Expert perspective: Maintaining mental health during the rigors of fellowship

By Jules Murtha | Fact-checked by Barbara Bekiesz
Published June 23, 2023

Key Takeaways

  • Stress, depression, and burnout are common themes for many medical fellows and residents, and they've voiced the need for increased attention on the mental health issues they experience during training.

  • Experts say that fellowship builds upon the difficulties presented by residency, and that the additional responsibilities and time constraints can pose unique mental health challenges for physicians.

  • In order to better maintain their mental health, fellows can carve out time for themselves, lean on their colleagues and community, and embrace treatments as needed.

It’s no secret that some medical trainees deal with debilitating mental health issues. The symptoms associated with depression and burnout alone can pave the way for increased rates of medical error, professional misconduct, and decreased empathy among medical trainees, according to an article published by Academic Medicine.[]

Related: Choosing your fellowship: How do you find the right fit?

Keeping up with mental health

While physicians in fellowship may experience more difficulty in maintaining mental health than during any other point of training, physicians at all levels deal with stress, burnout, and depression, according to an article by the Association of Medical School Pediatric Department Chairs.[]

“Although the prevalence of depression in physicians is comparable with that of the general population (12% self-identified in men, 19.5% in women), the rate of suicide is much higher (particularly in women physicians), with as many as 400 each year,” the authors wrote. 

“Increased rates of suicidal ideation have been found in medical students (11.2%) and surgeons (6.3%), compared with a 3.3% prevalence in the general population.”

In order to better understand the mental health challenges that fellows face, as well as how to troubleshoot them, we spoke with MDLinx advisory board member and psychiatrist, Amanda Zeglis, DO, MBA.

Dr. Zeglis says that fellows in particular may face steeper mental health challenges as a result of juggling more with less time to do so.

“While residency poses its own difficulties, fellowship builds upon those, adding further responsibilities and stressors as physicians continue to expand their knowledge base,” Dr. Zeglis said.

The rigors of fellowship may therefore exacerbate existing mental health issues among physicians, or pave the way for new ones to surface.

In Dr. Zeglis’s view, these challenges could prevent physicians from performing their best.

"In order to provide optimal care to the patients you are managing, it is critical to first ensure the stability of your own mental health."

Amanda Zeglis, DO, MBA

So, how can physicians keep up with their mental health amid the stress of fellowship?

Maintain your mental health with these tips

Although fellowship may present you with unique mental health challenges, there are several ways to prevent them from being a hindrance and affecting your education.

According to Dr. Zeglis, fellows can stay on top of their mental health by doing the following:

Prioritize “you” time: “It is crucial to find time for yourself, despite the increased time constraints and added responsibilities of fellowship,” Dr. Zeglis said.

Finding small moments to “reset” plays a major role in helping you to practice good mental health hygiene. Doing so will not only allow you to better manage your life, Dr. Zeglis said, but enable you to take better care of your patients.

Lean on your community: Whether you turn to your colleagues, supervisors, friends, or family, having a supportive community to fall back on during times of stress in fellowship is a game-changer.

Related: Doctor's perspective: Juggling parenthood and fellowship

“Surrounding yourself with peers and a support system is encouraging, and can really make a positive difference in managing and maintaining mental health,” Dr. Zeglis said.

Seek treatment if needed: If you find yourself unable to manage your mental health on your own, you may benefit from professional help—which some academic medical education systems are working to make more accessible.

The authors of the Academic Medicine article developed a comprehensive mental health service designed to offer “equitable, accessible, and responsive care to all trainees” at Indiana University School of Medicine.

Over the course of 4 academic years, participation steadily increased since the program’s inception, reaching 821 trainees who sought mental health services in the 2020–2021 academic year. This included 30% of the entire medical student population, as well as 25% of the total resident and fellow population.

Related: The evolution of fellowship: New tech, more competition, and the quest for inclusivity

Overall, the authors of the study noted a positive response to their medical trainee-centered mental health service: “When provided with access to care, a significant portion of medical learners used services,” they wrote, adding that the trainees gave “very high patient satisfaction ratings.”

What this means for you

If you’re struggling to keep your mental health in check during fellowship, you’re not alone. Fellows often juggle more responsibilities with less free time than residents. The additional stressors you may face while furthering your training in fellowship could create the conditions for new mental health issues to arise, or for existing ones to worsen. 

In order to prevent mental health challenges from negatively affecting your career and your patient responsibilities, be sure to carve out some time for yourself during fellowship. You may also lean on your colleagues, family, friends, and supervisors in times of need. Lastly, don’t shy away from professional help—it could make all the difference.

Related: Thriving abroad: Navigating the challenges of international fellowships
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