January in the hospital is difficult for most. The days are short, the weather is cold, and resources are stretched thin as the hospital fills to capacity. The hope of feeling the sun on your skin for just a moment as you walk to the parking lot has dissipated as most days you arrive before the sun has risen and leave after it sets. And yet every physician has made it through this difficult month, and all 12 months, of every year of residency. What keeps us going? For the vast majority of us what we do brings us a sense of fulfillment. But for some, is it instead a fear of change?
By December of my intern year I knew I had made a mistake in my specialty decision. The novelty of intern year had worn off and my co-residents and I were settling into our newly defined lives as residents. They were flourishing while I was having a daily internal dialogue of pushing through for my patients and my co-residents. Residency is an odd microcosm. You are inundated with talks of physician wellness, pet therapies, and free candy while simultaneously surrounded by sleep deprived, over worked colleagues trying to keep their heads above water in a sea of microtraumas. When you first start talking to colleagues and mentors about unhappiness in residency you are pushed toward all of the Wellness Wednesday activities. In their own right, it is fantastic that programs offer these services and that physician burnout has become a well-recognized and important topic. However, one wonders if activities like these are avoiding the discussion that maybe a change is the right option.
As I began to realize I was in the wrong field, I was stunned by how inconceivable the idea of changing was to my mentors and colleagues. I was told by many that leaving was an irreparable mistake, instructed to just push through this year and things would get better. Moving from one year to the next in residency the hours improve, the responsibilities become more tangible, and you inch ever closer to the Mecca of attending life and while those can help, happiness will never be achieved if you do not enjoy what you are doing.
While this is a story of a resident changing fields, the larger picture of physician burnout applies to many. Our solutions to burnout approach the issue as a problem that needs to be fixed, one that will eventually resolve. When one still has moments in each day that remind us of why we do what we do, I feel this may be successful. But at some point, there exists a distinction in which we no longer face burnout but rather exhaustion. We have lost joy in what once drove us into the field. You begin to realize that even the momentary satisfaction of patient interactions is not there. These are the points at which we need change.
Medicine is a peculiar field. In the rest of the workforce people are thought to change careers anywhere from 3 to 10 times. While this number is a topic of debate, there seems to be some consensus that it is greater than the one career change physicians have from residency to attending. And yet we expect different for ourselves. We seem to an arcane idealism that our young selves will be able to choose a field based on weeks to months of exposure in medical school and that field will somehow bring us satisfaction through retirement. Is it so inconceivable to think our views might change? Or that we might not have gotten it right in the first place?
The institutional barriers to changing fields abound: requirements for residency training and board certifications, ACGME (Accreditation Council for Graduate Medical Education) requirements to reenter the Match, financial concerns under oppressive student debt and much more. However, I think the larger barrier is our own biased perceptions of change. We fundamentally view medicine as different from all other fields. While other individuals have careers, we have a calling. We idealize the young medical school graduate who passes smoothly residency excelling with ease as she gains knowledge and finesse of the art of medicine before landing her first attending position from which she continues to advance and provide passionate care up through retirement. But life doesn’t always function in that ideal world. It is full of bumps and turns and halts, reverses and restarts. Why do we expect our field of medicine to be immune to that? Pursuing another specialty or another career shouldn’t be viewed as ghastly or a devastating career decision. It should be explored with more ease and acceptance.
For residents, this means increased acceptance of residency programs to hire applicants with prior training and increased flexibility for programs to extend their number of residents to accept an applicant part way through the program rather than reentering from the start. For physicians, it means increased flexibility for part time work, the option to pursue an idea or innovation, the ability to change careers entirely with less push back, and the flexibility to return if it doesn’t work out. Our field has become increasingly innovative and dynamic. Flexibility in career paths should be no exception. Sometimes change is the answer and we should have the option and support to pursue it.