10 Ways to Prevent Residency Burnout

1. Make the decision to stand up for your mental health

   Boundaries. It’s a big word that can be hard to both define and enforce when you feel like your entire career depends on gaining your attending’s approval. So in the precious weeks leading up to your intern year, or maybe the one mandatory 24 hour off period you have while in your third residency year, take the time to decide what standing up for your mental health looks like. It can be personal, like exercise in any form at least 15 – 30 minutes a day, or putting your phone on do not disturb while not at work. It can also apply to how you choose to approach work. For example, I have to finish all of my notes before I leave the hospital, or have to finish my clinic notes that night. It provides me with a peace of mind, helping me focus on non-work things when I am not at work. You have to figure out your priorities and set ways to ensure you can meet your mental health needs. 

2. Find all of your resources and use them

   ACGME acknowledges the struggles of residents, and mandates the programs at least try to help us educate ourselves about burnout. They also mandate programs giving us time to go to medical, mental health, and dental appointments. Now, this may look different in every program, but to break these mandates puts a program at a huge risk of losing their accreditation. It is in everyone’s best interest to keep residents healthy! Many programs even offer free counseling, either online or in person. Ask what is available!
   
   I have also taken a deep dive into searching for free resources via my company websites and health insurance websites. Click around, find what deals they have! You never know. I was lucky enough to find programs that give significant discounts for gym memberships. You’d be surprised what you can find.
   
   Not a talker? The AMA commonly pairs with apps like Headspace and Calm to bring significant discounts to meditation apps. ID me also is a great resource to sign up for discounts!
   
   Keep asking around, and you’ll find more resources than you’d expect.
   

3. TAKE YOUR DAYS OFF

   Seems like I shouldn’t have to say this, but those days off are essential. You get a limited amount of PTO. Use every bit of it. We have learned from the “burn the candle at both ends” generation, and know that without balance, things fall apart. There is a reason ACGME mandates days off. Even if you spend the entire day sleeping or doing laundry, take the rare moments of peace. Those breaks are what keep us sane. I don’t care if you CAN work 14 to 28 days in a row…that is not good for anyone. And since we are mandated to take the time, we might as well actually use it.
   

4. Move every day, even if it’s walking around the hospital

   I don’t care if it’s walking to lunch with your best friend, riding that spin bike you got off of Craigslist, or dancing in the middle of the office to Taylor Swift all by yourself. MOVE YOUR BODY. I could lecture about the benefits of dopamine and exercise, but since I am writing to a bunch of doctors, I suspect you know all of this. Instead, I offer this piece of advice: exercise comes in so many different forms. Find something you love! And it can change, just like our tastes change in a lifetime, but explore what makes you the happiest. If you are a video person, Youtube offers tons of free video workouts. I started with the wonderful Casey at Blogilates who offers free videos every month! Peloton offers a healthcare discount to their app. Your hospitals may even have their own programs you can utilize. I don’t care how you move, just that you move!
   

5. Find what gives you joy, and incorporate it into your life

   In talking with some of my non-medical friends, they commented on how it felt like my life was consumed with work…and it can be. When we are working 80 hours a week, and are emotionally drained, finding those moments of joy can seem impossible. In small ways, you can start adding joy back into your days. I personally love taking long bubble baths and reading my fantasy books! Or listening to music while finishing up notes. Many of my coresidents have their own versions of bright spots in their days, and we all learn to respect those moments. I would also be amiss if I didn’t mention hugs. I know some people are huggers, others aren’t, but creating friends you can hug on a bad day, or the ones you can send endless TikToks to, those little moments add so much to your life. Be intentional with creating joy.
   

6. Create a routine, no matter how simple, and make it your non-negotiable

   There is an odd science to routine. It can create peace in a chaotic world. I know residents who have to go get their morning bacon from the cafeteria before starting on chart review. Others journal every day. I personally drink my morning pre workout, answer a few study questions, and just take a moment to breathe before the pagers, texts, and phone calls begin. My days change with each rotation, but the morning routine stays roughly the same. Keep is simple. And keep the things you enjoy doing. Sometimes you have to throw in the “good for you” tasks too.
   
