Medical School

UNC Kenan Flagler Provides Alumni with Strategies to Avoid Post-MBA Burnout

Earlier this month, the Financial Times published an article on workplace wellbeing and burnout. The article included the results of a reader survey on how employers support employees’ mental health. Two-thirds said that their work had a somewhat to extremely negative effect on their health. Forty-four percent said that they did not think their organization took mental health seriously and half said that they either didn’t know where at work to go or had nowhere to go if they needed support. While the survey respondents were self-selecting, the results show a significant issue with employer support of mental health, including stress, burnout, anxiety, and depression.

 The article warns us that the problem runs across sectors, but may be particularly relevant to graduates of law, business, and medical schools; the authors note that “Fields such as law, finance, and consulting seem particularly prone to intense, demanding workplace cultures, but the issue affects people in all sectors. One doctor dies by suicide every day in the US.” Similarly, Blind, an anonymous social app for tech employees, surveyed its users in May 2018 and 57 percent of the 11, 487 respondents said that they were burned out. Only five of the 30 tech companies represented had an employee burnout rate below 50 percent, and 16 of the companies had a burnout rate higher than the average (57 percent). Later surveys, also by Blind, found that 52 percent of tech workers responded that they do not have a “healthy work environment” and that 39 percent of tech workers said they were depressed.

The FT survey also found that reasons behind burnout clustered into four themes: overwork, cultural stigma, pressure from the top, and fear of being penalized. The article suggested that many experts point to an epidemic of overwork resulting from the common expectation that employees be available and responsive to client needs 24/7. “In his book, Dying for a Paycheck, Stanford professor Jeffrey Pfeffer posits that this crisis is getting worse over time, amid stagnating wage growth and an increasing reliance on the gig economy. ‘We are on a path that is completely unsustainable,’ Pfeffer says. ‘The CDC [Centers for Disease Control] tells you that chronic illness is 86 percent of the $2.7tn US healthcare spend. Many come from stress-related behaviours. If you’re going to solve the healthcare cost crisis, a piece of that solution has to go through the workplace.’”

In an acknowledgment of the intense positions that many post-MBA graduates find themselves in, Robert Goldberg, an affiliate UNC Kenan-Flagler faculty member, recently led an interactive session for UNC alumni to build awareness of and strategies for preventing burnout.

First, Goldberg encouraged alumni to explore various “energy zones” which, described below, he adapted from The Power of Full Engagement (Loehr & Schwartz, 2003).

  • Performance zone: Passionate, enthusiastic, engaged, optimistic, alive, challenged, and absorbed

  • Survival zone: Anxious, impatient, angry, irritable, defensive, fearful, and frustrated

  • Burnout zone: Hopeless, exhausted, sad, discouraged, lost, empty, worried, and depleted

  • Recovery zone: Calm, peaceful, grateful, relaxed, receptive, relieved, rested, and renewed

Goldberg said that to stay in the performance zone, you must enter the recovery zone before you enter burnout. As such, those in intense professions may need to spend time recovering every working day. This can be done using various energy management techniques, including physical (stepping away from the desk at regular intervals), mental (prioritizing competing demands), emotional (feeling valued and appreciated), and spiritual (connecting work to higher purpose). 

Finally, Goldberg addressed the importance of “personal resilience” to maintain strong performance, defining resilience as “the ability to become strong, healthy, and successful after something bad happens.”

Goldberg shared the following five factors, summarized below, for building resilience capability:

  • Perspective: Take some space to view a situation, accepting the negative aspects and finding opportunities. “Recognize what can be changed and what can’t.”

  • Emotional intelligence: Become present in your emotions and name what you’re feeling. Don’t feel guilt or shame over the emotions that you experience, but give yourself time and space to process them.

  • Purpose, values, strengths: Be aware of the purpose that you find in your work, and how it relates to your larger moral compass. Use this awareness to stay centered during chaotic times.

  • Connections: Form relationships with your friends and colleagues and give and receive support from this network.

  • Managing physical energy: Take care of yourself. Exercise, eat well, and have hobbies and activities to engage in apart from your work.

