The Greatest Challenge Facing GME
Symposium on Medical Education — February 2016
Tex Med. 2016;112(2):23-24.
By Mani Akhtari, MD
The day I finished medical school was one of the proudest moments of my life, and I'm sure most physicians feel the same way. I could not wait to start the next stage of my medical career: residency. I was anxious but at the same time excited to have more responsibilities, more opportunities for learning, and more control over the care of people I could now truly call my patients.
When I started internship the next week, it felt exactly like drinking from the proverbial fire hose. It was a difficult challenge to juggle learning real medicine and handling the administrative side of patient care. The hours were long, but I was happy to be learning something new every day. But eight months into my training I started to want more. I felt that I was not given enough autonomy. Of all the admissions and discharges, I did not feel that any of them were truly "my patients." After all, I had gone to medical school to practice medicine. I was unsure how many more discharge summaries I had in me. Looking back, that was the first time I experienced resident burnout.
Last summer, two residents committed suicide in New York City within one week of each other. One student had just completed residency, and another had just begun his. Their deaths highlight the degree of mental health burden affecting all levels of our graduate medical trainees. In fact, resident burnout has become such a pervasive problem the Resident and Fellow Section of the American Medical Association is conducting a nationwide survey to try to pinpoint the exact reasons behind it. On a similar note, a recent study in the Journal of Graduate Medical Education published the results of a study conducted among the residents at the University of Calgary. Overall, poor mental health among residents correlated to multiple training environment problems, such as uncomfortable sleeping rooms and insufficient time to eat.
Other traits might in some sense be unique to our American education system and contribute to resident burnout. American medical schools are some of the most expensive in the world. Even more concerning is the fact that during the past two decades the average U.S. medical graduate's debt has risen by more than 300 percent to $170,000, according to the Association of American Medical Colleges' 2015 Medical School Graduation Questionnaire. Considering that the mean resident salary after adjustment for inflation has essentially remained the same for the past 40 years, one begins to appreciate the financial difficulties residents face in modern times. Additionally, the average age of entering medical students continues to rise, meaning more students are entering their training with greater financial obligations to meet.
No single universal factor leads to resident burnout. Each specialty's training and every resident's path come with unique challenges. There is now consensus among all involved parties that resident burnout is a real issue facing our current generation of trainees. Factors such as continued loss of residents' autonomy, the imbalance between "scut work" and real medicine, difficult training environments, and the financial strains of a lengthy medical education contribute to resident burnout.
A Medscape article titled "Physician Burnout: It Just Keeps Getting Worse" reports that 46 percent of all physicians who responded to a national survey published in the Archives of Internal Medicine in 2012 have experienced burnout. This is no longer a resident-specific issue. Nevertheless, current residents are our future practicing physicians, and our field depends on them. Stopping resident burnout will not be easy and will take a collective effort by our entire medical system. The first step is acknowledging this as a real issue and one we need to address as a community.
Mani Akhtari, MD, is a radiation oncology resident at The University of Texas Medical Branch in Galveston.
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