manage stress on call residency

How to Manage Stress During an On Call Residency

Medical residency is notorious for its heavy workload and long hours, which usually includes a rigorous call schedule. The perils of being on call include even longer hours with little to no sleep or food, incessant demands, and situations that are mentally, emotionally, and physically draining. Being on call compounds stress, as it taxes the mind and body for an extended time period, sometimes with little or no chance for rest. This can leave one feeling desperate and hopeless, but knowing how to manage stress during an on-call residency can not only help you survive, but flourish during the residency years. 

Many stress management techniques seek to reduce or eliminate stress, but in the trenches of an on-call residency, this usually isn’t possible. Stress is inherent and inevitable. The good news is, that the traditional elimination and reduction strategies aren’t the most effective strategies, anyway! Reframing and managing stress differently is the key to reclaiming control and maintaining balance in the midst of the chaos.

Perspective

Much of what happens on a call shift is outside the realm of control, but this does not render you powerless. Identifying what you can control, focusing your energy there, and keeping things in perspective puts YOU in charge, even when your circumstances are unpredictable. 

Perspective sets the stage for how we interpret external events. Expecting the worst will filter your inputs through this lens, making the negatives stand out in your mind. 

Being realistic is important, but giving the negative too much attention will only feed stress levels. There is no escaping the ugly side of call, but try to look for some positives throughout your shift to keep you grounded, such as enjoying the satisfaction of helping patients and fulfilling your mission, or looking forward to time spent with family or vacation. Look for glimmers of hope and cling to them. 

Proactive Stress Management 

While call is unpredictable and mostly outside the realm of your control, you can set yourself up for success during those shifts by starting from an optimal state. Healthy activities, such as proper nutrition, physical activity, recreation, sleep, and nurturing relationships give your mind and body the raw materials they need to process and manage stress during your shift. The strain of call can easily bleed over into your off-hours, as it’s hard to return to a relaxed state after such an intense one. Set firm boundaries and guard your precious time off. 

Devoting time to the above activities will increase your odds of functioning at your best during working hours.

Take control of your time

It’s often the latest and loudest inputs that get our immediate attention, especially in an on call scenario. Medicine is full of crises, but it’s also about using time effectively. 

A major misconception on time management is that all time is created equal, but research has proven this assumption misleading. We tend to get more done in eight hours of work if we take breaks (even five minutes) every couple of hours. This is because breaks give our mind a brief rest and reduce stress while enhancing focus, relaxing the mind, and improving decision-making. While they may be seen as taking away time, breaks make the use of time more efficient.

Taking a break will be easier on some shifts than others. Some may fear being perceived as lazy or making a poor impression on superiors. If you are apprehensive, talk to your senior residents or attendings. Better yet, show them this feature article from the APA as it logically explains the benefits of breaks with numerous evidence-based research studies to support your case. If you are a senior resident, contribute to setting a precedent by encouraging others to take breaks and helping cover them while they do. Unfortunately, the archaic viewpoint that breaks are lazy still lingers in some residency programs. They simply may not always be possible, but try to establish a habit of prioritizing time for yourself, even amidst a busy shift. 

Take Care of Your Body 

Residents are human beings confined to the limitations of the human body. The body’s state plays a key role in regulating stress. For example, hunger and fatigue can increase stress. Sleep is not always possible on call, but you can try to be well-rested before call begins. Meals are not always possible either, but healthy snacks, such as a protein bar as opposed to potato chips, give the body needed nutrients to fuel performance, including stress regulation.

Realistically, sleep, healthy nutrition, and exercise are not always possible, but try to prioritize them in your schedule. Doctors can be taxed beyond their limits with incessant demands, high stakes, and little reprieve. Even if a break isn’t possible, taking just a few seconds to breathe deeply can give the body a needed oxygen boost and lead to clearer thinking and lower stress levels. 

If traditional stress management strategies are not helping you manage the stress of an on call residency, trying a new management technique may be the answer. The above suggestions are by no means exhaustive, but they do form a solid foundation for prioritizing yourself and putting yourself in control. Try these strategies and use them as a starting point to explore new stress management strategies. To further explore ideas, see this article from Very Well Mind, or this article from Healthline, both of which give a variety of options to inspire you.

It’s been said that doctors don’t make the greatest patients, but proper mental wellness is critical to your success as a physician. If you think there may be something more going on than the typical stress of an on call residency, reach out to one of these physician-specific mental health resources. They understand what it’s like to be in your shoes and can help dig deeper into what may be troubling you.

  • Elizabeth is a Physician family advocate, Certified Life Coach for Physician Wives, EM wife of 20+ years, mother, and founder of The MedCommons – a marriage between her tech/business dev background and passion for helping physician families.

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