Online Therapy for Physician Burnout: Toxic Culture of Residency

I recently gave a talk to a group of residents. Many of the issues that we talked about resonated with the group. The issue that resonated most with the residents is how medicine is a toxic culture.

Toxic Culture of Residency can Lead to Burnout

Work is Long and Intense

First, the workload is long and intense. Who has 80 hours of work per week? Interns and residents do. 40 hours of work a week seems like a breeze to all the physicians that I’ve talked to. Who has time to do anything else besides be a resident? Who has time to recharge and do yoga for an hour? Residents are always tired and rarely have the opportunity to recharge. The only time to recharge is their Golden Weekend. I’ve known many who sleep as much as they can during that time. Some would say with the amount of work interns and residents do, it’s abuse. I can say for sure all work and no play makes for sad people.

The Hierarchical Structure

There is a hierarchical structure in medicine. As an intern, you’re at the bottom of the rung. You have to do all the work. As a junior and senior, you are starting to get your legs under you so the type of work changes, not necessarily the amount. You make sure the intern is doing things right. Then there is the almighty attending. The attending is the king. You will always be deferring to the attending. Now, this doesn’t even take into account your attending’s temperament or personality. If you have an excellent teacher who has a great understanding of teaching, wonderful. If you are like the many residents, you’ll have a less-than-stellar teaching attending and you may be pimped or put in my place. Being roasted in front of your colleagues is demoralizing. It creates a hostile and toxic atmosphere. It contributes to stress and anxiety. There are better ways to teach. 

Constant Pressure

The constant pressure to perform can create a toxic culture. Just like medicine, pressure in the right doses can be helpful. Pressure can help residents perform at a high level both academically and clinically. Too much pressure can contribute to anxiety, imposter syndrome, and fears of making mistakes. Many residents feel as though they are always on. They feel as though they have to be as close to perfection as possible. Many believe that any mistake made can end their career. That constant pressure to perform can be stressful. 

Lack of Support

Many residents feel they have a lack of support. They may feel isolated. Many of the residents that I’ve met have moved across the country to attend programs in new and uncharted areas. Not only do they have a lack of social support from their friends and family, but many feel they have limited access to resources for mental health support or supervision. When I talked with physicians, many felt that the support programs in their residency program fell short. They felt the program provided these ‘support programs’ to just check the ACGME requirement box. In addition, many residents do not feel comfortable sharing their in-depth experiences or being their authentic selves due to “attendings” or program managers watching. It doesn’t feel like a safe place to get support. A resident I spoke with said they only talked about surface-level issues and weren’t able to get the real help they needed.

Feeling Taken Advantage Of

The last issue some residents spoke on is the feeling as though they are being workhorses and the residency program is making money off of them. Yes, residents get paid. Being paid is a loose term because if you break it down by the hour, it’s not much. Residents also get trained while providing medical care to patients. This is where some residents get rubbed the wrong way. Many residency programs are providing services that could be filled by physicians, NPs, and PAs. What’s the cost of services residents provide versus what they are receiving? What are the salary, benefits, and teaching costs of residents vs CMS payment for teaching, billed services, as well as the salary for replacing the residents with physicians, NPs, and PAs? All this while having residents work 80 hours a week. Understandably, many residents feel this way.

Does it End?

When residents graduate, many feel like they’ve finally made it. Sure, they’ve made it through their residency, fellowship, and training. Congratulations. It’s a huge accomplishment. Though many of the issues may stop when a person finishes their training and leaves academia, the impact on the physician is already done and may follow physicians throughout their career. The toxic culture can lead to hating life as an attending and burnout.

Reach out for Therapy for Physician Burnout

When you’re ready to start therapy with Chris Rabanera, take the first steps with a free 15-minute consultation. I provide online therapy in California, online therapy in Michigan, online therapy in Nebraska, and online therapy in Las Vegas. As an experienced therapist, I specialize in physician burnout, grief counseling, anxiety, and depression. I also provide mental health treatment for men.