TL:DR — When burnt out, don’t burn bridges, don’t make abrupt choices, do reach out to attendings, co-residents, friends, and family, do ask for time off to get well and reassess. Save yourself years of going through the school of hard knocks and a lot of heartache by not making an abrupt decision to leave residency while burnt out!
Five years ago, one of the first questions I was asked by an attending physician after word spread in my competitive surgical subspecialty residency program that I abruptly announced my immediate resignation in the beginning of my third year of training was, “are you going to commit suicide?” Those were his exact words. At the time, I thought it was such a strange and random question. I never exhibited symptoms of depression or suicide ideation during residency. In fact, at that moment in time, I was filled with feelings of elation, excitement, and ecstasy at finally “freeing myself” from the “torture” of my residency program. I felt suspicious about the motive behind that question. Was that attending genuinely concerned about my well-being or was he more concerned that word about one of their residents committing suicide would quickly spread and tarnish the reputation of one of the most competitive residency programs? Five years later, I can appreciate his genuine concern for his junior resident who was obviously burnt out and making a decision that had far greater life consequences than he realized at that moment. Not only was I leaving residency, but I chose to leave the entire field of medicine altogether. At that time, it seemed like it was the most rational decision that I had made in my entire life. I did not recognize that I was burnt out and I would learn later that I made the biggest mistake of my life by quitting residency the way I did.
Presently, after five years of trials, tribulations, and finally redemptions, I can breathe a sigh of relief when I reflect back on my life since resigning from residency. That initial feeling of elation was short-lived when I realized just how tough life can be for someone with a medical degree and without a board certification (more on this on a future post). In the beginning, I borrowed heavily from my wife (who was my girlfriend at the time), brother, and mother (my parents are not financially well-off). I worked as a Lyft driver in the early days (I still have a pink mustache decal on my car that I display proudly) and other odd end jobs. I found myself in dark places in both my mind and my surroundings and I struggled with feelings of guilt and shame, knowing that the punishment I was enduring was self-imposed. My pride initially did not allow me to accept that my abrupt departure in a state of burn out was one of my life’s biggest mistakes. I spent the early years hanging on to tiny shreds of hope, that I would somehow find my path outside of medicine.
These days, my soul wells up with pride when I reflect on the countless challenges and struggles that I faced and overcame. I have made many mistakes since leaving my surgical career and each one of them continues to teach me a valuable lesson about how the world around me works, about how my mind and body best functions, and the importance of wellness. I was able to get back into primary care residency and completed my training. I am so grateful to my wife, who stuck by my side through the darkest of times. When I saw only dead-end paths in front of me, she always saw possibilities and opportunities. The whole reason I am who I am today is thanks to her. Now I am in a position to start to give back towards those who are about to make similar, or even worse, mistakes than I did. So I want to write about my experiences, reflections, and learnings for those of you experiencing a similar path in residency training.
I wish I can somehow target this post to my residency brothers and sisters in arms, who feel as if they are on the edge of sanity, and whose mental, physical, emotional, and spiritual health has been crushed and demoralized due to the rigors of their training programs, or due to shitty personal life circumstances during residency, or both. I hope my reflections will reach those of you who have been pushed to that edge and you are seriously considering making an abrupt decision that spans the fucked-up spectrum between announcing your immediate resignation from your program to ending your life. I hope that there are only a few of you that I am writing this post for and that most of you will still have the capacity to make rational decisions after becoming disenfranchised by your residency program, or your choice of medical specialty, or just the field of medicine in general. Regardless of the reasons you chose to read up to this point, if this post helps you and you know someone whom this post can help, please spread the word.
I am grateful that the topic of burn out, which was once taboo and even shame-inducing among residents, has recently taken center stage for physicians in training. If you speak to physicians in practice, many will know of a resident who committed suicide during their training. It’s shocking that some of the most intelligent and compassionate among society, individuals who made countless sacrifices in their youth to get through medical school and match into residency, would succumb to their deepest, darkest, and loneliest desire to end all that causes them suffering once in for all. Although I have never entertained thoughts of suicide, I have faced enough depressing, anxiety-inducing, and desperate situations to have danced on the edge of life. But thankfully, I never stared longingly down at the endless crevice and darkness of death, to make another mistake that I could never recover from.
The tricky thing about burn out is that while you are going through it, you will still feel like the same person you were before you reach that point. Burn out can behave like an insidious acute or subacute or chronic disease, that is sub-clinical at first. It starts to emerge as irritability, anger, worry, or whatever negative emotional response that is out of character. If the stressors of residency continue, both mind and body start to wear out. Eventually, the accumulated suffering wears down our usual intelligent and thoughtful minds. Most of us will still not give up at this point. Some of us will succumb to addictive and unhealthful behaviors. Some of us cheat on our spouses or engage in other behaviors that have lasting consequences on our spiritual well-being. If nothing changes, eventually our mind will get so fucking tired of suffering, that it will convince us that removing what is causing the suffering is the most logical choice.
My advice for those on that path is to be aware that a mind that has been beaten down will not make the most logical decision. Reach out to your networks, including attendings and residents you trust. Talk to your best friends from medical school. Seek advice from your close friends and family members. Talk to them all. My biggest mistake was internalizing all that was causing me suffering. I was afraid to be vulnerable to anyone. I had never quit any challenge in life and coming from first generation immigrant parents, I have had many challenges to overcome. I was used to taking care of things on my own. I was always used to trusting my mind to find solutions, but I had never experienced burn out until that point.
Next, ask your program director or chair for some time off. Your body and mind need rest and space to heal. Come up with any reason, no one wants a burnt-out resident to be responsible for the lives of their patients. So what if your co-residents may gripe about it? They’ll have an even bigger reason to complain if you quit residency altogether. And you would be surprised how compassionate some may be in empathizing with your situation.
During your time off, take a hard-inner look and be able to convince yourself that the sacrifices you will be making to continue residency is worth the work that you will engage in as an attending. If you cannot be convinced, investigate other fields in medicine. If you want to leave medicine altogether, there’s a saying that the best time to look for a job is when you have a job so feel free to put your resume/CV out on the job market.
Most of all, don’t burn bridges. Keep professionalism as your number one priority. A residency is supposed to help guide you to your job and program directors and chairmen get it. They may not seem happy to help, and you may not be able to enlist their help in the end. But at least give it your best effort so that even if you do not have their support in the end, you are able to share your story on how you maintained professional conduct in the face of burn out. That is not an easy feat.