Residency has been a challenging but fulfilling chapter in my life. But there have been times when I've fought cynicism and burnout. On a recent stretch of back-to-back night shifts, my typically optimistic and empathic temperament was replaced by a short fuse, and I found myself blaming my patients for their condition instead of focusing on how I could help them. My wife noted my snappiness and compared my behavior to a grumpy child. I realized I hadn't been taking care of myself. I hadn't been sleeping well, I had not worked out in a week, I was eating terribly, and I had been finishing my shifts with a few beers before going to bed. I wasn't well — and it was affecting both my work and home life. Does this sound familiar?
The topic of wellness has come to the forefront in residencies across the country. Statistics show that 7-10% of physicians are disabled by depression, suicide, alcoholism, drug abuse, or unhappy marriages.1 Emergency medicine residents have been found to have a higher prevalence of substance abuse compared to other specialties.2 This leads to burnout, which has been defined as a combination of three elements:
- Emotional exhaustion: the depletion of emotional energy by continued work-related demands.
- Depersonalization: a sense of emotional distance from one's patients or job.
- Low personal accomplishment: a decreased sense of self-worth or efficacy related to work.3
Burnout obliterates our job satisfaction and can lead to medical errors. Wellness is not only important to physician health, but also affects the care we give our patients.
Yet wellness has not traditionally been a focus in resident education. One limitation is the lack of a shared model of wellness. If you ask 10 different people what wellness means, you may get 10 different answers. The World Health Organization defines wellness as “a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity.” The National Wellness Institute describes it as “a conscious, self-directed, and evolving process of achieving full potential.” No matter your definition, it is clear that residency training presents an imminent threat to physician wellness at a time when physicians are developing work-life habits that will impact the rest of their lives. Resident wellness must be addressed.
EMRA is taking steps to help residents and residencies across the country improve wellness. To start, EMRA established a Wellness Committee tasked with identifying resources to incorporate into training. We took part in the first-ever Emergency Medicine Wellness Week™ Jan. 24-30, and we will be publishing wellness-related articles throughout the year. As EMRA works to create an online community, we invite you to share what you and your residency are doing to address wellness. This will establish a database of national best practices.
One of my attendings, Dr. Steve Smith (author of the ECG blog and one of the happiest people I know) told me his secret to wellness is to be grateful. In his words, “Expectations drive your mental state.” Take this to heart, especially when you're feeling negative. Be grateful for your family, your friends, your health, and your job.
Now is the time to confront a dangerous stigma in emergency medicine: that it is a sign of weakness to admit to experiencing rough patches. As a professional society, we must look out for one another and find meaningful ways to support our colleagues. We can change our culture, but we must first acknowledge there is a problem. Speak up! The road to wellness starts with you.
- Nelson SB. Some dynamics of medical marriages.J R Coll Gen Pract.1978;28:585–6.
- Hughes PH, Baldwin DC, Sheehan DV, Conard S, Storr CL. Resident physician substance abuse by specialty.Am J Psychiatry.1992;129:1348–54.
- Maslach C, Jackson SE, Leiter MP. 3rd ed. Palo Alto: Consulting Psychologists Press; 1996. Maslach Burnout Inventory Manual.