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Preventing Burnout: a Housestaff Hazard

House Staff

Residents on patient care units loved the goodies and giveaways they received in daily cart rounds during Housestaff Week at HUP.


The path to becoming a physician can seem almost like a mystery to those not working in the medical profession. Many terms, such as “intern,” “resident,” and “fellow,” or “housestaff” (which refers to all three), don’t hold much meaning to the average patient, who simply wants to know how the person fits into their large care team. But the truth is that there is a training hierarchy at most academic medical centers, meaning that even after graduating medical school, new MDs may still have many years of training in front of them – a time period known as a medical or surgical residency – which can range anywhere from three to eight years, depending on the specialty. And those first few years after medical school can be some of the most challenging, as new doctors are learning the ins and outs of their field all while striving to provide the best possible patient care. It’s a time of intense learning, but it can be stressful and potentially leave these new physicians at risk of burnout.

In any profession, burnout can leave a person feeling physically and emotionally tired, disengaged, and “lost” – but due to the long hours and often life and death matters confronted on the job, burnout is more common among health care workers. This is especially true for doctors in training, who must “figure out how to survive and thrive on the job while constantly adapting to new environments with new bosses and sets of expectations… all the while facing expectations to provide excellent care,” noted a STAT News article co-authored by Neha Vapiwala, MD, assistant dean of Student Affairs in Penn’s Perelman School of Medicine, and Jason Han, MD, a resident in Cardiothoracic Surgery at the Hospital of the University of Pennsylvania.

It’s essential to help residents get ahead of these feelings of isolation and doubt. While physician burnout was once considered a stigma, over the past decade, hospitals have been developing resident programs that address well-being and mental health issues head on, giving residents a voice in many areas, such as benefits, adequacy of supervision, and workflow issues.

“People need to see that trainees today are different. This generation is much more in tune with work/life balance and we have to adapt to that expectation… which is a good thing,” said Jeffrey Berns, MD, associate dean for Graduate Medical Education at the Perelman School of Medicine.

At Penn Medicine, which trains nearly 1,200 residents and fellows each year, the wheels of change are evident. Each residency program at Penn has its own wellness initiatives, ranging from an annual holiday party to organized events like happy hours, book clubs, or hiking trips. “I think it helps with isolation issues,” said Oana Tomescu, MD, PhD, director of the Personal Resilience Curriculum at Penn’s SOM and an associate program director for internal medicine and pediatrics residency. “Anything a program can do to talk about it will help dissipate the stigma.”

The department of Internal Medicine holds workshops for its residents, offering a “safe space to talk about struggles,” Tomescu said, adding that “faculty members are also more transparent. They acknowledge how hard residency is and tell residents that it’s ok to get help, to be a human being. It’s a conscious opening of dialogue.”

At HUP, the Housestaff Governing Council works with the office of Graduate Medical Education to better address resident concerns.

“What I think is important to residents is not necessarily accurate so their voice is important,” Berns said. For example, resident benefits cannot be a one-size-fits all. “The suite of benefits that are valuable for an intern – who may have no children and lives close to the hospital – is different from someone with five to six years of training whose situation could be very different. The Council provides valuable input.”

To both recognize housestaff and help raise awareness about their crucial role in patient care, the Council launched its first annual “Housestaff Week” last month. February marks the halfway point in a year of residency, which is traditionally a low point in morale for housestaff. The week included sessions geared specifically toward housestaff needs, including lectures on employee benefits and financial planning. Both staff and patients learned more about residents through a display of the timeline of training.

But, sometimes, little things can make the biggest impact. Such was the case for the week’s daily “cart rounds.” Program coordinators and faculty brought carts with coffee, beverages, snacks, and giveaways to the residents on the patient units. Berns took a turn, pushing the cart to the medical and cardiac intensive care units.

“They were quite surprised to see me!” he said. “But very appreciative. The Graduate Medical Education team made up stickers that said ‘We ‘heart’ housestaff.’”

“We received many in-person thank-yous during the cart visits,” said Grace Lee, MD, a General Surgery resident who is on the Housestaff Governing Council Board.

Another resident emailed, “I’m so glad you guys are doing this. There are few means to acknowledge all of the incredible residents at Penn.”

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