How I Became Active in Fight For Trainee Wellness

In August of 2014, just two months into my intern year as a psychiatry resident, two internal medicine interns died by apparent suicides in New York City. One of them was my co-intern, friend, and roommate. As a psychiatry resident, I anticipated that at some point in my career I might experience the loss of a patient to suicide, but I never imagined losing a fellow resident and friend in this way.

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Since then, I have been confronted with many unanswered questions about his death, moments of guilt and regret that are so common among friends and family of people who die by suicide, and frequent reminders of the demands that residency places on new physicians everywhere. These experiences motivated me to better understand the obstacles to physician well-being and to identify potential areas for improvement. I sought to improve conditions for residents through writing, speaking, organizing, and advocating. It is my hope that by sharing the story of my efforts, I can help pave the way for other residents and fellows to make changes at their own institutions and beyond. Here are the avenues I pursued:

• Writing. The events of 2014 sparked a national movement to encourage depression treatment and suicide prevention for physicians. Resident voices have played a central role in this response, including an op-ed in the New York Times by an internal medicine intern. Shortly after those events, I co-wrote a Viewpoint piece for JAMA Psychiatry with my co-resident, Ravi Shah, M.D., M.B.A., and Carol Bernstein, M.D., past president of APA. Titled “Depression and Suicide Among Physician Trainees: Recommendations for a National Response,” it highlighted the need for increased education, screening, and treatment of mental illness during training. Psychiatry residents and fellows are particularly well suited for writing pieces like this one because we have a unique perspective as both trainees and budding experts on mental health. Every new article helps to increase awareness and advance the dialogue that is essential to the culture change we seek.

• Speaking. Providing education on the issues of burnout, depression, and suicide among physicians is a high-yield, low-cost intervention. Whether you are looking within your own department or across the hospital system, opportunities for teaching are plentiful: orientations and well-being workshops, resident didactics, medical student courses on preparing for residency, and departmental grand rounds. My colleagues and I convened a speaker’s bureau of local experts available to discuss physician well-being, burnout, depression, and suicide. Psychiatry trainees are well positioned to be the ambassadors for well-being at their home institutions. Presentations at APA meetings provide an ideal medium for networking and engaging in scholarly work at the national level. At APA’s Annual Meeting in San Diego in May, there were no fewer than six symposia and workshops—not to mention multiple posters and abstracts—that focused on physician well-being, and APA’s 2018 Annual Meeting will feature a special track on this topic.

• Organizing. As my co-residents and I discussed how to reduce burnout and depression, we felt compelled to organize and advocate for changes to our work environment. We found our footing by establishing a GME-sponsored Resident/Fellow Forum, which is mandated by the Accreditation Council for Graduate Medical Education (ACGME) in its Institutional Requirements. Since its inception two years ago, our Resident/Fellow Forum has held monthly meetings with broad representation, developed and implemented an outreach program for families of new interns and residents, and focused on making small improvements such as cafeteria meal-card convenience for trainees. Every ACGME-accredited program is required to have some version of a Resident/Fellow Forum, which affords participating trainees with unique leadership experiences while making a meaningful impact.

• Advocating. Advocacy for physician well-being has grown dramatically in recent years, and national organizations are listening. The ACGME revised its Common Program Requirements to expand well-being resources at every ACGME-accredited training program, while the National Academy of Medicine established the Action Collaborative on Clinician Well-Being and Resilience. Also, APA offers advocacy opportunities. I co-wrote an Assembly action paper with Jeremy Kidd, M.D., titled, “Addressing Physician Burnout, Depression, and Suicide—Within Psychiatry and Beyond,” which was approved by the APA Assembly at the 2017 Annual Meeting. The APA Workgroup on Psychiatrist Well-Being and Burnout was convened by Anita Everett, M.D., as a key focus of her APA presidency. Such opportunities are within reach for resident-fellow members as we develop strategies to contribute to the national conversation.

Trainees can find their own path to writing, speaking, organizing, and advocating—yours is a highly valued voice. To sustain the pressure for change, we will always need motivated residents and fellows to represent the trainee perspective. ■