   One thing that has been proven to help is journaling. It creates both an outlet and guidance for your brain. It’s hard to find the right journal sometimes. And even harder to have one that reminds you of your journey. While initially meant for premeds, Motivate MD created a beautiful planner that can be used as a daily guidance for anyone and everyone. While residency may dictate more of your daily tasks, keeping your personal tasks and why can help make sure you don’t lose sight of yourself in the chaos of residency.
   

7. Work on inner reflection and understanding how you handle stress

   Tying into the themes above, learning how you handle these new life stressors will help you create coping mechanisms to work through them. As an EMT and Paramedic, I thought those jobs were stressful, and I could handle anything after that…turns out no matter previous life experience, residency is its own challenge. One of my favorite books for self reflection is called The Emergency Mind by Dan Dworkis, MD, PhD. One of his chapters goes over just this: how to start thinking about how you handle stress. It is important that we not only acknowledge the unique stressors we face as residents, but that we learn and evolve our coping mechanisms. Just like our medical education is never done, neither is our exploration of the self.
   

8. Find your safe space, and use it without guilt

   Be it a hidden bathroom, a work friend’s office, your own home, or even your car, finding a safe space to cry, yell, vent, breathe is so important. One of my favorite things to point out to new interns and medical students are the “poop” bathrooms…which also happen to be amazing places to cry. Our work is stressful, and I think sometimes the toxic “don’t show emotions” mentality is over emphasized. Residency is so odd because you can feel completely surrounded but all alone at the exact same time. Never apologize for taking time when you need it. The amount of times I have walked into my friend’s office, shut the door, and just let it out…those moments allow us to be human in an environment filled with death and pain.
   
   Having trouble finding those spots at work? Or looking for someone you can trust that is not connected to your residency program? Social workers have been a godsend for me. These men and women went into the field to help, and understand the messed up nature of medicine. They will cry with you, give you a donut, or just let you sit quietly in the corner to breathe. I remember clearly the day I was on the verge of tears, and burst into my social workers’ office. They could see how upset I was, offered me a donut, let me sit in the comfy chair, and just exist in an environment away from the frustration. Find your safe spot and your safe people. They will save you time and time again.

9. Leave work at work, and find a way to accept the things you cannot control

   We all know the “leave work at work” phrase, but how do you truly implement it? My go to technique is to create a deliberate pause after work. It can be in your car, at your front door, maybe even as you change out of your work clothes. But in this pause, take three deep breaths. You can say a mantra to yourself, or simply listen to the quiet. In that moment create separation. Understand that the day is done, you have done all you can, and tomorrow is another day. There will be days that will almost destroy you, and when your head hits the pillow, you have to find a way to let it go. Intentionally. This is a practice that should happen every day of your life. We have to learn to let go.
   

10. Know you are not alone, and you have survived every horrendous day. You can make it through this one. Give just one more day

    Suicide rates rose severely during COVID, and while the ACGME is emphasizing mental health, there is nothing that can truly prepare us for the horror of medicine. There are days you may not know if you can continue. There are days that no light seems to get into the black hole in your mind. Please call or text 988 Lifeline if you or someone you know is having these thoughts. Just know, you are not facing those days alone. You are not the only one who feels stupid, beat down, burnt out from residency. Know that your co-residents care. Your friends and family care.
    
    

All these things I wish I could tell my best friend who took his own life in 2019. He was an amazing human, and would have made an amazing doctor. We cannot stop saying the names of those taken too soon from us. We cannot stop fighting for a better tomorrow. I know you will get so tired you can’t function. I know that feeling all too well. Just give it one more day. Just take life day by day. You are so much stronger than all of the stress that comes with medicine. Be here tomorrow.

“We can all help prevent suicide. The 988 Lifeline provides 24/7, free and confidential support for people in distress, prevention and crisis resources for you or your loved ones, and best practices for professionals in the United States.” – 988 Suicide & Crisis Lifeline