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Burnout and mental health

After yesterday’s post on the whole match situation, I figure it’s probably time to talk about burnout. Because truthfully when you work yourself past your limit and you get even a small rejection, much less a rejection of that magnitude, you’re setting yourself up for a bad time. As a society we are told to push ourselves, to work harder, to “grind” as much as we can because only then will the system acknowledge our worth and reward us for our efforts. It’s a lie and we all know it, but propaganda is a powerful thing.

The thing about burnout isn’t exactly that it by itself is bad. It is, don’t get me wrong, but it isn’t something that you hit like a wall, instead it’s like quicksand, you slowly start to sink and by the time you realize something is wrong you’re barely breathing. Yet most of us, when we find ourselves burt out and unable to focus on the work we need to, push ourselves even harder because we’re not supposed to feel this way. We are supposed to be productive and when we aren’t productive we’re told to feel bad about ourselves, I think we can all agree when you take a break you feel anxious about not producing.

I think when you’re doing a PhD or frankly any sort of advanced degree, MD for example, you fall into this trap more than you would like to admit. The problem is that were told that if we push ourselves like this, if we break every bone in our body and keep moving because we have to be that strong, if we bleed and starve and hurt, if we grind ourselves to dust, we will get a pat on the head for being a good worker.

Instead what we often get is a kick to the face.

Burnout puts a person in a very bad position mentally and when a small failure comes around it can feel earth shattering. When something big happens, like say not matching, it can feel like you are worthless. It’s incongruous with what we’re told, so the problem isn’t the system or the culture, clearly the problem is… us. We didn’t work hard enough, weren’t smart enough, didn’t DO enough, we weren’t deserving, so we weren’t rewarded.

The truth is that a lot of this is luck, from match to a PhD, hitting your milestones the exact way you want, or are told to do it, is not a matter of not working hard enough. You’re in the program and doing the things you’re doing because you belong, not because you aren’t doing enough. It’s the system that is the problem and the fact that we do need to rely a lot on luck to help us make the plodding march forward. However, when you’re in the middle of it, you can’t really see it and that’s the problem.

If you’re too tired to fight, then there’s nothing for you to do except rollover and I think that’s partly why the system exists the way it does. To make sure we as a society are so tired, so burnt out, we won’t question why the system is so crappy. The cost is obviously our mental health and in a lot of cases that bleeds over into our physical health, because if we’re completely honest with ourselves, they are very much related concepts.

I know I’m tired and my mental and physical health suffer. I don’t think I’m alone here.

Today ends a very stressful time for medical students, going off to residency programs is a huge step forward. For the PhD crowd, this time period is also grant season and fellowship season where a lot of us find out if we’ll be getting paid or not. That’s an oversimplification, but it is a worry I’ve only recently had success dealing with. For medical students the celebration is quite a bit more public because it comes all at once unlike grants/fellowships which have a range of announcement periods.

With the announcement not only of a successful match, but today med students find out where they are headed, there will be another wave of celebration. After all, they earned it. If that isn’t you and you either didn’t get matched during SOAP or didn’t want to take on the stress of SOAP, this isn’t anything to do with you, it’s the system that’s broken, not you.

I can’t pretend to know what students who didn’t match are feeling right now, but I do remember seeing fellowship announcements when I got passed over and feeling pretty fucking worthless. Last year the number of people who didn’t match was over a staggering 8,000 people (official count). Numbers like that help keep things in perspective because this year I’m seeing estimates of roughly ~11,000 people who didn’t match even after SOAP.

That’s a systematic issue, that doesn’t mean that there are ~ 8,000 – 11,000 bad or lazy doctors. It means the system is broken. The same thing applies to fellowships and grants. Fun fact, even when grants are awarded they often get cut from the original amount. Imagine giving a budget, having it approved, then later you’re told to cut 20-30% of it out and still do the originally funded project.

In the end, when you’ve hit a point of burnout, then push yourself beyond that, this is probably still not comforting news. For that I am sorry, truely. I hope that one day this will not be the case, the system has been created to be as cruel as possible and not only is that not fair, it leads to deadly consequences for the people who the system spits back out.

As with my last post I want to point out that remaining silent helps no one and only hurts you. If you or a loved one is dealing with a rejection, just poke them to let them know they aren’t alone. If you’re the loved one that is dealing with the rejection, might I suggest talking to someone about it. Friends, family, or as usual the hotline: https://suicidepreventionlifeline.org/ which is literally a lifesaver, I used the veterans version so frequently I literally still have the number on speed dial.

Failure isn’t something to be ashamed about. I promise no one who cares about you, will make you feel bad about it.


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