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Random Post-Residency Thoughts

I was an attending when I woke up July 1st. There was absolutely nothing different with me as a person compared to when I went to bed the night before, as a PGY-3.

An arbitrary date in the calendar year marked a seven year (four years of medical school, three years of residency) career transition, yet the fatigue and emotional burnout lingered.

A few hikes, bike rides, and river floats later —with the luxury of having no set daily schedule— I've revisited old hobbies, connected with old friends (on the phone!), and slowly emerged from the hardened exoskeleton that I developed as a resident.

Enjoying post-residency Montana life on Trapper Peak.

Enjoying post-residency Montana life on Trapper Peak.

As a first generation immigrant from the Philippines, I fully acknowledge that becoming a Board Certified doctor in the United States is the American Dream and I am privileged to be where I am today.

I even view myself as one of the luckier residents in that I completed a Clinic First, three-year residency program. Whereas, I have classmates from medical school in more rigorous, inpatient-heavy training programs with 3+ years to go.

A few (random) thoughts I've pondered:

How do young, new doctors challenge the current health landscape without getting sucked in?

"If you can't beat 'em, join 'em."

"Work smarter, not harder."

I've sometimes thought about these two phrases interchangeably when it comes to our health care delivery system. How can you encourage change within the current fee-for-service reimbursement model (toward a value-based payment system) without adopting the same adverse patterns and behaviors?

From an organizational perspective, I've always thought that change happens best from within, rather than from the outside.

As an example, I believe that the administration at a a small, rural hospital is more adept at implementing a hospital-wide policy within their institution rather than a larger, umbrella organization that is trying to enact the same policy from headquarters.

Smaller organizations confer the benefit of better understanding the nuances of their daily operations (in theory, smaller = less complexity). The hospital administrators at the rural hospitals may also carry more influence than an unfamiliar face from Corporate.

Where do I impart my influence as a medical provider?

As I enter the medical field, I question how much (and where) to impart change, without losing sight of the reasons I chose Family Medicine. It's easy to forget about the patient when EMRs and archaic workflows act as barriers —rather than solutions— to seeing patients. Enough barriers and challenges = burnout.

How much can you push the medical system to change toward a better (perhaps a more efficienct and affordable) health care delivery model from within without compromising your own value and belief systems?

Is it easier to challenge the medical system as an active participant in the medical system (i.e. through leadership positions, advisory board involvement, etc.) or as an outsider through direct primary care models or non-clinical endeavors?

The current COVID-19 pandemic has not only created new problems for our health care system, but more importantly, it has exposed the deficits and shortcomings of our existing delivery model.

Have the (limited) changes we've seen in our national COVID-19 containment plan been influenced by the elected officials and policy makers in Washington, D.C. or has change come from public outcry, hospital organizations, insurance providers, billionaires, and non-profit organizations?

Where is the balance between striving for clinical competence and excellence vs. minimizing burnout?

"What doesn't kill you makes you stronger."

This saying has always resonated with me, especially as someone who likes to mountain bike more for the grueling climb rather than the exhilarating descent (the latter part is fun, too, I will admit).

Full disclosure: I struggled with burnout during residency.

One may argue that the sleepless OB nights, late ER traumas, and early morning continuity deliveries make a resident more capable to handle cases independently as an attending physician. However, the alarming statistic is that medical training actually does kill people. Not just medical training, but the medical profession, with about 300 physicians dying of suicide each year. Of note, the Accreditation Council for Graduate Medical Education (ACGME) has taken steps to address resident burnout during training, yet mental health continues to be a pervasive issue in the medical field.

I know that it was easier for me to follow an entire hospital team census after I followed more patients on my own. It was physically and emotionally challenging at first, but it got easier. On the other hand, fatigue can negatively impact learning and retention. Even worse, it can lead to medical errors and compassion fatigue.

Where is the balance?

How do I support my friends who are still in training?

When you live and breathe medicine for three years, your colleagues become close friends.

I'm free from the shackles of medical education, however my junior resident colleagues are still fighting the good fight (for another few years).

Aside from providing emotional support, I feel constrained by the reality that I can't offer more reassurances than "it gets better after graduation."

However, I remember that as a resident, "it gets better" didn't seem tangible nor attainable (although there is truth to the statement; I'm living proof).

Leave your thoughts in the comments.

If you feel like someone you know can relate to any of this, please share!