How to Take Care of Yourself as a Medical Resident

If you’ve recently Matched into a medical residency program as a foreign medical graduate (FMG) or are just beginning the Match process, then you have been warned about burnout syndrome. This warning came not because of your status as an FMG but rather the overwhelming amount of residents and medical doctors who leave the profession because of burnout.

Burnout is described as mental fatigue caused by constant stressors. Stressors during the first year of residency may come from adjusting to a new location, missing family, large workloads and learning/studying demands. Additionally, physicians are expected to exercise empathy with patients in order to provide better quality care. This caring for others is essential but does take a toll on the physician’s self-care.

The results of burnout do not affect the resident only. While new physicians may experience depression, anxiety, disturbed sleep and co-existing effects of burnout, patients also suffer. Evaluation and treatment from a provider who is burned out will not have the same level of quality. The provider may not have the focus necessary to make a diagnosis, and they may lack the empathy to deliver care in a way that fits the situation. In more extreme cases, the resident will leave the career path. All of that hard work for nothing.

As a new medical resident, you might think that burnout is not in your future. Especially after getting Matched, you’re likely pumped up and ready to get in there and practice medicine. This is normal, and you should be proud and excited, but don’t forget that you need to care for yourself during this time. Preparation and studying is essential to a successful residency. Also essential is self-care. A little focus on yourself will make your hard work less of a stressor, and you will reap many rewards in the form of motivation and mental health.

Ten Ways to Take Care of Yourself as a Medical Resident

  1. Have a hobby:

Your hobby should not be your career. Since you’ve made it this far, you are likely very passionate about medicine. However, this isn’t what your colleagues are going to want to talk about at dinner parties (at least not the entire time). Not having anything else can remove your sense of self, and it can make you feel beholden to your career at an unhealthy level. You are not a physician only. You are a person who happens to be a physician. Right now that might be hard to believe, but if you have a hobby, you’ll get some of that back. Part of the reason burnout happens is because physicians get absorbed by their careers leaving very little left of the actual person.

  1. Live with people:

Another reason for burnout is that much of medicine is emotionally charged. You will deal with death and grief, pain and suffering. It takes its toll, and you need to talk about it. Living alone is a perfect way to sink into solitude and depression, but having a couple roommates will save you. They will not only notice your slippage into the doldrums, but they are there to lend their shoulders or simply their ears. Especially if you’ve moved away, having these types of connections can be very good for emotional health. If you are a private person, make sure you have your own private areas.

  1. Exercise:

As a physician, you know about the health effects of exercise. Don’t forget about the mental health benefits. If you can do it outside, even better.

  1. Journal:

Much like communicating with others, expressing yourself on paper is an excellent stress reliever. This is particularly important when you can’t really talk about certain situations aloud.

  1. Start a project:

Much like a hobby, a project is a distraction from your career and a reminder that you are more than your position in the medical field. Any project, even doing your backed up laundry, can have a meditative effect. At the end, you get a normal, everyday sense of accomplishment without the stressful grandeur that medical accomplishment can sometimes create.

  1. Eat and drink healthily:

Avoid caffeine, alcohol, and fast food. If you eat healthy, your mind will thank you. You’ll be less likely to suffer volatile emotions, and you’ll be able to persevere during those long nights and trying circumstances.

  1. Sleep:

Yes, you can sleep as a resident. And you should…any time you get. Long hours happen, but ensuring that you get enough sleep is important for your physical and mental health.

  1. Engage in leisure:

Leisurely activities are closely connected to well being. This isn’t to dissuade a person from hard work and studying habits, but even the grueling expected work of being a resident needs to be coupled with some leisurely activities.

  1. Meditate:

If you haven’t practiced meditation, it is a great way to center yourself and awaken your mind to the positive aspects of life. Finishing an effective episode of meditation is like taking a huge breath of fresh air. It is cleansing and invigorating.

  1. Laugh:

In the midst of everything, don’t forget to laugh. It truly is the best medicine for physician burnout. Get together with friends, watch funny movies, and tell jokes! Life is too short to live without laughter.

