Disclaimer: This article is for informational purposes only and does not constitute medical, legal, or professional advice. The content reflects the author’s personal experiences and perspectives and may vary across residency programs or institutions. Consult your program leadership, institutional resources, or a qualified professional for guidance tailored to your specific situation.
They say residency is like a marathon, perhaps one with a different course every day. Often, it’s a sprint with grueling hours, emotional fatigue, and the pressure of constant engagement.
As immortalized by the famous words of the character Dr. Cox in the first episode of Scrubs: “Now, your job is to stay sane enough so that when someone does come in that you actually can help, you’re not so brain-dead that you can’t function.”
In gentler terms, to be our best selves for our patients, we first have to take care of ourselves.
The Dark Truth About Mental Health in Residency
1 | The Wellness Paradox
If health is survival, wellness is our ability to thrive. It involves getting through the day and leaving with a deep sense of fulfillment. It’s more than just the ability to relax after work; it’s a deep sense of meaning and cohesion that comes from a balanced life.
However, wellness is not easy—especially during training. Programs nationwide are unionizing to address some of the deeply entrenched cultural and systemic failures in creating reasonable workplaces.
The Bell Commission’s reforms in 2003 followed significant public concern about the working conditions in medical training, particularly highlighted by the Libby Zion case. Although she passed in 1984, it took courts nearly 20 years to enact basic protections. Before 2003, many residents worked 100-120 hours per week, took call every second or third night (36-hour shifts or more), and programs prided themselves in endurance (limited rest, lack of supervision, and exhaustion as a right of passage).
Residents across the country still feel the echoes of this machismo culture, in addition to wage stagnation and blurred boundaries due to the rise in remote work. Many residents always feel “on,” and it is no wonder that wellness may feel more like a buzzword than a possibility.
2 | Program Selection
Today’s applicants reasonably weigh lifestyle into their ranking decisions. While everyone wants quality training, gone are the days when a program’s rigor is equated with its desirability. Just as prevention is the best cure, selecting a program that balances quality of training with “the good life” is the best strategy for preventing burnout and promoting wellness.
However, even this is easier said than done. What exactly defines “lifestyle,” and how can we ensure that program marketing is truthful? There are no easy answers.
Many applicants ask programs about the same themes: vacation time, food, and the call schedule. But any factor can be spun in many different ways.
For example, which is better: The total number of days off, or the ability to take time off when preferred? Is home call preferable if it doesn’t require protected time off the following day and causes interrupted sleep and being frequently called in? Does the mere presence of a doctor’s lounge ensure free food, or is it limited to attendings and providers but not trainees?
I’d argue that these are not the best predictors of what is desirable and that the idea that life can ever be balanced is an illusion. We have one life to live, and our work is never truly compartmentalized; the integrity of a program is more critical than any fringe benefit.
Wellness modules and desk yoga alone cannot address deeper structural issues. For example, there is a massive difference in quality of life between 60 hours working with curious, hardworking, and supportive mentors and 40 hours in a toxic environment. Negative program cultures can hinder your career and personal growth.
These things are not written down and are rarely discussed honestly during the interview process. Our Insiders know the scoop and can help optimize your goals to find the best program for you on the front end.
3 | Optimizing Wellness
Making the most of any situation is a core life skill, and wellness is no exception. Every specialty, program, and career has strengths, weaknesses, pros, and cons. This is why “goodness of fit” is critical in residency selection. If you enjoy hiking outdoors and camping, attending residency in New York City may not afford you many opportunities to do so.
To help optimize wellness in any situation, it’s essential to know ourselves. What are your values? Be critically honest. Do you envision a career marked by service to the community, or do you aspire to the lucrative side of things? Do you have children or plan to during training? How important is your faith?
These deep questions are fundamental to crafting a life worth living. Therapy can be a great place to sort out these foundations while identifying ways to tie them into your residency journey.
An example of wellness that should be discussed more often is family planning. Many medical students enter residency during a stage of life that involves settling down. They may be married or engaged to become married. Many either have children or are thinking about starting a family.
Thanks to federal protections, including ACGME regulations, many programs offer some form of family leave but keep in mind that this is only sometimes the case with attending positions. While residency has traditionally been considered a difficult time to start a family, it is also a time of protected employment with contractual salary guarantees.
4 | Climbing the Hierarchy of Needs
We all studied Maslow’s hierarchy of needs for the MCAT. As a review, Maslow theorized that there is a predictable, rational prioritization of needs where psychological homeostasis is required for the ultimate goal: self-actualization.
For example, it’s hard to focus on a higher-level need if you’re distracted by lower-level needs. It’s essential to take inventory and ensure your basic needs are met. Do you have stable housing, a food plan, and a sense of safety? These considerations are, by definition, essential, and wellness will remain a distant goal if they are not met.
Unfortunately, many residents are houseless or experience existential threats during their training. Finding a safe, affordable refuge to rest and recharge during training can be one of the most essential matters to sort out for mental health.
Given the body of research demonstrating the correlation between commute and a sense of satisfaction with life, I am a fan of living as close to your training as possible. I would take a short walk to my job over a high rise with a pool any day.
Many training programs are located in urban, high-cost living areas. It’s important to assess if they offer any cost-of-living stipends or operate their own affordable housing. Financial planning is notoriously difficult as a resident, and housing costs are typically the most extensive line item in any budget.
Learn more: Do You Get Paid in Residency? How Much Do Resident Doctors Make?
While many people decide to purchase a home during residency, it’s essential to explore this deeply, as it can come with its own challenges. Many financial experts recommend renting in most situations to streamline stress and expenses. If your apartment comes with a gym, even better!
Once your biological needs are as predictable and stable as possible, we can focus on the psychological needs: belongingness, love, and esteem. This includes friendship, intimate relationships, prestige, and a sense of accomplishment. Exploring these areas is best done in therapy, where the therapeutic relationship is the primary tool for exploring how to deepen your understanding of connection in these areas.
In general, this is another reason why program selection is so important. Relationships matter whether you are considering the dating scene or finding a program matching your personality. You ultimately want to feel good about your life and work, which draws deeply upon alignment with your values and access to opportunities.
The final stage in Maslow’s hierarchy is defined as self-actualization. One criticism of his theory is the vagueness of this stage, although it can be defined as achieving one’s full potential, including creative activities.
Altruism and connection with a higher purpose are also essential at this step, and achievement depends mainly on having the other areas of life in order. This is another area where Med School Insiders strategic advising and application preparation can help take things to the next level. It’s one thing to assemble an application and another to craft a narrative for your career.
The Long Game
Despite the challenges, residency offers unique opportunities for growth, connection, and fulfillment when approached with the right mindset and support. Building a sense of wellness can feel harder during medical school and residency than at any other stage in your career. Building this foundation now is essential, as it can set the tone for the rest of your job.
Developing sustainable habits can also help avoid burnout, which leads to career longevity and accomplishing your other goals in life. The goal is to thrive rather than survive in training, and we are here to help.
If you enjoyed this article, check out Burnout in Medical Students & Residents: What to Do About It, How to Exercise with a Busy Schedule, and How Students Can Harness the Powerful Benefits of Journaling.
