Emergency Medicine Residency Survival Guide

How to survive Emergency Medicine Residency.


Graduating from emergency medicine residency is a career milestone, but if you leave a pile of emotional baggage, a broken family, and rampant discontentment in your wake, then is it worth it? Thankfully, our EM leadership has recognized wellness as vital to resiliency and career success, and has invested significant effort and emphasis into improving our community’s wellness collectively and individually. According to ACEP’s free publication – Being Well in Emergency Medicine: ACEP’s Guide to Investing in Yourself – “wellness” is defined as “a state of complete physical, mental, and social well-being.” This guide is a thorough 128 pages, so it really gets into the weeds with some topics, but overall it is a great resource that should at least be perused during residency and digested in whole later. Below are some of my simple thoughts and practices that allowed me to survive and thrive in residency.

NMCP EM resident community service wellness activity.

My Story. A few years ago, I heard incredibly impactful words of wisdom regarding time management in residency while watching a YouTube video interview of a Crossfit Games athlete – I know, lame. When talking about her life, Crossfit, and her pursuit of Medicine (currently a Family Medicine resident), Julie Foucher referenced the Oprah Winfrey quote, “You can have it all. Just not all at once.” Another similar quote echoes, “You can do anything, but not everything.” At that time, I was about to return to residency, I had accumulated a plethora of interests and hobbies, I had many life and career goals, and I was married with four kiddos to support and entertain. The Oprah Winfrey quote hit home. We live in America, the land of freedom and opportunity. If your imagination and work ethic are epic, you can do anything. But you can’t have everything at once, especially during residency.

You can have it all. Just not all at once.

Oprah Winfrey

During residency, you must suspend many of your interests, hobbies, spare time, time with family, time alone, etc. to merely survive and graduate. So, I deeply evaluated my priorities, and established a general guideline for how I would focus my time during the next few years of training. I finished with a list of alliterated words that all started with the letter “F.” These priorities are incidentally somewhat similar to the ACEP’s Seven Spokes of the Wellness Wheel. Residency is without explanation the most important aspect and the centerpiece of these few years, so if you have not already done so, review all of the information above to succeed in this area. So outside of the above information, how did I survive and thrive in residency? What is the glue that held me together?

McAfee Knob on the Appalachian trail during a Backpacking Medicine Course.

Family. The most important people to me in the world are my family. It seemed pointless to me to succeed in residency but fail as a husband and father. Thankfully, my wife is awesome, very independent, self-motivated and adventurous, so the family continued life with or without me. Some months are better for family life than others. During many of the inpatient months, you will leave in the morning long before the family is awake, and arrive home late at night exhausted and fall asleep on the couch, only to repeat this cycle over and over again. And your few days off are spent merely recovering, catching up on sleep and admin work, and prepping for the next day. Other months are great – electives, selectives, toxicology, ER months – purpose to spend more quality and quantity time with your family then. It seemed there was always a project brewing, or a task to complete, or a test or board to study for, but sometimes, you just need to set those things aside and play with your kids, or watch a TV show while drinking a glass of wine with your spouse/SO. Make sure that you also schedule specific vacation time each year and do something that the family loves – Disney, camping, beach outings, etc. Maximize your allowed vacation time away from the residency every year, you and your family need this.

You can do anything, but not everything.

Avoid bringing work home, or at least avoid bringing the stress of work home. Some have a specific time period of decompression before they drive home, I never established a personal rule, but maybe I should have. Occasionally, if I did not decompress after an especially difficult shift, I found myself impatient and short-tempered with my children when they acted like children, which is asinine, right? It seemed that I gave all of my good energy to the residency, and the family just got the left-overs. It took me a while to figure this out, but recognizing this as an issue is important. So whether you listen to a non-medical podcast on the drive, or wait an hour before heading home, or spend some time meditating, or workout in the gym first, whatever works for you, figure that out. Also, despite their ultimate importance, you occasionally need alone time away from the family for your own resiliency. Hopefully your family or significant other is as understanding as mine.

Family hike at Tarzan Falls in Guam.

Faith. I’m a Christian, and participated as much as able with my church during residency, which unfortunately was not much due to the busy residency schedule. Occasionally, I played guitar in the worship band, which was a nice creative release and a time to spend with other fellow believers. Whatever your faith may be, or whatever centers you, make sure that you maintain that to some degree for your own spiritual health. This will ultimately make you a better and more balanced physician, and will free you to invest yourself into your professional purpose and into your patients.

The kiddos touring the USNS Comfort.

Friends. During residency, you will bond with others in your profession in a way that may never occur again to that magnitude in your professional life. Enjoy it. Enduring adversity with a group of likeminded individuals creates a brother/sister-hood that is not easily broken. Pizza and beer while laughing and complaining with fellow residents after long week is emotionally therapeutic and also normalizing. Occasionally, residents hosted house parties that I believe contributed significantly to the robust morale and teamwork of our residency program. Of course we all had our low points, and you will likely have a low point at some point during residency, this is normal. But providing a listening ear and a gentle hug are often enough to encourage each other and lift each other up. Our residency program also provides many official opportunities to get together, enjoy life, and decompress – Journal Clubs, Christmas Parties, the annual Kangaroo Court and Graduation Party, the Summer Welcome Party, and various other similar activities. Enjoy these protected moments away from the craziness of residency, and when able, spend time with your friends.

