Senior physicians at Yale New Haven Hospital were in the middle of presentations during a recent meeting of the graduate medical education committee when a group of interns, residents and fellows interrupted.
At the front of the room, they unfurled a banner painted with the words “Doctors Are Humans Too.”
The group of training doctors then presented staff with what they called a Resident and Fellow Bill of Rights.
“Establishing what we have as rights as people — I mean as doctors, but as people, because we are people — I think it came to us as a group because it made sense, because if we’re going to help people, we have to take care of ourselves,” said Dr. Walker Keenan, a psychiatric resident.
The document outlines requirements for working conditions and patient safety, diversity, respect and equity, living wages, fair evaluation, supervision and mentorship, workers’ health care needs and more.
The initiative at Yale New Haven Hospital comes as health care providers across the country work to increase awareness about the high rates of depression, burnout and suicide in the industry. Meanwhile, studies predict that the United States is on course for a shortage of physicians in the next decade as health care demands increase and an aging population grows.
Keenan said systematic change needs to happen across the board to improve the professional environment for clinicians still in training, as well as for established doctors and their patients.
“The vast majority of people go into medicine to help people, but it’s hard to be empathetic and to give of yourself to others if you cannot take care of your basic needs,” he said. “I think what happens is there’s a chronicity to this, and this over time burns people out and makes people less empathetic.”
The National Academies of Sciences, Engineering, and Medicine released a new report last week on clinician burnout. It cited studies that found residents with burnout are more likely to report delivering care of lesser quality or having committed a medical error.
A 2012 study that involved about 1,700 medical residents showed that “the prevalence of high emotional exhaustion, high depersonalization, and overall burnout was higher among residents than among age-similar college graduates not studying medicine.”
The most recent national report found similar conclusions among older physicians and in the nursing, dental and pharmacy populations.
Becoming a doctor and getting board certification takes years of medical school, residency training and sometimes fellowship work. Physicians in training may work up to 80 hours a week, they get paid less than senior doctors, and they may be supporting a family.
There may also be financial stressors — about 75% of residents graduated with student loan debt at a median amount of $200,000 in 2018, according to the Association of American Medical Colleges.
Dr. Linda Alvarez, a family physician based in Florida, said the stakes are high.
“It takes a lot to get through undergrad and med school, but this is really your first step in your career, and it’s nerve-wracking,” she said. “Not only are you in this time where this is your first job, you’re kind of out there professionally for the first time, but also, too, these are life-and-death situations that you’re dealing with.”
Alvarez is the secretary and treasurer for the Committee of Interns and Residents, a national advocacy organization and an employee union division of SEIU Healthcare. CIR represents more than 16,000 medical interns and residents at training programs across the country in employment contract negotiations.
The organization plans to issue its own bill of rights in 2020 to lay down expectations regarding working conditions for medical residents and other trainees.
“The supervising bodies of medicine, I think we all have the same goal, which is to make sure residents get the best quality education they can get, the best quality of training they can get,” Alvarez said, “but also taking care of a quality of life that’s sustainable.”
Alvarez said it’ll take time, but she believes more directors and leaders in medicine are making physician well-being a priority as they recognize issues like excessive job demands, administrative burdens, erosion of provider-patient relationships and others that plague the workforce.
Dr. Stephen Huot, director of graduate medication education at Yale School of Medicine and the New Haven hospital, said in a written statement that the profession places a great deal of responsibility on trainees and others, which is why providing care to those professionals has risen to the forefront.
While there’s more to do in this area, Huot said the Yale health system has taken several steps in the last couple years to support its residents and fellows that have included taking feedback and recommendations when making changes to the working environment, making behavioral health resources accessible in a confidential way, and creating a diverse workforce that reflects the communities providers serve.
But Dr. Alice Shen, a psychiatry resident at Yale New Haven Health, said physicians in training around the country continue to struggle. Several training doctors at the committee meeting held up signs that said, “I signed the Bill of Rights because residency made my friend depressed and suicidal,” and “I signed the Bill of Rights because wellness initiatives are not enough.”
“If someone that I know who is in training doesn’t have depression or has never experienced that, I see that as the exception, actually,” Shen said.
Financial, personal and career-related pressures on top of any behavioral health issues can make people feel trapped, she said, and the reality of day-to-day tasks can diminish doctors' passion for their work.
“I feel like I went through medical school because I like being with people, but then I realize, as a resident, my job is to just make the hospital money, like I’m just there to sit at a computer and type notes so that they can bill for things,” Shen said, “and then maybe if I’m lucky, I get to spend like 10 minutes with someone and listen to them, but then there’s always the pressure of like, that’s not actually my real job, my real job is to just be a paperwork monkey.”
Major medical organizations have pledged to address and review changes to graduate medical education policies and requirements. At Yale New Haven Hospital, residents and fellows say they hope adopting a bill of rights is one step among many that may lead to change — if not for them, then for future trainees.
If you or someone you know is experiencing a mental health crisis, call the National Suicide Prevention Lifeline at 1-800-273-8255.