Graduate students, particularly within business, law, and medical school, may want to consider incorporating these strategies into their lives now. Building healthy and sustainable stress management habits, within the hectic graduate school environment, will be good preparation for managing career stress, avoiding burnout, and maintaining wellness in the future.

Medical Schools Focus on Student Wellbeing and Mental Health to Reduce Burnout

In our recent newsletter, we highlighted the topic of burnout among today’s working population. Burnout, or the experience of chronic stress which leads to physical and emotional exhaustion, cynicism and detachment, and feelings of ineffectiveness and lack of accomplishment, remains a pressing issue within the medical student population. A literature review published in late 2018 “confirmed that suicidal ideation in medical students remains a significant concern” and cites studies showing that “medical students in their first year of studies have similar rates of psychological morbidity to the age-matched general population, but experience a worsening of their mental health as they progress through medical studies.”

Medical students and residents, who are often under intense pressure physically and emotionally, suffer from a lack of sleep, extremely long hours of work and study, as well as the emotional, life and death decision-making involved in the work. This is often compounded with a subconscious need to avoid seeking mental health professionals for fear of negative judgment from those around them or even endangering their medical licenses.

The accumulation of data on the mental health of medical students, coupled with the recent high-profile losses of medical students in New York City and California have spurred action and a recognition of the need for additional support for physicians in training. The Accreditation Council for Graduate Medical Education is promoting the importance of wellbeing, which goes beyond addressing burnout, and has compiled and posted a tools and resources page on its website: https://www.acgme.org/What-We-Do/Initiatives/Physician-Well-Being/Resources.

Moreover, many medical schools are showing that they too are committed to changing the culture of medical education to improve students’ wellbeing. Prospective students should pay particular attention to the following when further evaluating the schools on their list:

  • Commitment to wellbeing: Many schools have codified their commitment to their students by creating wellbeing mission statements and making significant investments in wellbeing resources. At the Icahn School of Medicine in NYC, a wellbeing task force was created in 2016. In addition to creating a mission statement to focus momentum and drive steady action, the school has renovated student housing to include a wellness center.

  • Accessible, confidential, and judgment-free mental health resources: This may include access to psychologists or psychiatrists, confidential check-in surveys or interviews, and/or counseling sessions during hospital rotations. At USC Keck Medical School and the University of Pittsburgh School of Medicine, mental health teams have been put in place to ensure the schools do not lose sight of the mental health and wellness needs of their students. Both are working to decrease the stigma around using mental health resources as well as increasing confidential mental health evaluations and services.

  • Culture promoting a healthy academic environment: Some schools are taking tangible actions to create an academic environment that promotes rigor but not burnout and depression. Many programs also encourage collaboration, provide wellness curriculums, and promote comradery within the classes through social activities (appropriate for various personality types) and occasional days off. Examples include Duke School of Medicine’s wellness curriculum starting with a resiliency course at orientation, USC’s requirement for students to take several “mental health” days to combat burnout, and Icahn’s assessment and restructuring of grade distributions.

In September of this year, Weill Cornell is partnering with AAMC, AMSNY, and the American Foundation for Suicide Prevention to put on the National Conference on Medical Student Mental Health and Well-Being. It is billed as being the “first comprehensive, multidisciplinary forum to examine the mental health needs of medical students.” Change is underway and it is an exciting time to be considering medical school. However, prospective and current students must engage in the dialogue, stay informed, and ultimately commit to making their wellbeing and health a priority.

As Physician Demand Will Continue to Outpace Supply, Medical School Admissions Committees are Particularly Interested in Applicants Committed to Practicing Primary Care in Underserved Locations

The AAMC recently published updated results of its physician workforce analysis, which modeled physician demand and supply to project the needs of the 2030 workforce. The analysis shows that physician demand will continue to outpace supply, which will lead to a physician shortage of between 42,600 and 121,300 full time equivalencies (FTEs) by 2030.

Within primary care, the shortage is projected to fall between 14,800 and 49,300 physicians, which incorporates various assumptions about the supply and partnership of Advanced Practice Registered Nurses and Physicians Assistants in the future, as well as the current estimated need for 13,800 physicians to reconcile the primary care shortage from currently designated shortage areas.

