By Katherine Nazimek

­After years of studying in medical school, young doctors are thrown into the rigorous, real-world practice of medical residency. They hold on their shoulders the new, nerve-wracking duty of saving people’s lives. They may experience long work hours, sleep deprivation, and overwhelming expectations. It is because of these pressures, that experts suspect many medical residents will also experience high levels of burnout.

In a survey conducted by the Canadian Medical Association in 2018, more than one in four physicians and residents reported high levels of burnout, and one in three screened positive for depression.

“Physician health, and especially the health of our medical residents, is a growing concern in Canada, and arguably around the world,” says Dr. Ari Zaretsky, Vice-President of Education and Chief, Department of Psychiatry at Sunnybrook Health Sciences Centre in Toronto.

According to the survey, residents were 48 per cent more likely to report burnout and 95 per cent more likely to screen positive for depression than all other physician groups.

“In a hospital, human resources are our most precious resource,” Zaretsky adds. “If we can’t look after ourselves – after our own resident learners – then what does that say about our profession?”

The rabbit hole runs deep

Dr. Shelly Dev, now a critical care physician at Sunnybrook says her second year of an internal medicine residency was the year she began to unravel.

“While determined to keep learning and growing, I started to become perpetually angry, frustrated, and anxious,” said Dev in an article she wrote for University of Toronto’s UofTMed magazine. “I discharged patients too early, and had to readmit them days later. And I’d loathe them for coming back – as if they were doing it to spite me, to prove I wasn’t smart or capable enough.”

In a recent interview, Dev admitted that being a senior resident and no longer a junior, meant expectations of being competent, fast and unflappable. “To think about how hardened I had become, was devastating,” she says. “I was treating my patients as tasks. I wasn’t connecting with them as humans. As a result, I thought I wasn’t cut out for medicine.”

Burnout is caused by more than the physical and mental exhaustion that comes with “the business of health care,” says Zaretsky. He says there is an emotional weight: life-altering and sometimes devastating medical illnesses, family challenges, and limitations on how much help one person and even an entire healthcare system can provide.

“Residents are often the first to see the systematic problems within the healthcare system,” he says. “They see people suffering and may feel powerless in making a difference.”

Ironically, left unaddressed, burnout can lead to further systematic issues, like medical errors, reduced patient satisfaction, and more physicians on disability leave, suggests Zaretsky.

Support services do exist through some universities and healthcare organizations, but many residents are not seeking help. According to the survey, 81 per cent of physicians and residents were aware of health services available to them, but only 15 per cent accessed those services in the past five years. Among the most cited reasons for not seeking help were thinking their situation was not severe enough and feeling ashamed.

 Charity begins at home

To help mitigate resident burnout, Sunnybrook conducted a survey of its own; asking residents not only about their experience of burnout and depression, but also what they’d like to see as possible interventions. Despite its personal nature, and with assured anonymity, the survey had a response rate of 56 per cent.

“Our residents told us they did not want peer support groups composed of different resident groups together,” says Zaretsky. “This is probably because those peer support groups would lack anonymity and, as residents, they are in constant fear of being assessed.”

Instead, Sunnybrook’s Department of Psychiatry is conducting a pilot project that aims to ensure residents across the hospital can get the care they need, quickly. In addition to their regularly scheduled patient clinics, a group of psychiatrists are volunteering their time to offer psychiatric care to residents in distress.

While counselling services are available to residents through their university, the geographical distance of Sunnybrook was cited as a barrier to accessing those services.

“We can speak to them, meet with them, and provide the support they need locally for as long as they are struggling emotionally – whether it’s chronic or situational,” says Zaretsky. “Our hope is that residents won’t delay getting help.”

Zaretsky adds that there is merit for peer support groups among individual departments, but residents need to feel safe.

Dev says this would require a system-wide cultural change. “There needs to be a lot more space for people as peers to talk to each other, or as seniors to talk to juniors, encouraging these conversations and telling each other our stories,” she says. “As physicians, we are going to see things that really find their way into our hearts – in positive and in sad ways. Sharing that bond and acknowledging that sometimes this job is really painful would create so much collegiality and support.”

All a mentor or leader needs to do to start the conversation, she says, is to ask: “How are you doing with everything?”

Katherine Nazimek is a Communications Advisor at Sunnybrook Health Sciences Centre.

How hospitals can support resident wellness

Dr. Heather Flett, psychiatrist at Sunnybrook Health Sciences Centre and associate director at University of Toronto’s Post-Graduate Wellness Office, offers suggestions on what hospitals can do to help support the health of their residents:

Be aware. Conduct a needs assessment to evaluate (and re-evaluate) the health of your residents. What is and is not working?

Recruit champions for wellness. Create formal roles within teams and programs to develop wellness initiatives for residency programs. These initiatives may include educational sessions about depression, substance abuse, sleep hygiene, and nutrition, for example. Champions may also plan fun activities or ones that promote exercise.

Revisit cafeteria hours. Residents are often on shift until the late evening or early morning hours. Offering healthy food options during these hours can help ensure they eat regularly.

Schedule meetings within regular work hours. Ontario regulations indicate that a trainee is to be released after they’ve worked 24 hours. Make sure duty hour regulations are followed and supported. Explore how the culture of medicine may impact a resident’s decision to stay beyond regular duty hours.

Although these are suggestions for how a hospital can help support its residents, it is equally important that each resident – and any individual – takes care of themselves and seeks help when they feel they may need it, says Flett.