In this TikTok Live video, Jeremy Faust, MD, editor-in-chief of 鶹ý, and Adriana Wong, MD, MPH, a fellow in reproductive endocrinology and infertility at the Los Angeles General Medical Center, discuss the intricacies of the residency process. Faust and Wong talk toxic work cultures, burnout, and how to maintain your mental health and finances during this challenging period in your career.
The following is a transcript of their remarks:
Faust: Nice to meet you. You just finished residency, right?
Wong: Yes. Oh my gosh. It's one of those things that is so surreal when it actually ends, because you think it's just going to keep on going forever. But I just finished at the end of June.
Faust: You're ob/gyn?
Wong: Yes, ob/gyn.
Faust: And you're not done with your training. You're in like the 35th grade now?
Wong: Correct, it just keeps on going. I'm doing 3 years of reproductive endocrinology and infertility, so I'll be starting my fellowship on August 1.
Faust: Alright. Now that you've survived -- I know it's easy, because you've just survived -- how'd it go? How was residency? What did you like about residency? What was not so great?
Wong: You know, it's kind of interesting. I've tried to do a lot of reflection on that just to have some sort of meaningful thing to say here today.
But it's kind of like what people say: the days really are long, but the years go quickly. I remember thinking at the beginning of intern year how gruesome and long the hours were, and I couldn't believe that I was going to be doing the exact same thing for 4 years because it feels like that will truly be forever.
But as you get this graduated autonomy, it really becomes amazing to see the skills and the knowledge that you're able to develop throughout all of those years. Then by the end of your chief year, you feel like you really could handle anything that can come through the door.
It's a really amazing feeling to see that growth. I don't feel like I'm the same person that I started residency as, because you just experience so much personal and professional growth.
Faust: I'm a PGY-12, I've only been out for 6 years. I remember that transition. I remember just being so tired, but also in a 4-year residency for emergency medicine, the fourth year's not that bad. So I kind of felt like, "Okay, I'm in the second year and I'm really tired, but less than 2 years from now I'll be a fourth year and that'll be okay." I started doing the math of, how am I going to survive this? Which is maybe a sign that it's a little bit much, or as the kids say, residency is a little extra.
Let's just talk about the nuts and bolts of the elephant in the room. People are working 80 hours a week, more in some cases and less than others; do you think that this is the only way to train?
Wong: I don't know. I think it's hard, right? Because you have so much to cover, especially in procedural services, you have to be really good at what you do in order to feel confident in independent practice. It's hard to imagine it being successful in any other way.
Then you hear other people saying, "Back in my day we did X amount of hours every day, and that's why we're so good at what we're doing." But I feel like the way that things are going now, I've been able to graduate with the skills that I'll need to be able to perform and do things independently. But I see the argument for why more training would be better. It's just kind of hard to think about doing that and making those adjustments for more years or more hours per day.
Faust: Also, there's the culture of residency, which I always think is interesting. I actually have a theory, it's totally unsubstantiated, which is that people are mean and they yell as a proof of being important or as proof they can. It's almost like a hierarchical thing. I don't know.
Wong: That's what you think?
Faust: Yeah. I also, I don't know. It's like I can't yell at somebody [because] I'm going to get fired. But if someone yells, they think that they're invincible. I don't know. That's just one part of it.
You went to residency in the, whatever you call these, the '20s, and I went to residency in the teens and I feel like my attendings had, in a bad way, license to be a little bit more toxic without any recourse. Do you think that's changed?
Wong: I think so, but I think the way that I see that kind of behavior from other people is a little bit different. I see it more as reflective of burnout. I feel like when people are more willing to be really curt or rude to other people, it's more reflective on their threshold of what they're currently able to handle at the moment. But maybe that's just what I've figured out through my own therapy and the way that I interpret other people's behavior and also learning to not take those things as personally.
But I do think that probably a lot of it does come from hierarchy, a feeling of self-importance, like you're saying. Feeling validated in their own leadership or whatever positions as the medical hierarchy, there's probably an element of that too.
Faust: When I was in residency, there was just this idea of self-care and a little bit of resilience kind of stuff. Wellness was the buzzword. I was always like, "Yeah, if you want us to have wellness, don't make us work 80 hours a week. That's it. Everything else is window dressing." How did you feel? Did you feel like you were able to take care of yourself in the last few years whilst becoming a surgeon and an ob/gyn?
Wong: You know, I think it kind of ebbs and flows, but I do think that one of the things that I am proud of is being able to have a fairly balanced life. But I think that's because I've always been very conscientious of that. Going into residency, I've always prioritized [that].
When I knew I was going to have one day off, I always made sure to have plans for that one day because I noticed on the weekends where I didn't make plans, I would feel like I wasted the day. Even if I was relaxing, and that obviously has value, it felt like a wasted day to me. But even if I had lunch plans with a friend or called people back at home, I felt like that was a more valuable day to me.
And then making sure that I had a therapist or some other healthy outlet, like exercise, even if it's a 20 minute walk -- I noticed that those things made the way that I performed and felt at work a lot better. But I recognize that that's really difficult for some people, but at least having a balanced life made me feel like I was a better physician at work.
Faust: And relaxation has different meanings. Like I'm just not – I like to exercise, but if someone told me that I had to spend my day off rock climbing, I'd be like that's more torture.
Wong: I know I'd be so mad. I'd be so mad.
Faust: Wake up then go out and we're going to go kayaking and rock climbing and I'm like, "I just want to be either running around the park" -- I was in New York at the time -- "or in the gym or sleeping." And it's okay also now to be – they're calling it bed-rotting – sitting around and doing nothing as wellness. That's cool. I used to watch a lot of "Seinfeld" reruns in my apartment.
Wong: That's what I do even now!
Faust: Yeah, while eating takeout. That was my sort of '"whew." But you have to do that because you just spend a lot of time, in your case, in the OR or in clinic and there's time. But I think you're right that you have to be very deliberate about it, otherwise 4 years just goes by and you never did anything.
Wong: Yeah, totally. Or making that vacation that comes along really valuable and meaningful to you, so that way you have something to look forward to. I know you can't necessarily count on those things coming. You have to have little delights along the way by having fun plans, but having a big vacation that you're looking forward to really makes it all worth it.
Faust: There's always the question of, what should you spend with what little money you have versus saving and all that. I mean, how did you handle that?
Wong: Oh, the guilt of making no money and spending money is terrible. Especially in fellowship, it doesn't get any better. It's just a tiny little bit more [money]. But you just have to remind yourself that it'll eventually work out. At least that's what I tell myself, that eventually it'll be okay.
Faust: Yeah. There is a day coming when you'll be able to actually not be in the red constantly, which is nice. And that's honestly the biggest take-home I always have for residents.
I just had lunch with a resident today who's a mentee and they're doing great, but I was just reminding them: this is a very discreet period of time. That's not an excuse for any toxicity that anyone's going through, everyone deserves dignity and all that. But it is a moment; it's not your whole life.