Projections for non-primary care specialties, including medical, surgical and other specialties, show an estimated shortage of between 33,800 and 72,700 physicians. The greatest projected gap is for surgeons, which is between 20,700 and 30,500 by 2030. While the supply of surgeons is projected to stay steady over time, the demand is expected to increase. “Other” specialties, which include emergency medicine, anesthesiology, psychiatry, radiology, and others, has a projected gap of between 18,600 and 31,800.

The main driver behind the increasing demand for physicians is the growing and aging U.S. population. Between 2016 and 2030, “the U.S. population is projected to grow about 11 percent, from about 324 million to 359 million. The population under age 18 is projected to grow by 3 percent; the population aged 65 and older is projected to grow by 50 percent; and the population aged 75 and older is projected to grow by 69 percent.”[i] Similarly, on the supply side, the aging population of physicians and their associated retirement decisions will impact the severity of the gap. “More than one-third of all currently active physicians will be 65 or older within the next decade. Physicians aged 65 and older account for 13.5 percent of the active workforce, and those between the ages of 55 and 64 make up nearly 27.2 percent of the active workforce.” [ii] Physicians’ weekly working hours are also currently trending downward across all physician age groups.

The report also modeled access to care, which is another factor that may impact demand in the future. There are currently inequities in access to care based on geographic, economic and sociodemographic factors. While projected physician shortages based on these factors was not included in the long-term projection estimates, the 2016 models show that if the country commits to improving access to care for disenfranchised groups, the demand for physicians will be drastically increased.

The AAMC is currently advocating for a multipronged approach to address the physician shortage including the improved use of technology, team-based care, and delivery innovations, as well as the increase of federal funding for additional residency positions. The AAMC is clear that the U.S. government needs to act in the short-term to expand graduate medical education to address the long-term physician demand identified in the report, as physician training is a ten-year process. Federal funding for residency positions has not been expanded since the 1997 Balanced Budget Act. While there have been two pieces of legislation recently introduced (explained below), which would provide funding for additional residency spots,[iii] neither have gained much traction since introduction.

  • The Resident Physician Shortage Reduction Act of 2017 provides comprehensive reform to federal funding for graduate medical education.
  • Lifts the funding cap placed on the number of residents and fellows funded by Medicare
  • Adds an additional 3,000 federally-supported residency positions each year for the next five years
  • The Opioid Workforce Act of 2018 specifically targets and funds residency training for areas of critical need.
  • Adds an additional 1,000 federally-supported resident positions over the next five years in hospitals that have, or are establishing, programs in addiction medicine, addiction psychiatry, or pain management

Prospective and current medical students should familiarize themselves with this report, especially when considering their future fields of study.  Many medical schools are echoing the demand for students interested in primary care, as well as those committed to working in rural or otherwise underserved locations; In 2017, the AAMC reports that nearly 30% of those entering medical school plan to work in an underserved area. Additionally, these topics are likely to come up in interviews and at networking events.  

The AAMC has committed to updating the projections on an annual basis and makes the report available online.

The final report for 2018 created by IHS Markit Ltd for the AAMC is available here: https://aamc-black.global.ssl.fastly.net/production/media/filer_public/85/d7/85d7b689-f417-4ef0-97fb-ecc129836829/aamc_2018_workforce_projections_update_april_11_2018.pdf

 

[i] https://aamc-black.global.ssl.fastly.net/production/media/filer_public/85/d7/85d7b689-f417-4ef0-97fb-ecc129836829/aamc_2018_workforce_projections_update_april_11_2018.pdf

[ii] https://aamc-black.global.ssl.fastly.net/production/media/filer_public/85/d7/85d7b689-f417-4ef0-97fb-ecc129836829/aamc_2018_workforce_projections_update_april_11_2018.pdf

[iii] https://www.forbes.com/sites/brucejapsen/2018/05/17/congressional-bill-would-add-1000-doctors-to-fight-opioid-addiction/#60926102684a

 

Waitlisted? Don’t Give Up Hope. Write a Letter of Intent.

News you have been waitlisted at one of your top-choice medical schools can bring a range of emotions. It’s not the desired outcome, of course, but the game isn’t over. Their admissions committee still sees you as a worthy applicant, capable of handling the rigors of the program.

