Life… After Residency?

by Kyle Sanniec, MD, MHA (@DrKyleSanniec)

“I can’t wait for residency to end so my life can begin.” This phrase was recently spoken at a national meeting from another resident nearing the end of their plastic surgery residency.  While perhaps a flippant remark, there was definitely truth in what they said.  I think this is a trap that many residents fall into.  I have spoken to many rotating medical students aspiring to become plastic surgeons who have similar thoughts.  Plastic surgery residency is a 6 year “sentence” of sleeping, eating and studying plastic surgery.  Six years of putting “life” on hold to focus on your craft, after all we only have 6 years to learn as much plastic surgery as we can, so it’s necessary to postpone life so to speak.  It makes sense, we do 4 years of undergrad, 4 years of medical school, and residency seems like the next process on an assembly line of making us plastic surgeons.  There is a reason plastic surgery is one of the hardest specialties to match into, and as such requires significant personal sacrifice.  It is no wonder it leads some to feel that life is on hold.

However, in my experience, “postponing” life only leads to resentment and bitterness and ultimately leads many plastic surgeons to leave the field entirely.  While residency is a challenging time, it does not need to be devoid of “life” pursuits.  In my residency program, residents have gotten married, had children, traveled the world, trained for fitness competitions and competed in endurance races all while thriving in the residency environment.  Granted, there are seasons and rotations in residency where those pursuits have to slow, but they should never be completely put off. In fact, putting off life pursuits decreases plastic surgery resident’s satisfaction scores leaving them dissatisfied with their career plans.  This increases the plastic surgeon burnout rate (1) and decreases career satisfaction (2, 3).

Schwingshackl (4) has a fascinating article that discusses the problems with compartmentalizing work and life in medicine.  In summary, he comments that keeping up this distinction prohibits us from enjoying our lives.  We freely chose plastic surgery as our field and it is part of our life.  It shouldn’t be a separation but rather an integration into our lives.  Our time in residency isn’t simply relegated to a task we must complete before we can enjoy life, but integrated into our life.  Residency is a time for us to build and create indelible relationships with our co-residents doing something together that is truly special.

As Schwingshakl further explains the hours spent treating patients is just as much a part of our lives as a family vacation or our exercise regimen. The border between life and work has vanished and we are no longer forced to “postpone” our lives until the rotation is done, or the exam is finished or residency is completed.  Bajaj (5) sheds light further on the “work-life balance” fallacy that “work” is inherently bad/obligatory and “life” is inherently good. There are plenty of times when “work” provides immense satisfaction and joy.  There aren’t many things that can provide more satisfaction than being able to deliver a successful surgical result that greatly improved one of our patient’s lives. If you ask most plastic surgeons, it’s what originally drew them to the field.

In addition, by seeing residency as a “sentence” we are missing out on the deeper residency experience. There are very few things in life where individuals can be teamed up and accomplish something greater than the sum of their parts.  The synergistic effect of a service from intern to chief resident, working together against difficult odds to deliver great patient care, running around covering cases, seeing consults, preparing for conference.  Lasting memories that define your residency experience and helps to develop lifelong friendships in return.

Each year at our resident graduation, various alumni classes return and in a matter of minutes of being around their co-residents they snap back, retelling story after story as if it happened yesterday.  Each story seemingly better than the last, and all playing a significant role in not only their professional development as surgeons, but also in their personal development.  Residency was hard, but one of the best times of their lives.  The bond with their co-residents forged from the constant replants and conference prep, to bad evaluations from difficult faculty members or in-service exams, but also from spending years doing life together.

If we are so focused on the result, finishing residency and “starting life”; we miss out on the many great times that residency affords us.  Even something as simple as reminiscing about a crazy call shift over drinks or haggling over an “unfair” in-service question is something that can’t be replicated once residency is over with.

As the new academic year starts, and hundreds of new interns start the process of residency, it’s important for them, and for all of us to remember that residency isn’t a sentence we have to serve before our life can start, but rather a great opportunity of pursuing both our passion for plastic surgery as well as our personal goals with driven likeminded people.  I encourage every newly minted resident to have not only professional goals for each year but also personal goals.  While this may be daunting on July 1, when you are still trying to learn how to order Tylenol, it is necessary for long term wellness and personal satisfaction.  Remember life doesn’t stop for residency, in fact, if we let it, we may find that residency was one of the greatest times of our lives.  Instead of separating “work” (residency) and our “life”, we should be integrating the two together, fully living up to the moniker of “integrated plastic surgery residents”.


References:

  1. Chaput, B., Bertheuil, N., Jacques, J., et al. Professional Burnout Among Plastic Surgery Residents: Can it be Prevented? Outcomes of a National Survey. Annals of plastic surgery 2015;75:2-8.
  2. Qureshi, H. A., Rawlani, R., Mioton, L. M., Dumanian, G. A., Kim, J. Y. S., Rawlani, V. Burnout Phenomenon in U.S. Plastic Surgeons: Risk Factors and Impact on Quality of Life. Plastic and Reconstructive Surgery 2015;135:619-626.
  3. Streu, R., McGrath, M. H., Gay, A., Salem, B., Abrahamse, P., Alderman, A. K. Plastic surgeons’ satisfaction with work-life balance: results from a national survey. Plast Reconstr Surg 2011;127:1713-1719.
  4. Schwingshackl, A. The fallacy of chasing after work-life balance. Frontiers in pediatrics 2014;2:26.
  5. Cheesborough, J. E., Gray, S. S., Bajaj, A. K. Striking a Better Integration of Work and Life: Challenges and Solutions. Plast Reconstr Surg 2017;139:495-500.
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