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Young doctors leading under pressure
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I remember one on-all night as a first year medical intern at 4 AM. My first year teammate was exhausted and our senior resident looked worn out. After working a straight 20 hour shift with no breaks, we were beat. In my twenties, I looked fresh, and could continue to work in the Emergency Room like the Energizer Bunny. I knew I could go on all night without sleep but would also feel my speech would be somewhat off the next day. This was more of a subjective observation as others told me I looked just fine. My head would feel heavy and full, I felt my speech was not as clear as usual, and I’d still work the whole next day. This schedule went on for months. There is a caveat, though. My fellow intern and I had a brilliant idea which we put into effect the first few weeks: she had a hard time staying awake after midnight and, instead, I felt better if I went on through the night and then got a few hours of sleep before the next workday. She would go to bed at midnight and I would take care of all hospital needs until 4 AM. We would then switch places, she would take care of all consults and I would try to get some sleep from 4 AM to 8 AM. The deal was in place as long as the other one didn’t feel overwhelmed with all the admissions and consults. We never called the other one for back-up; we took the hectic schedule as those hours made a great difference in our performance the following day. We usually worked weekends and had a full free weekend every few months. My colleague and I had families and young children.
This was almost two decades ago. At the time, residents stayed awake and worked all night long for months and even years. Doctors took pride of their ability – whether because of a genetic-based capability or an ability to adapt to an environmental demand. The idea was: if you wanted to be a doctor, you first needed to live up to the challenge.
While practicing physicians understand that reducing errors and improving working conditions are of essence, many of us have also observed some new attitudes. Not that there weren’t ever senior residents taking advantage of the younger ones. And yet, some of the younger physicians will now say their time is up and they may be more reluctant to seeing any more patients although there may be a need. Other doctors would present a smoother transition before their shift is up. Many experienced physicians miss the old days with a bitter-sweet taste. Many believe they chose the challenges of being available to serve in extreme circumstances. Medicine has been a profession of service although the current practicing scenario has converted into more of a commodity.
Here are some suggestions:
- Use Six Sigma principles to improve the provision of care by residents in training: Most hospitals save millions of dollars by overworking their medical residents. Although it may seem this system is efficient, it is cheap and does not offer quality of service. Six-sigma enhances both efficiency as well as the promotion of improvement. A system that has players who are burnt-out is inefficient. Even the best of residents can’t serve three patients with emergency care needs at the same time.
- Ensure that seasoned physicians are available for consult on site: residency programs usually have teaching physicians available on call via telephone. The truth is, the physician will “trust” the resident’s eyes, ears and findings instead of having direct contact with the patient. This will be hospital dollars paying for physician’s call services rather than teaching physicians being on call for free.
- Rather than having a junior doctor working for twenty or thirty hours without getting a break: have doctors take more frequent breaks, i.e.: every four to six hours. Even a 15 minute power nap may be of help. More so, having a 30 minute repetitive daily exercise in their busy schedules may make a great difference for residents to endure long and stressful hours.
- Of course, residency programs can be designed like a full-time job with shifts: Instead of 30+ hour shifts, 12 hour shifts can be created instead.
- If these young doctors are burning out when they haven’t even started practicing medicine, what will happen next? There is a well-anticipated shortage of physicians expected in the coming years. Add the younger generation’s expectations to live a better life with less work and many young women doctors already planning a part-time practice.
For more info: Dr. Gaby Cora is a Wellness Doctor and Coach. She's the author of Leading Under Pressure: Maximize Your Health While Building Your Wealth.
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