Are physician wellness programs just another checkbox?

Recently, I saw a photo of a slide from the American College of Surgeons Clinical Congress: “The Program Directors Guide to Implementation of Well-being Programs.” While I applaud the ongoing focus in medicine on wellness for both trainees and faculty, I am troubled by the perceived need to standardize and program wellness, creating a “checkbox” that may not improve actual well-being. As a recent graduate now living my best life with adequate sleep, I have a renewed perspective on this issue.

I did a five-year surgery residency, with research years in the middle, and two fellowships totaling three years. I lied about my work hours for much of that time, most flagrantly during my ACGME-accredited fellowship where I routinely worked over 100 hours a week. I truly believe that many of those times of work overload made me a better doctor and a better surgeon and that I am better prepared to practice than some of my colleagues with lighter schedules during fellowship.

While these work hours prepare us to save lives, they simultaneously take their toll on our physical and emotional well-being. About a year ago, with over half a year left in my fellowship, every day I seriously pondered quitting. I am not alone in this. When I was a resident, a fellow who is now rising through leadership ranks in my field told me “Every day I have to convince myself to stay here” with two months left in her surgical training. My best friend is still a fellow, and texted me this week “The exhaustion goes away, right? I can be a normal functional human again someday?”

I finished training this summer and took two full months off before starting my first job as faculty. The impact on what I felt to be my overall wellness was remarkable. I slept at least eight hours a night, exercised daily and ate well. While my problems with my spouse didn’t disappear, we stopped fighting. Instead of getting a respiratory virus at least every couple of months, I haven’t been sick for six months.

The trend toward mandated “wellness programs” seems to be creating one more checkbox for program directors and trainees alike. I was at one point made to talk to a social worker in a roundtable format about my feelings. All I could think about the entire time was that I would be able to get breakfast if we didn’t have to pretend to talk about our feelings with this stranger. What actually helped?

1. Time off. During residency and fellowship, we would sign out responsibilities to each other in order to be able to leave the hospital instead of all staying around. During fellowship, this was at times impossible but when I scheduled this time with my co-fellow, and we respected it, about 80 percent of the time we were able to kick the other one out of the hospital for an afternoon every-other-week. While this may not sound like a large amount of time, it made a huge difference. We were able to make doctor’s appointments, get haircuts, exercise in the daylight, or sleep uninterrupted. This made things a little busier in the hospital for the remaining trainee, but this was helped when staff shared the work, which brings me to my next point.

2. Attending surgeons who help. It is not a secret that residents and fellows find some of their staff to be “needier” than others. I stated before that the work overload was helpful to learn, but after a certain point, busywork does not educate. The addition of a faculty member who demands concierge service exacerbated this. I was eternally grateful for faculty who would do small cases without demanding the fellow be present, write their own orders, look up their own labs, and call their own secretaries. Creating a system in which the faculty members are entirely dependent upon the trainees does not allow any flexible time, and thus impedes learning and wellness.

3. Kindness without judgment. During days, weeks and months in which I was overworked, I remained functional not through mandated wellness exercises or lavender aromatherapy, but when people who had gained my trust checked on me. An anesthesiologist consoled me on a patient death at midnight in the OR hallway. A charge nurse brought me a quesadilla in the middle of a day too busy to eat. These types of things are simple but vital. I believe that these people, as trusted friends who I knew cared about me, provided a safety net and had I had issues that impaired my ability to work, I would have asked them for help when I wouldn’t have talked to my program director.

If program directors and teaching faculty want to improve resident wellness, they have to start with hiring an adequate number of people for the workload, sharing in the workload themselves, and genuinely caring. No “well-being program” is going to overcome a deficiency in the others.

The author is an anonymous physician.

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