Maybe it’s the 80-hour week residents put in, maybe the feelings of being an imposter that afflicts many of them, maybe the stress, or perhaps just the weight of feeling, after four long years of medical school, that they’re back to square one again. Whatever it is, it happens to nearly all new residents, and it happens pretty much like clockwork midway through their first year. They begin to question their choice of careers. The altruism that drew most of them to the profession begins to compete with a creeping sense of cynicism. They find themselves feeling irritable, undervalued, and under-rewarded. The personal meaning in the practice of medicine gets lost in the overwhelming fatigue.

It’s a trajectory that long has troubled Donald Girard, MD, OHSU’s Associate Dean for Graduate Medical Education. “We’ve done a lot of studies over the years,” said Dr. Girard, “and have consistently found that most residents, not all, but most, began struggling sometime around the middle of their first year. It’s not the rain, it turns out, and it’s not even necessarily the hours.” Australian residents, who are limited to 55 hours, encounter the same problem.

“The suicide of an OHSU resident was the ‘sentinel event’ that ultimately impelled OHSU to establish the Resident Wellness Program,” said Mary Moffit, PhD, Assistant Professor, Department of Psychiatry, who joined Dr. Girard, and the Department of Psychiatry's Sydney Ey, PhD, Associate Professor, and Mark Kinzie, MD, PhD, Assistant Professor, to develop and staff the Resident Wellness Program. The program is rooted in the theory that staying well is at least as important for residents as learning to help others get well. The six-year old pioneering program has proven so successful that in July 2008 it was opened up to faculty.

“Physicians are not high utilizers of health care services,” said Dr. Moffit. “Often, they don’t have primary care docs, they don’t go for wellness checkups, and they don’t go to counseling.” Yet, said Dr. Ey, “at least 50 percent of physicians in practice report that they know a colleague who has been, or is, burned out.”  

“The focus is on keeping people well,” said Dr. Girard. “It includes convincing them to reflect on what they’re doing, recognizing that the struggles they’re going through are not completely unique to them.”

The program is confidential and there is no cost. “The Oregon Board of Medical Examiners supports this program and, unless a physician is impaired by an illness – is practicing medicine impaired – no information is disclosed to the Board.”

Clinical faculty and residents participate in workshops to talk about an adverse event or patient outcome that deeply affected them and how they dealt with it. But the emphasis of the program is on practical strategies for coping with burnout and stress. “We focus on strengthening resilience.”

The team’s approach to coaching or counseling a resident or faculty member is customized to each individual.  Cognitive behavioral, or mindfulness-based interventions are focused on the present and have proven to be both popular and effective. The goal is to focus on the here and now – to support our physicians during stressful times and help them access their own natural resilience.

One particular emotional drain on residents – and some practicing physicians – is the anxiety produced by the “imposter phenomenon.” “We have met with extremely competent faculty leaders who have experienced this,” said Dr. Moffit . They are surprised when we recognize these feelings of self-doubt. ‘You mean there’s a name for this? Other people feel this way too?’”  

The wellness team’s efforts are working. A growing stream of visitors is showing up on the program’s doorstep, which is in a private, low-profile location on campus. The team is clocking more than 100 individual resident and faculty appointments every month. “We’ve heard of residents getting together, and one will admit they’ve seen us, and pretty soon the whole group is admitting they’ve seen us,” said Dr. Kinzie.

For more information: http://www.ohsu.edu/xd/education/schools/school-of-medicine/faculty/faculty-affairs/wellness.cfm

To schedule a meeting with the Resident and Faculty Wellness Program,  contact Dr. Moffit: moffitm@ohsu.edu or 494-1208. If urgent,  call 503 330-7880.