By the end of her first year of residency, Dr Elisabeth Poorman knew she was in trouble. She was overwhelmed by the 15-hour days, the sadness of the tragedies she witnessed, her feelings of impotence and fears of making a mistake. As she writes in this article for WBUR, her life was her work and everything else seemed to be falling apart: her physical health, relationships, ability to sleep after months of night shifts.
She thought she was alone. But she wasn’t.
After interviewing residents at Boston teaching hospitals and reviewing research, she is starting to understand the scale of mental health disorders in residency and why the problem is getting worse.
Residency’s long hours, trauma, sleeplessness and social isolation erode our healthy coping mechanisms. At the same time, there is a powerful culture of fear, stigma and lack of self-care that prevents residents from seeking help. The resources that are in place in residency programs are simply not adequate.
Depression, anxiety and other mental health disorders are incredibly common in residency. In a review article, Dr. Douglas Mata, an intern at Brigham and Women’s Hospital, and his colleagues concluded that the prevalence of depression was around 29 percent.
During the first year of residency — commonly referred to as “intern year” — depression rates increase by about 15 to 30 percent, the biggest jump in medical training. After that first year, depression rates decrease, but they never return to the level they were before training started.
Intern year is marked by a paradoxical marriage of responsibility and lack of power. At the end of her intern year, a psychiatrist she with in the clinic said she had noticed that I seemed to be struggling. She was referred to a counselor.
After about a month, I began to feel like she was going to recover. In the summer after her intern year, she was visiting a friend in New York. On the way back to her dorm building we heard someone had jumped from the roof, one of the two interns who would take their lives that week. Shortly afterwards, our program had a meeting about those suicides. The directors told the residents that there were plenty of resources in place. It was easy to get help, they said. But it’s not easy.
The system has been far too slow to respond to this crisis. For those who are still struggling, please know, you are not alone.