NMCP EM Residents ready to rock in “Casualty Receiving” (CASREC) during the USNS Comfort Exercise (COMFEX).

Fitness. It is my personal belief that we as physicians should model to our patients the ideal image of physical and mental health. Many of the diseases that we encounter daily are a result of poor life choices – the consequence of unrestrained, undisciplined living and the ravages of the metabolic syndrome. Physical fitness combined with a relatively healthy diet would prevent much of the first world health problems that pervade our health care system. As naval officers, it is especially important to maintain some level of fitness, our bodies are the engine and the tool through which we accomplish our responsibilities. Someday, our patients, our service members, may rely on our health and fitness for their survival. I’m not advocating that you maintain athlete level fitness during residency, but do something, hopefully regularly.

Many of the diseases that we encounter daily are a result of poor life choices – the consequence of unrestrained, undisciplined living and the ravages of the metabolic syndrome.

Before residency, I set a goal to work out at least every 3-4 days on average, and I met that goal despite being a husband, father, home-owner, and chief resident. If I can do it, you can too. Whether you run, swim, bike, lift, or physically exert yourself in some other fashion, just get after it. I’ll admit, often I did not feel like working out, but just starting a work out was all I needed. It became so much easier after that. Building my own small home gym helped tremendously. Despite limited time, I could walk out to my garage and start lifting. The greatest thing about having a home gym was that I didn’t have to leave my home to work out. Often my kids would “work-out” with me, and my wife would join as well. So we spent time together as a family, it was a much more efficient option than driving to a gym, and it established good habits and a healthy mindset for my family as well. The gym cleared frustrations and reset my mind, provided a sense of accomplishment outside of medicine, improved my mental toughness and stress modulation during shifts, and just helped me feel better over all. So just get after it. You can do it.

Get after it!

Fun. If you have too many interests and hobbies like me, these need to be sacrificed during residency due to the limited time and the importance of the other variables. But don’t eliminate them completely, you need something to pursue outside of medicine that brings you meaning and satisfaction. Whether you occasionally hunt, fish, climb, ski, snowboard, home brew, shoot, dive, run, swim, lift, read, travel, etc. Of course, this will be in a limited fashion, but it will make you a much more balanced and fulfilled emergency medicine physician. I chose to invest my extracurricular “fun time” in physical fitness and the occasional wilderness medicine pursuits, and nearly fulfilled the requirements for my FAWM (Fellowship of the Academy of Wilderness Medicine). We need an outlet. Those who only “do medicine,” often don’t last long in the emergency department. Creating occasional time during residency for fun pursuits will establish healthy career habits that should continue after residency.

A couple that plays together, stays together.

Food. During busy ER shifts, I quickly realized that I had to eat or my brain just hit a wall. As a junior resident, I didn’t prioritize eating and near the end of shifts I found it hard to think, I experienced headaches, and I felt physically weak. No matter how busy the ER becomes, your brain needs glucose. My routine became: eat a good meal before each shift, drink a cup of coffee during the first few hours, and then down a zero calorie “White Monster” (caffeine bolus) and eat a quick lunch halfway through the shift. I also ate snacks throughout the shift – jerky, fruit, granola, etc., and drank multiple Nalgenes of water to stay hydrated. You and your patients need you at your best, your brain needs fuel, so figure out a system that works for you. But you need to eat.

ACEPnow for the win.

Finances. The last thing you need to stress about during residency is your finances. Don’t be tempted to buy the big house or to over-extend yourself financially in other ways. Residency is temporary, and the work of residency should be the main source of your stress, not wondering how you are going to pay your bills. A great resource for physicians is the White Coat Investor. Dr. Jim Dahle is an EM physician who established the White Coat Investor website to “help those who wear the white coat get a fair shake on Wall Street.” He now hosts a blog on his website, a podcast with a plethora of great information, and he has also written multiple books – The White Coat Investor, Financial Boot Camp. Both of these books contain great advice, thankfully we had fulfilled a lot of his recommendations already, and now that residency is complete we are investing much more effort into living financially responsible. Appropriately, Dr. Dahle’s advice is tailored for physicians, and he occasionally offers advice for military physicians in his books and podcasts (he was a former Air Force MD). Dr. Joel Schofer, one of our own Navy attendings, also gives excellent financial advice on his blog and podcast MCCareer.org. He was featured in the White Coat Investor Podcast #92 “Being a Military Doctor,” and contributes regularly to AAEM’s Common Sense regarding physician specific financial concerns. Being squared away financially will erase much unnecessary stress and will allow you to focus on what truly matters during residency.

One of the many beautiful panoramic views on the Appalachian Trail.

The Light at the End of the Tunnel

Remember, residency is a finite period, so make the most of it! Study hard and prepare diligently for the rest of your career during these few years. Make sure though that you incorporate life habits that will help you survive and succeed in residency and beyond. A word of encouragement…staff life is awesome! Just keep on crushing residency, and get after it!

NMCP EM Class of 2019.

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