable for their care and wellness. But we, too, need to hold our institutions accountable for the treatment of their employees and the systems that allow medical training to continue to be such a toxic negative environment.
We chose and continue to choose to form a strong union with CIR precisely so we could focus on resident well-being and make an impact.
Chronic stress is linked to the six leading causes of death. Suicide is one of them, and it’s responsible for over 400 physician deaths every year.
Four hundred men and women. Each one with a name. Each one leaving family, friends, colleagues, and patients behind. Each an incalculable loss. Each a reason to treat all those around us and ourselves with respect and integrity.
Eve Kellner, DO