Intern Year

Maybe it is just me, but when I talk to a student, or an intern, or a resident, I can immediately put myself back in that phase of life and feel what I felt then and relate to them. When I read the Annals article by Fang and colleagues (1), I immediately went to the first weekend of intern year. I was on long call in the coronary care unit. It was my birthday. No one else knew. I went through the busy day admitting sick patients, trying very hard not to be inept in front of my attendings, and being overly concerned about my critically ill patients’ potassium levels. I left my long call day after 7 p.m. and was met with a voicemail from my brother and his wife singing me “Happy Birthday.” I cried the entire walk back. Now, when I meet new interns who have traveled miles from their homes, some coming from different countries, I can sense the loneliness, fear, and excitement they feel. I am immediately brought back. However, what Fang and colleagues’ article shows is that many interns enter residency with depressive symptoms but are actually improved on their way out of intern year. It is difficult for me to reconcile this when I know that each year trainees are dying by suicide and that life is just so much harder training through a pandemic. I also wonder is this in spite of residency training? Are people just more aware of mental health and proactive in getting help despite the challenges of residency? Should training programs address mental health head on to improve the lives of residents and prevent physician suicide?

I think about this because, like many of you who will read this, I know people who have died by suicide in medicine, and I wonder how I can be optimistic about this when an entire medical school class of physicians each year dies by suicide (2). I wonder what more we could have done as a country, as health care systems, and as training programs to save the lives of our colleagues. This Annals article left me wanting more. What is it that reduced depressive symptoms? Is there a correlation with reduced suicide rates? What are training programs doing to help residents? The thing I know for sure is that we have all had days where we’ve left work near tears, and we see each other.  

References

1. Fang Y, Bohnert ASB, Pereira-Lima K, et al. Trends in depressive symptoms and associated factors during residency, 2007 to 2019. A repeated annual cohort study. Ann Intern Med. 16 November 2021. [Epub ahead of print]. [PMID: 34781718] doi:10.7326/M21-1594
2. American Foundation for Suicide Prevention. 10 facts about physician suicide and mental health. Accessed at www.acgme.org/globalassets/PDFs/ten-facts-about-physician-suicide.pdf on 7 December 2021.