There are numerous challenges during residency, especially as an early trainee, that can contribute to physician burnout. In my experience, as a PM&R PGY2, switching from a medicine-focused approach in patient care to a rehabilitation-focused approach was a challenge, especially with limited rehabilitation-specific knowledge early in the year (and I still have much to learn!). Furthermore, an inpatient-heavy academic year along with more call burden is another challenge and potential avenue for resident burnout. Navigating early-career building, extracurricular involvement and working toward post-residency plans, such as fellowship, is another challenge. Therefore, it is paramount to have a supportive and cohesive overall residency.
PM&R residencies vary widely in the number of residents in each cohort. At UTSW, we have a structure of six categorical residents and three advanced residents per year, thus our program is a larger-than-typical PM&R residency program. Because larger residency cohorts naturally encompass a wider range of personalities, backgrounds, cultures and perspectives, it is vital to find the balance between maintaining an inclusive family atmosphere and allowing everyone’s unique personalities to shine. The first step in establishing a strong residency culture is to achieve that balance.
The next step is to enrich and develop meaningful interpersonal relationships. At UTSW PM&R, we have a dedicated wellness committee that plans monthly formal residency outings and informal events more often. Some examples of these events from this academic year include: a summer pool party, a murder mystery Halloween party, our annual football game and a winter holiday party. Facilitating more interaction with co-residents outside of work in a pre-planned and structured way has led to a greater sense of community in our program. The community and friendships built “off-the-clock” has translated to the workplace, where residents are happy to assist other residents when needed and the work environment is engaging and cordial.
We have also focused on the inclusion of attendings in events to strengthen the attending-resident relationship. One key example is our weekly scheduled pick-up basketball. Both attendings and residents participate and this has allowed early introductions in a low-pressure setting. Having a planned, weekly physical activity has reduced burnout as it is something the residents and attendings look forward to and build into their weekly agenda.
Ultimately, there are many reasons why physician burnout is so prevalent, specifically for trainees. I firmly believe that having supportive resident cohorts and a robust wellness program greatly quells the likelihood of burnout or the intensity of burnout if it strikes. It all starts with developing relationships with co-residents and attendings and building personal relationships before professional ones. With strong personal connections, professional relationships almost feel second nature. At UTSW PM&R, we have developed a multi-tiered approach to confront burnout and will continue to improve our approach as we move forward.