Insights on Residency Training

Dr. Temte is a Chief Resident in Internal Medicine at Providence Portland Medical Center in Portland, OR

A few years back, I was a third-year medical student, exhausted on my general surgery rotation. I woke up at 4 am to the sound and smell of my coffee maker, muttering to myself, “only 1 week left.” I did not intend to become a surgeon, but I showed up early each day to get the best marks I could. Ready and driven, I threw myself into the demands of my work. After all, these were the days I had dreamt of as a first- and second-year medical student. I could remember sitting in class, enthusiastically waiting to be out in the clinical world. This experience is not unique. I am sure we can all remember times in medical school and residency when we looked to the future, just waiting for the current rotation to be over.

The Journey of a Medicine Trainee

Most of our early career is about moving from one milestone to the next, reaching the next stage, and graduating. Whether it is completing medical school or the latest cardiology rotation, our early careers move us in increments of achievement. By nature, we are goal-driven professionals and reaching these accomplishments is what we do best.

In medical school, we change jobs the way others change clothes. To start the month as a surgeon and end it delivering babies gives us the chance to sample the immense range of the human experience. But, that day in the operating room as a third-year medical student, busy counting down the hours, minutes, and seconds — I missed a genuine opportunity to enjoy the rewarding difference we made in a patient’s life.

My Journey 

Exhaustion and inertia overshadowed many profound, beautiful, and educational experiences during my years of medical training. I focused on maintaining momentum, with an inability to pause. In retrospect, I was burned out and continuously grasping for the next ledge, no matter how small.

During times of rest and clarity, I would be able to find my stride and passion again. In times of prolonged fatigue, I would only look toward the future, unable to focus on the beauty of my journey. I would convince myself that it was all a passing feeling. It wasn’t until my second year of residency that a trusted faculty member said to me, “Brandon, you look burned out.” In a state of shock, I wanted to be defensive, but I finally let my guard down. This was one of the most important days of my medical training. Acknowledging my burnout changed my life and career. Since then, I have been more intentional about my day-to-day and more focused on how burnout can alter the journey.

Burnout — A Growing Concern

The path we have chosen is long, and we are never done learning or achieving. Our entire careers are part of the journey, each stage is different but nonetheless an integral part. Physician and trainee burnout is a massive issue requiring intense continued discussion. At times, confronting burnout can feel like a hopeless task. Systems and organizations often drive the increasing mental health burden on our trainees and providers. The perceived lack of control and increased bureaucratic tasks can deprive us of our individual inspiration. In the most-recent (2022) report on physician burnout from Medscape, burnout was reported by 47% of physicians, up from 42% the year prior (Medscape 2022 Physician Burnout Report). This article is a personal recollection of my story so far, and we all have our own to share.

Confronting Physician Burnout

While we continue the critical discussions about physician burnout, take a few minutes to reflect on the amazing knowledge you gain and share each day. Consider the patients who have felt comforted and found solace in your care. Allow yourself to practice the gratitude you have earned, even for something as simple as showing up that day. When gratitude feels far away, and you’re having difficulty seeing through the fog, reach out to those around you. Take time to recognize your personal signs of burnout. They may be more subtle than you think. Our continued involvement in the discussion of burnout will help to protect the future of physicians.

To all those simply surviving the latest rotation: you deserve to enjoy your journey.