It was a tangent in conversation, but I felt my jaw tighten as soon as I heard it. Proposed changes, increase in work hours, for the good of the patients and of the doctors too. It was a Friday evening as I was working on a project with colleagues. As we scuttled toward a new topic, my thoughts were heavy and my hands, anxious. A friend brought up the proposed revisions concerning medical interns’ work hours the Accreditation Council for Graduate Medical Education is pushing to a vote in February. ACGME is looking to raise the number of hours that can be worked consecutively by medical interns from 16 to 24 hours, plus an extra four hours for patient handoffs.
The issue nudged me over an emotional cliff. I was worn down from inpatient hospital weeks, when my days began and ended with no sign of the sun. The hours brimmed with work I enjoyed — reading articles, working together to crack open diagnoses — but my own health had recently taken a nosedive and academic responsibilities were on the upswing. As I cocooned myself into bed, I delved into the suggested revisions. The sting of betrayal turned into a steady but indignant sadness.
Perusing through ACGME’s proposal, I read the points they emphasize in resident education, like “excellence in the safety and quality of care rendered to patients… joy in curiosity, problem-solving, intellectual rigor, and discovery.” I read that they strongly uphold a “commitment to the well-being of the residents,” at least on paper. The November 4th open letter from ACGME also touts these changes as having a “greater emphasis on systems of, and experiences in, team care, patient safety, quality of care, and physician well-being.” The physician “well-being” seems to be an oft-repeated talking point, but I wonder what they mean by well-being. To me, it means allowing for full lives, allowing doctors time and mental space to reflect on patient encounters and to have healthy relationships with those dear to them. I am skeptical that their definition of well-being approximates mine.
I cannot count how many times I have had classmates confide in me that they were tired. And not just the I-need-to-take-a-nap kind of tired, but the kind deep in one’s bones. There have been friends who have had their hair thinned and their relationships crumble from a lack of time and the high expectations to which we are held. I have crossed paths with young physicians who are hopeful, but still veering toward “burnout” (read: depression) at an accelerated rate.
I would say the great majority of us go into medical school to work hard — to learn the nuances of pathophysiology while cultivating relationships with patients, with the wider vision of becoming a fantastically educated physician by the time our four plus years are up. How much more do we have to give of ourselves to prove that we have earned our right to be where we are?
There is a mirage that doctors-in-training might believe lies in wait: pride, a so-called badge of honor. It stems from maxing out your body’s physical and mental capacities, clawing your way through rotations and exams, albeit tinged with the Schadenfreude-laced feelings for those who weren’t able to keep up. But we want to feel valued, like our work and personal lives mean something more than arriving to an imagined place with our energy sputtering and the zest for life and medicine worn thin. We want to feel that the joy and love of helping people reverberates back and that others are helping and watching out for us along the way, too.