Anyone who has watched ABC’s Grey’s Anatomy knows the life of a first-year physician, colloquially known as “interns,” is arduous, to say the least. Mindless paperwork, long hours and ceaseless stress are hallmarks of the experience. While stress in health care is hardly uncommon, researchers have found first-year resident physicians experience increased rates.
Srijan Sen, director of the Eisenberg Family Depression Center, and senior lab researcher Yu Fang conducted research using surveys and data from 2009 to 2020. The total number of participants was about 17,000 interns.
The surveys followed a PHQ-9 score — a score based on a set of questions monitoring the severity of patients’ depression and their response to treatments — which gave researchers an idea of who could be at risk of depression. On the scoring sheet, a number above nine is considered to be at moderate risk for depression. Interns that volunteered to be part of the surveys would fill these out in their last semester as an intern before becoming a first-year physician.
According to the study, 33.4% of the interns that met the criteria for depression were working more than 90 hours per week, showing a correlation between work hours and depression. The symptom scores were almost three times as high for those who worked more than 90 hours per week when compared to those that worked 40 to 45 hours per week.
The study proposed having more employees in the workforce and making sure physicians do not work more than 80 hours per week to help mitigate the risk of depression. Sen said having more employees would help currently overworked physicians have a more balanced schedule.
“There’s been some progress over the last few years of reducing workload, and we’ve seen a corresponding decrease in depression,” Sen said. “But there’s a lot more to do.”
Second-year resident physician at Michigan Medicine Stefanie Stallard was a participant in the survey and said first-year residents are not given enough time to ease into their jobs. She said most of the stress faced by first-year residents may come from feeling unprepared when transitioning from being an intern to a working physician.
“(Resident physicians) have a whirlwind orientation that is really focused on logistics more than anything, like making sure you have your badge,” Stallard said.
Stallard said just focusing on reducing the workload and work hours of physicians, especially first-year resident physicians, isn’t enough to combat the stress they face. She said while it is important to take into account the correlation between work hours and risks of depression, it is not the full picture since it is hard to tell exactly what “work hours” mean for an individual resident.
“For example, you work 12 hours in a day; are those 12 hours where you are having to take a break and eat lunch? … or is it 12 hours where you are just frantically, nonstop, attempting not to drown in the amount of work you have?” Stallard said.
Stallard said providing more aid to interns and first-year physicians to transition into the workforce would help decrease resident stress levels. Stallard drew from her experience in transitioning from first- to second-year residency and said the orientation they called “boot camp” was part of what helped her ease into the second year. Part of the orientation was practice time to review topics residents needed to know, in what Stallard described as a learning environment.
“Just getting exposed to things to get educational reminders of things that we’re going to be seeing when we are working with patients took some edge off of that transition into starting neurology,” Stallard said.
Stallard said having more conversations surrounding mental health for physicians is a good way of combating the risks of depression and was glad Michigan Medicine was talking about mental health.
“I’m just really glad that folks are looking into (depression risks in physicians) and putting stories out there,” Stallard said. “Because it’s a conversation that needs to be had.”
Tasha Hughes, clinical assistant professor specializing in surgery at Michigan Medicine, said while the study’s researchers have been tracking surveys for a long time, it is hard to tell if this increase in work hours was caused by the COVID-19 pandemic. Hughes said while the data is not new, the number of first-year resident physicians with a risk of depression should be noted.
“We still see about a third of interns, 32% of interns, that start out as not depressed have depression on at least one of those checkpoints throughout their intern year based on their PHQ-9 score,” Hughes said. “So we think it’s a pretty significant problem.”
Hughes said while the way mental health is discussed varies from department to department, it is still important that Michigan Medicine takes action to address residents’ mental health concerns. Michigan Medicine’s House Officer Mental Health Program is one such initiative that provides support to residents.
“We have different roles and programs set up that address both resident health and well-being, and mental health is part of that,” Hughes said. “Some of (the focuses) include control over your time, finding value or meaning in your work and reducing harassment or unfair treatment in the workplace for residents.”
Fang, senior neuroscience researcher at Michigan Medicine, said depression rates among resident physicians is an issue that needed to be addressed not just in the U.S., but across the world.
“Although the data is only (based on) U.S. interns, I think it is also not only the U.S. medical system that needs to fight this battle” Fang said. “I think it’s a global issue that at least junior doctors or medical trainees are suffering from.”
Yu also said the healthcare system as a whole could help combat depression by providing more support for incoming first-year physicians.
“I think what the overall medical system could do is try to reduce the burden (on physicians) in order to make their work more efficient,” Yu said. “At the same time, ensure they have enough training. (Ensure) they can learn what they need to learn but reduce some unnecessary burdens.”
Though facing mental health and depression is a risk resident physicians take during their internships, LSA freshman Sikander Choudhary says this issue affects everyone, even those outside the medical field.
“It’s important to take care of yourself, especially if you are someone taking care of others,” Choudhary said.
Daily Staff Reporter Ji Hoon Choi can be reached at email@example.com