Starting Residency with Chronic Medical Conditions
Written by Lindsey Ulin, MD
There’s no denying the transition to residency is tough. Navigating working long hours with greater responsibility, and perhaps figuring out a new city or hospital system takes time to adjust to. Having a chronic illness or disability presents additional challenges, balancing caring for patients without putting your health on the backburner. While systemic ableist notions in medicine are gaining wider recognition, there is much progress to be made in making our field more accommodating and accessible for both patients and providers. The issues of stigma and disclosure are exacerbated with starting a new job that is both physically and emotionally demanding.
Being a doctor and a patient is both a complex dynamic and deeply personal journey. Over halfway into intern year I’m still learning to make caring for myself a bigger priority, admittedly there are times when I’m doing a better or worse job. Here are some lessons I’ve learned along the way and things I wish I would’ve done last year. I hope these tips will make your transition easier and give you things to start thinking about now.
Auto-refill prescriptions- Simplify your life and avoid realizing you’ve run out until it’s too late. See if your pharmacy offers a delivery option.
Appointments- Make your primary care and specialty appointments now to avoid gaps in care if moving somewhere new for residency. Ask for 90-day supplies of your medications and 6 months to a year of refills to get you through. Talk to your doctors about any medication scheduling adjustments as you may be working nights and 28-hour call shifts. Get those age-appropriate preventive screenings done now!
Occupational health- Get plugged in with the occupational (occ) health department early. Your onboarding paperwork will include a screening questionnaire to see if you are physically able to do your job. This questionnaire will likely not be comprehensive or representative of the breadth of issues occ health can assist with. I encourage you to check out their website and get in touch with them early. Even if you think you may not need accommodations, if you have any concerns at all this is a great place to start. Additionally, if you do not want to go to faculty evaluating you for help, occ health legally cannot disclose your medical history to your program besides communicating to the program the accommodations you will need.
Understand your jeopardy system- Things happen, know your program’s process for calling out sick. Will you be responsible for finding your own coverage? Who is your contact? If you need to make an appointment during work is that handled through jeopardy or internal coverage on your team (ie another resident covers your list)?
Establishing care- Consider whether or not you want your care to be at your hospital system. My city has five academic medical centers within three miles of each other and when I called in April, I couldn’t get in to see a specialist at any of them until September. Start early, ask your program for help if you feel comfortable doing so.
Program support- Find out the structural supports for residents which could include counseling resources or arranging for primary care appointments. If your program offers these ask for an appointment early in the year. Once you’re at your program you’ll figure out who you are comfortable going to with issues.
Be kind to yourself- In residency, it’s easy to be so busy that caring for yourself gets put last. Feel empowered to advocate for yourself and lean on your support system.
