Dear young doctor,

What to say to you? There are few times with as much emotional upheaval as the transition from medical school to residency, both in your professional and personal lives. At graduation you feel proud, satisfied, and excited about your future. You are still excited but increasingly apprehensive and stressed as you start residency. Perhaps some lyrical inspiration from Hamilton: An American Musical can carry you through this challenging time in your career (all lyrics appear in italics).1 

Welcome to our noble profession. While you are eager to help patients and start a long career in health care, you may also be skeptical about the challenges of being a physician. But look around, look around, at how lucky we are to be alive right now. Medical knowledge is growing exponentially, allowing us to offer more treatment options, and health care innovations are afoot.

As you gain your diploma, move to a new city, get your first long white coat, and try to learn the halls of your new hospital, you are likely energized and inspired, thinking: “I'm young, scrappy, and hungry…There's a million things I haven't done. Just you wait.” Regardless of your path to medicine, regardless of your upbringing, especially if you got a lot farther by working a lot harder, by being a lot smarter, by being a self-starter—you are here and you are now a physician.

Your excitement at this momentous occasion is best tempered with some cautious optimism. There will be tough days at the hospital, when you're spending more time in front of a computer than at the bedside, when you're nervous about violating duty hours again, when you think, “there are a million things I haven't done,” when you or your peers face an endless uphill climb.

But, look at where you are, look at where you started. On those difficult days, know that physician wellness, burnout, and resilience are as much about the system you work in as they are about you. The negative health consequences of being a physician are real. The job doesn't discriminate between the sinners and the saints; it takes and it takes and it takes, but we keep living anyway. Medicine may take from us on a daily basis; it may contribute to depression, burnout, and physician suicide; it may contribute to work-life imbalance like delayed pregnancy, infertility, and changes in career plans when we start families.

The challenges of wellness in work and life are now an increasingly common part of discussions in health care. As you move through your new career in medicine with varied pace, sometimes feeling like life is passing you by at light speed, remind yourself to slow down and think, “I am the one thing in life I can control—I am inimitable, I am an original.” We hope that this will empower you to be willing to wait for it and also to be an instrument of change so that you are not waiting too long.

Can you recognize the signs of burnout, in yourself or in a colleague? Ask for help when you need it; speak up when you see a colleague suffering or in need of help. Know that other people are working to improve working conditions to combat physician burnout. We'll bleed and fight for you. We'll make it right for you. If we lay a strong enough foundation, we'll pass it on to you, we'll give the world to you, and you'll blow us all away. But do not leave advocacy to the older members of the profession. Residents and students absolutely deserve to be in the room where it happens—to be part of the story you will write someday. Let this moment be the first chapter.

Another big recent change in health care is the realization that diversity is a strength. For decades, there were many groups of physicians who were told to talk less, smile more—women, underrepresented minorities, international medical graduates (IMGs). Those of us in those groups have felt like we have to holler just to be heard. But momentum is building; it's time to rise up, wise up, eyes up. Time's up.

Despite current anti-immigrant and anti-refugee policies as well as broader racial and ethnic biases, we know that immigrants, we get the job done. Outcomes improve with diversity and inclusion, and the US health care workforce relies on IMGs, especially in rural underserved areas. If you are an IMG and you feel like you are another immigrant coming up from the bottom, know that greatness lies in you, and no matter where you went to school or where you end up practicing you can make a difference. History has its eyes on you.

Be it through gender inequity or sexual harassment, women in medicine have for decades had reason to think, “So men say that I'm intense or I'm insane.” Women are now 50.9% of medical school applicants and 51.6% of matriculants,2  but only 42% of medical school faculty, including 25% of full professors.3  In Hamilton: An American Musical, while Angelica wanted to compel Thomas Jefferson to include women in the sequel, movements like TIME'S UP Healthcare give us hope that we will be included not just in the sequel, but the primary narrative. This is not a moment; it's a movement. If we continue to be intentional about diversity, inclusion, and equity, tomorrow there'll be more of us.

At the end of the day, and every day, remember that you became a physician to care for patients. Be encouraged and empowered by initiatives like Patients Before Paperwork4  and ACGME's Back to Bedside initiative.5  For all the administrative hurdles and challenges our profession faces, do not forget to ground yourself in your patients' stories. Put your patients back in the narrative.

Make the most of residency training: you've gotta start a new chapter, gotta get the job done. It may not be a smooth journey, but you have to seize the moment and stay in it. Being a physician is a heavy responsibility. Don't forget from whence you came, because the world's gonna know your name, doctor. We have the honor of seeing your mind at work.

Hamilton: An American Musical [music recording]
Avatar, NYC
Atlantic Records;
Association of American Medical Colleges
2018 Fall Applicant and Matriculant Data Tables
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Association of American Medical Colleges
US Medical School Faculty
Medical Practice and Quality Committee of the American College of Physicians. Putting patients first by reducing administrative tasks in health care: a position paper of the American College of Physicians
Ann Intern Med
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Accreditation Council for Graduate Medical Education
Back to Bedside