By Ben Brown, MD, MPH
It was nearly 1 year ago I made my plunge into the proverbial 1st post graduate medical training year also known as ‘Intern’ year. In many ways, it was like jumping from the high dive into the deep end of a pool for the first time. You slowly climb the ladder of 4 years of medical school to reach the elevated spring board. You stand up and walk to the edge of the board and in theory you should be prepared for the jump, however, the pool which is 15 feet below suddenly seems 100 feet away and you wonder if your head will ever re-surface after jumping from such a height. Prior to making this jump, we medical graduates spent hours upon hours deliberating over the type of specialty to apply for. We applied through a most odd, unbelievable, and yet crazily satisfying hiring process called the match. We then await July 1st, the universal start date of residency. You reach the edge of the diving board, your toes are hanging over the cool wetted turquoise green metal, and you know the only way to really do this is to just jump knowing many have jumped before you. You take courage and jump forward losing ground below your feet and entering into a life full of new experience.
Again, this jump was 1 year ago for me. In that year I’ve had highs and lows, sleepless nights and exhausting days. Intern year has fluctuations in its demand but in the end it is all about survival. As a brief overview, during intern year we are ‘allowed’ to work up to 80 hours per week. Our shifts are limited to no more than 16 hours in total (recently increased to 24 hours). We must be given at least 1 day off for every 6 days worked (although we still might work 12-14 days in a row). Lastly, we must have at least 8 hours off between shifts. Granted, not every week are we pushed to these limits. At one point I figured I was working on average about 60 hours per week. In addition, in family medicine we work on drastically different services switching every 4 weeks. My first two rotations were adult inpatient medicine and the well-baby nursery. This characteristic of our training adds its own unique set of challenges. Working under stressful conditions for so many hours and over many weekends has its effect. Many days after work you desperately seek to have some semblance of what you perceive of a normal life (i.e., getting something to eat, connecting with a friend or family member, sleeping). Sometimes you can fit in exercise or laundry, but usually that comes at the expense of one of your other essential daily activities.
Why does our training have to be this way? A question I have pondered many times. I don’t have a perfect answer. Now looking back, I can see that the long hours, the night shifts, the increased responsibilities, and the sleep deprivation have put me miles ahead of where I was as a graduating medical student. I had a loving family member tell me prior to residency to not be afraid to work hard and I often reflect on that. Many great things are produced from hard work and I believe that includes becoming a skilled, experienced, and knowledgeable physician. This work life can be difficult in the context of the current social culture where much of what you see of those around you are the ‘good’ times. All of us tend to post about our happiest moments and a full feed of this makes it seem like life for others is a constant vacation or party. Friends and family don’t get to see the waking at 4:30 am, driving to work in the dark, working for 12-13 hours, and then returning home in the dark only to feel lonely, unhealthy, and depressed. Is it ironic that we physicians regularly recommend to our patients to get regular exercise, adequate sleep, practice mindfulness, and eat healthily where we ourselves struggle mightily with such life activities?
Despite the darkness which I may have painted above, intern year has been filled with just as much light. Intern year has been very meaningful and even fun. I’ve had excited mornings driving to the hospital in anticipation to see how our patient’s fared overnight and to see my fellow co-residents and other staff. In fact, our demanding work schedule forges bonds that cannot be replicated elsewhere. These bonds are intensified by laboring over challenging patients and working through difficult cases. Being part of a team is very meaningful, especially when your team’s goal is to help in the delivery of a baby, helping to support someone’s life through CPR, or helping families and patients through making very difficult healthcare decisions. As an intern, your membership in these teams is much more integral than it ever has been before. You are now someone’s doctor rather than the accessory medical student (don’t get me wrong, medical students are integral to our teams too).
Other light that came during this year was from loving family members and friends who offered support through all the ups and downs. They were the safe havens, the listeners, and the giving souls that allowed you to find respite when in greatest need. In addition, having a program that emphasizes wellness has been a great blessing. During intern year, we had nearly every Friday afternoon blocked from clinical duties to spend time learning, participating in wellness activities, checking-in with each other, and often times confidentially complaining about our lives and experiences.
Working month in and month out, over nights, over Christmas, and even New Years Eve we interns slowly but surely undergo change. Our co-workers in the clinic and hospital add to our family and friends. We slowly grow in our sense of confidence and begin the delicate process of refining our art of practicing medicine. We grow into our defined role on our team and we become teachers to medical students. We become more equipped to deal with stress, face new challenges, and to recognize the limits of our knowledge and where and when to ask for help. Also, finally getting a pay check is not so bad as well. About to move into my second year of residency, I feel that I am consistently keeping my head above water in the deep end of this pool, I am ready to see another group of newly minted MDs make their plunge off the high dive, and I am excited to continue being part of this great story.
Ben Brown, MD, MPH is a second year Family Medicine Resident in the Department of Family & Preventive Medicine at the University of Utah School of Medicine.