Residency is not easy, and you won’t have time to fit all of these activities in between the necessary demands of your career. But try to do some of them, and don’t forget to take care of yourself during this incredible and rewarding journey.

Residency Match Program Types

When you are considering residency programs, one of the things to consider is the type of program in which you will be seeking. This includes evaluating how you will personally fit into a program, if you got along well with current residents in the program and whether or not you can see yourself their long-term. It is less about how programs rank and the reputation of the program. If it doesn’t feel right during your interview and other interactions with people in the program, then it shouldn’t appear on your rank order list.

Beginning the Match process can seem overwhelming, especially after recently finishing the USMLE-2 exam. It seems like life is one whirlwind after another, and for the foreign medical graduate (FMG), there can be added stress in communication and logistics. With this may also come difficulty over Visa processing or difficulty getting ECFMG certification. It is not easy to maneuver life throughout your transition to PGY-1 (Post-graduate year 1), and one thing that can help is understanding how residency programs are set up. If nothing else, it clarifies a bit of the “mud” when you are trying to navigate the NRMP process.

One thing you may not completely understand is the program types offered through the Match. There are 5 program types available, and they each specifically coded for your rank order list.

How are programs coded?

Each program has a 9-character code that is recognized by the rank order list computer algorithm when you create your list. The first four characters are the institution code. The next five to seven characters are the ACGME specialty code, and then comes the program type or letter. Last is the track number, which is typically zero unless there is more than one track in the program. If there are more tracks, they are listed sequentially.

For example, anesthesiology programs at George Washington University – DC have the codes 1802040A0, 180204C0 and 1802040R0. Emergency medicine programs at the same university have the codes 1802110C0 and 1802110C1. The first four characters remain the same for the university. 1802 is the code for George Washington University – DC. The number 040 is the code for anesthesiology, while the number 110 is the code for emergency medicine. Anesthesiology offers three program types, advanced (A), categorical (C) and physician reserved (R).  Emergency medicine only offers categorical (C). The anesthesiology programs only offer one track, while emergency medicine offers two tracks. The second track is an international track.

You may not think it is important to understand how the programs are coded, but understanding the codes can help you to avoid errors when choosing programs for your rank order list. It also helps to understand that there are different categories of programs for planning purposes. For example preliminary and advanced programs are meant to be ranked together but separately, as the advanced program will be on your primary rank order list, while the preliminary will be on your supplementary rank order list.

What are the categories?

There are five categories of programs, and they tell you what post-graduate year they will start in along with the level of training offered.

  1. Categorical (C).

    If the program code has a C as its second to last character, it is categorical. This means it starts in PGY-1 (year one following medical school), and it offers full residency training. At the end of the program, a resident should be prepared for specialty board certification. Common categorical specialties are internal medicine, family medicine and neurological surgery. The length of categorical programs is 3 to 5 years.

  2. Primary (M).

    Primary programs are very similar to categorical programs in that they begin in PGY-1 and prepare the resident for boards. What makes M programs different is that they focus on primary care in that specialty. For example, they may focus on primary care in internal medicine or pediatrics. These programs may only take 3 years.

  3. Preliminary (P).

    Preliminary programs are to be coupled with Advanced programs (A). Common examples of preliminary programs are internal medicine and surgery. In P programs, the skill set learned is broader and covers a variety of disciplines in preparation for Advanced programs. They may take 1 or 2 years and begin in PGY-1.

  4. Advanced (A).

    Advanced programs follow preliminary and complete the full course of training began during preliminary training. Examples of Advanced programs are anesthesiology or dermatology.

  5. Physician Reserved (R).

    Physician reserved programs are advanced programs for physicians with graduate medical education. There are not many positions available in these programs, and they are for physicians that already have prerequisite resident training. These programs begin in PGY-1.

If you are beginning your journey to the Match, you may feel like it is a little premature to start figuring out the details of programs and how they are handled by NRMP to make sure your Match meets your needs and the needs of the program. However, there is a wealth of information and small details that can confuse the process if you aren’t adequately prepared. Casually studying these details will reduce the stress of the Match once it comes time for interviews and ranking.