The number of students who are admitted each year from the waitlist varies based on the school. Highly ranked and competitive programs will typically admit fewer from the waitlist than those further down in the rankings, as they will have a higher yield (acceptances resulting from initial admissions offers).

You can influence your chance of being selected from the waitlist of any school by continuing to showcase your interest in their program. Just as it is critical for medical schools not to overfill their incoming class, they do not want to have empty seats when the school year begins. Therefore, if you can show that you will improve their yield, a key component in medical school rankings, they will be more likely to send to you a letter of acceptance. Engagement with the program through visits and meetings with professors, admissions directors, and current students is an effective way to show interest. But don’t forget to craft a compelling letter of intent too. It should include the following:

  • Meaningful updates since you’ve submitted your application. Did your research study finally get published? What have been the key takeaways in that internship you began in August?
  • Reiterate your interest in the school by citing specific courses, experiential learning opportunities, professors, etc. that make sense given where you’ve been in your life and career so far and where you want to go. Why do you believe you are a good fit?  What will you bring to the incoming class? How will their program help you achieve your goals?
  • Mention any experiences you’ve had on a campus visit/tour or during your interview that increased your commitment to the school.
  • The Yield Protection Statement: “Medical School X is my first choice and, if admitted, I would absolutely attend.” If you can make such a statement, this will be the most impactful component of your letter.

As the waiting game continues, keep in mind that many schools do not use “rolling waitlists.” Instead, they often wait until they have received final admissions decisions from prospective students on May 15th. After this date, prospective students will only be able to hold a seat at one medical school. While prospective students can withdraw from a school if they are accepted from the waitlist into a preferred school up to the point of matriculation, students cannot hold a seat at both schools.

Good luck!        

The Medical School Application’s Work and Activities Section: Key Tips to Consider Before You Begin Drafting

Crafting a compelling Work and Activities Section is an important priority for any medical school applicant. It will allow you provide depth on your most meaningful experiences and communicate how a particular research position, teaching opportunity, or clinical exposure inspired your interest in the study of medicine. It will also give you the chance to show through anecdotes such characteristics as intellectual curiosity, adaptability, empathy, as well as your aptitude in critical and creative thinking, or your ability to thrive in a collaborative environment.   

The AMCAS application allows for a total of 15 entries, with three designated as “most meaningful.”  While all of the entries allow for a 700-character (including spaces) description of the activity, the three most meaningful entries include an additional requirement of 1,325 characters (including spaces) where you can provide further context on the perspective you gained and lessons you learned.

Key tips to consider before you begin drafting:

·       Take advantage of all 15 entries, considering the various experiences you have had that influenced your decision to apply to medical school. To start, brainstorm and write them all down in chronological order, limiting yourself to college or post-graduate experiences. This section is purposely broad and can include activities from a multitude of categories (listed below). If you find that you do not have 15, carefully consider even one-day community service events that had a particular impact on you. Keep in mind that while not all experiences will be equally meaningful, several experiences are probably still worth sharing if they influenced your path in some way.

·       After brainstorming all the potential activities, make note of the 15 most relevant, making sure to span a diverse array of categories. Pay particular attention, however, to clinical activities, research, and community service.

·       When selecting your three most meaningful experiences, highlight first those that demonstrate a commitment to medicine and service to others. After that, consider work/activities that are unique and, therefore, will help differentiate you to the admissions committee.

·       When you describe your work/activities, be sure to clearly articulate what you did and what the outcome(s) of your participation included. In your descriptions, highlight also the qualities that you used or developed through your involvement, noting your academic/intellectual growth, maturity, sound judgment, and compassion, as well as ability interact well with others. It is also important to include, where possible, the impact of the activity on your decision to apply to medical school.

·       After writing your descriptions, read them aloud, and edit. Confirm that you are within the allotted number of characters. Such a stringent character limitation emphasizes the importance of tight, clear language and perfect grammar.

The Work and Activities section gives the medical school admissions committee a summary of all those experiences that ultimately inspired your interest in and commitment to a rigorous, yet rewarding career path. Thus, it is vital to ensure each word moves your candidacy forward in a compelling way.