I’m a child psychiatrist. Psychiatry has historically had a reputation of being a more “touchy feely” specialty compared to something more “Hulk smash” like orthopedic surgery. Regardless of the specialty, the same ideas apply.

What I find ironic about the whole institution of medicine is that we teach empathy and compassion in the delivery of patient care while simultaneously rewarding terribly unhealthy behaviors in our own profession behind the curtains.

We “cash out” physicians if they don’t take vacation or sick days, we turn our noses up at mental health days, we call our trainees lazy when they ask to leave early for a family event. We rapid fire questions at them, then tell them they’re stupid and need to study more if they get an answer wrong. And when they start to internalize the message we send them that they’re not smart and won’t be good doctors we call them weak and threaten to drop them from the program because “maybe you’re just not cut out for this.”

We also do a terrible job of helping trainees navigate through the other parts of their life, the non-medical side including:

-financial planning
-interpersonal relationships
-transitioning from a medical student to a resident to a fellow to an attending
-becoming a homeowner
-paying off debt
-managing stress
-talking about depression/anxiety/addiction/physician suicide

We don’t teach our kids to be confident, compassionate and competent by telling them they need to study more or they’re going to get kicked out of school. So why do we treat our trainees this way?

As responsible educators our goal should be to inspire, guide, and help them manage and navigate the struggles they are experiencing so they become capable, empathetic and successful beings.

I just finished my fellowship. It took me 14 years (5 years of college, 4 years of medical school, 3 years of residency, 2 years of fellowship) to get here and I’m exhausted. I feel like I’ve been running myself ragged these last few years doing somersaults through flaming hoops and obeying commands from the “powers that be” like a circus animal.

What sustains me is my love for what I do, the support from my family, and my ability to compartmentalize. But not everyone is lucky enough to have these supports available to them.

Just because academic medicine has historically been stoic, cold and Machiavellian, doesn’t mean it should continue to be. In the realm of research science we reward innovation, ingenuity and progress. In my opinion academic medicine should be no different. We should not continue to teach by humiliation, sleep deprivation, competition or allow the mistreatment of trainees simply because “that’s how it’s always been.” When our generation of physicians is gone our trainees will be our legacy. And we should ask ourselves, is this the mindset we want to perpetuate?

I argue that there is a better way, and ideas for what that looks like should come directly from our trainees. They have the brightest minds and biggest hearts. Because despite the inherent struggles, astronomical debt, and personal sacrifice that is asked of them, they knowingly take on the imperfections and challenges of the system to take care of patients.

They should be the beacon we follow not the ship we allow to crash against the rocks.

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