Pathology Resident Burnout

While the duties and responsibilities of a pathology resident differ drastically from our clinical colleagues, the demands on our time, energy, and resources are no less draining on our physical, mental, and emotional health. It's important to recognize that even pathology residents can suffer from burnout. Below are a few reasons why pathology training can lead to burnout and what you can do about it.

These are just four of many reasons contributing to pathology resident burnout. 

1. Long hours. The laboratory has a precise and linear workflow that requires a specific stepwise approach over a 24-hour cycle. As a pathology resident, you are often required to participate in many different parts of the pathology workflow. With so many moving parts in the laboratory, it can easily make for a 12-hour day, every day of the week, depending on the rotation. This might be a typical anatomical pathology schedule in your institution:
1. 7:30 AM: Morning lecture 
2. 8:30 AM: Grab first cases of the day 
3. 10:30 AM: Gastrointestinal (GI) consensus conference 
4. 11:30 AM: Grab more slides 
5. 12 Noon: Eat lunch while you read more cases 
6. 1:00 PM: Head and Neck (H&N) consensus conference 
7. 2:00 PM: Begin grossing your first specimen for the day 
8. 5:00 PM: Get called out of the gross room to review special stains and immunohistochemistry 
9. 6:00 PM: Start grossing your next large specimen for the day 
10. 8:00 PM: …still looking for lymph nodes… 
11. 8:30 PM: Throw in some fat and call it "fat for possible lymph node capture" and call it a night 

And this is only an example of an average day. 

2. Learning a completely new skill set. In medical school, you likely had very little exposure to pathology. This can be very disheartening and make you feel like you are starting over in your journey to becoming a doctor. 
1. Sitting at a desk all day. Some of you may be involuntarily sedentary at work instead of walking around the hospital. 
2. Standing all day. Conversely, you might be standing at a gross bench all day that is 1 foot too short and your back and feet ache. 
3. Staring through a microscope. You're likely starting through a microscope 8 to 10 times longer than you've ever done before, which in turn causes eye strain and headaches. 
4. Poor ergonomics. You were never taught proper desk ergonomics in medical school, so your current positioning and setup lead to back and neck pain. 
5. Feeling like you'll never learn enough. You may get this creeping feeling that you will never be able to learn everything you need to to become a practicing pathologist. 
3. Research. By comparison, some of our clinical colleagues have it easy when it comes to research expectations. Many pathology programs expect research without accounting for the labor intensiveness of the endeavor. Your schedule is already full of service and learning responsibilities, and it's rare that your program will allot time for your research. Regardless, you still are expected to produce abstracts and posters and submit manuscripts to journals. This doesn't include the times when clinical residents ask you to take histology pictures and teach them about their own research projects, and you're not guaranteed to be included as an author in their paper.
4. A sometimes thankless job. You provide a valuable service by making the diagnosis, but this value often goes unrecognized. Patients and even physicians have very little knowledge about what you do, and sometimes it can feel like you're taken for granted. You don't have the benefit of making someone feel better and seeing the relief on their faces. There is satisfaction and reward to be found in making the correct diagnosis, but some pathology residents aren’t accustomed to this at first.

It is a difficult exercise to be self aware and know your own emotional well-being. Often times, those who are close to us recognize something is wrong and try to help. Remember the CAGE questions for alcohol screening? If you're feeling someone's RATH (sounds like wrath), they might be just trying to see if you're getting burned out and want to help.

RATH Screening

• Regretting your choice in residency training
• Anger easily
• Tired more than usual
• Hobbies and activities are no longer enjoyable

We are all going to get stressed. It's just a matter of what you can do to manage it so that it doesn't lead to serious burnout. Here are some excellent methods to stave off burnout:

1. Hobbies. More specifically, find something outside of work that you really enjoy and take it to the next level. Annie, one of my co-residents at Indiana, is famous for her food blog Annie's Eats. You can tell she spends a lot of quality time in her kitchen, and in an oblique way, her grossing skills and kitchen skills are complementary. A quick review of her website makes it easy to see why she was the nicest and most affable resident in our program. She was even chief resident.

   For me, my extra-pathology hobby was ultimate frisbee. I hadn't played since intramurals in undergrad so I decided to pick it back up. Late PGY-2, I bought myself a pair of cleats and a frisbee and started learning how to improve my game. I found a local pickup game and pretty soon I was playing every week. This dovetails well with the next method.

2. Exercise. Exercise may seem like a no-brainer, but we often struggle to find the time for quality exercise during residency. In an effort to remain scientific, research published in Journal of Graduate Medical Education provided the the following summary
   1. More than one half (53.9%) of the residents were determined to have burnout, as measured according to the Maslach Burnout Inventory-Human Services Survey. Of note, residents who were able to meet physical activity guidelines were much less likely to be burned out than their fellow residents (odds ratio, 0.38; 95% confidence interval, 0.147-0.99).
3. A day to relax. Everyone needs one day each week to take time for themselves. Those with a religious background may use their day of rest to attend a service at a local church, temple, or mosque. Others might unwind with a fun book, take a hike, sleep in, or binge on Netflix, Hulu, Amazon Prime, or HBO Now. The point is that you’re taking time to focus your mind on something other than work.
4. Volunteer. Volunteering is one of the best ways to both give back and take your mind off your own daily stresses. Luckily, working in a hospital means there are abundant opportunities to volunteer. Volunteering doesn't necessarily require a special skill set, but there are times when you can leverage your experience as a pathologist. For example, the CAP Foundation sponsors the See, Test & Treat program, which provides free pap smears to women in underserved communities. You can visit their website and see if there is an event near you. Nonetheless, there are hundreds if not thousands of ways to volunteer in your community. Sometimes it's as simple as checking the homepage of your hospital's website.

You are only beginning your career as a physician. According to the 2016 Medscape Lifestyle Report, 45% of practicing pathologists report burnout at some point in their career. Now is the time to learning how to manage the stresses of a career in medicine and the unique challenges of being a pathologist; it can only help you in the future.