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Dear First-Year Me: A Letter to a Burned-Out Resident

Cherie A. Fathy, MD, MPH

Disclosures

June 13, 2022

Dear first-year Cherie,

First off, God bless you. You are tired. You deserve that whole pizza you ordered for yourself after your first week on peds ophthalmology. Those kids look weak, but they've got the strength of an Olympian, and getting those dilation drops into their eyes is an admirable feat. You go, girl!

But really, I get it. You're scared. You are scared that you're going to fail. Miserably. The thought never seems to leave you that this will be the moment when everyone realizes that the jig is up. You were never meant to get into this residency. You're not cut out for ophthalmology and the delicate skills and supreme focus that it requires. And, inevitably, everyone will figure this out by week 2.

What is most debilitating is the fear of failing your patients. The learning curve of a first-year ophthalmology resident seems far too steep and you do not feel up to the task. You're wracked with guilt, endlessly worrying about whether those flashes/floaters were actually just floaters or if you missed a retinal tear. (Perhaps you're being a little full of yourself here — it's not like the buck stops with you. Patients can still follow up in clinic and be seen by an attending there. Nonetheless, the fear persists.)

Then there's the indescribable annoyance of charting through a clunky EMR, the endless click...click...click as you surf through a medical record that only seems to drive a wedge between you and your patient.

It all sort of comes to a head when your family members start to ask why you seem so stressed all the time. Wasn't this supposed to be your dream job? Your "a-ha, I've found my calling" life moment?

But, at some point during first year, it really doesn't feel that way. Instead, you just feel burned out. And like you could be doing anything else better than you are doing ophthalmology. You hate feeling so lost in something you wished so passionately to do well.

It takes a good crying session (or several) and a candid conversation with your family before things start to change.

Although you won't like hearing it, it's the advice you receive that you need to stop fearing failure that puts things into perspective. Residency has not been your greatest challenge, but it's one that has been intricately tied to your self-worth. And perhaps incorrectly so! The awkward truth is that so much of the pressure you face is internal: you projecting your own fears of inadequacy into every interaction and viewing yourself only in the harshest of lights. You will realize that these internal comparisons you make serve no healthy purpose.

Before too long, you will grant yourself the grace and space to take on one of your biggest challenges.

With time.

With patience.

With persistence.

With the re-incorporation of Netflix binges and exercise bike rides.

You will learn to be comfortable with the uncomfortable. That is when you'll truly start to grow.

Gradually, and without really realizing it, the eye exam becomes a matter of muscle memory. Less daunting, more replicable. You start to see more patients and catch subtler pathology cues. By the end of the year, in addition to a slew of ophthalmic diagnoses, you will have diagnosed brain tumors, optic neuritis, a pheochromocytoma, and even an IgA nephropathy with hypertensive retinopathy.

So go ahead, finish up that pizza, give yourself some grace, because it will get better. And get plenty of sleep; you have a full clinic day with those kiddos again in the morning!

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About Dr Cherie Fathy
Cherie A. Fathy, MD, MPH, is a cornea fellow at the Wilmer Eye Institute at The Johns Hopkins Hospital. She completed her undergraduate, master's in public health, and medical degrees at Vanderbilt University School of Medicine and her ophthalmology residency at the Wills Eye Hospital. Cherie is interested in constantly improving how we deliver care to our patients. You can usually find Cherie napping, contemplating whether she should ride her Peloton, or bookmarking recipes that she'll probably never make.

Opinions expressed are solely Cherie's own and do not express the views or opinions of her employer.

You can connect with Cherie on Twitter: @CherieEyeMD

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