Research Suggests Residency Is a Key Turning Point in Long-term Physician Wellbeing February 7, 2022

Residency marks a significant step in the physician career path. However, according to a JAMA Network Open research letter, it also comes with a significant negative shift in wellbeing. The analysis, conducted by Lisa Meeks, PhD, of the University of Michigan, and colleagues, identifies an increase in depression relating to clinical impairment during internship. More disturbingly, it suggests that residency marks a turning point in how depressive symptoms are experienced. According to the analysis, depressive symptoms become internalized in residency as “just part of the job.” This alarming mindset contributes to long-term professional burnout and negatively impacts physician wellbeing. Such findings reinforce the need for physician wellbeing programs such as MSDC’s Wellbeing Program supported by the Healthy Physician Foundation. 

There is abundant literature citing the moral injury and stress that physicians experience and its negative impact. But how does that impact early career physicians? In a cohort study of 15,566 medical interns, many first-year residents reported new depressive symptoms which impaired their functionality and lives. Based on self-reported Patient Health Questionnaire-9 (PHQ-9) data, interns' mean depressive symptom scores were significantly higher during internship than the year prior to internship. Examples of depressive symptoms included trouble sleeping or feeling down about oneself. That increase in depression was consistent at both high and low levels of perceived impairment. 

Increased expectations and responsibility during residency are to be expected, but the acceptance of depressive symptoms should not be. Coupled with stigma against seeking help or fear of negative professional impact, such acceptance can have long-term negative consequences. The damage can manifest itself in many ways: burnout, disengagement, diminished patient care, medical errors, substance use disorder, or suicide ideation. The impact of such burnout impacts not just the resident, but also patients, institutions, and the profession.

Given the finding that this normalization of depression takes place in residency, there should be heightened attention to wellbeing during residency. At the individual level, MSDC offers a suite of resources to support wellbeing including coaching and counseling, social events, a wellbeing app, and much more. These resources, supported by the Healthy Physician Foundation, are available at www.msdc.org/HPP .  Institutions also need to rethink wellbeing during residency. To help with that, the American Medical Association has created resources and grants that institutions can use to reimagine residency.