You never expected your junior doctor years to be easy. But what you might not have been prepared for is the emotional and psychological impact. The bit that’s not talked about as much. The anxiety when the responsibility keeps stepping up, having to adapt to changing teams and departments, navigating exam and portfolio work alongside the job, and somehow keep the rest of your life going at the same time.
This article looks at the specific experiences and difficulties that many resident doctors go through, and talks about how therapy fits with this.
Coming up in this article I’ll cover:
- Struggling in silence
- The impact of shift work
- The F1/F2 years
- Exam & Portfolio stress
- Junior doctor Burnout
- Imposter syndrome, confidence wobbles & feeling the responsibility
- Overthinking & difficulty switching off
- Depression
- Therapy for Junior Doctors
- Therapy with me & next steps
Therapy for Doctors series
This article is part of a series of 6.
Links for these are at the end of this article.
- Therapy for Doctors
- Burnout in Doctors
- Decision-Making Anxiety and Managing Uncertainty
- PTSD in Doctors
- Return to Work Support for Doctors
1. Why trainee doctors struggle in silence
A lot of trainee doctors struggle without really letting on. Not because they’re trying to be martyrs, but because the culture of training doesn’t exactly make it easy to say, “I’m not coping”.
You move teams often. You don’t always know people well enough to trust them with how you’re really doing. There’s also a sense that you’re meant to get on with it. Everyone’s busy. Everyone’s tired. You don’t want to be the one who “can’t handle it”.
On top of that, there are real worries about what taking time off might mean for your training, so you keep pushing rather than taking time off when you need it.
Many of the resident doctors I’ve worked with describe feeling as if they are the only ones struggling, that others have it sussed. Yet the BMA found that 60% of junior doctors experience stress, anxiety, low mood or burnout – so in reality you’re far from the only one.
Therapy can’t change the challenges of the job, or the realities of working in the NHS. But therapy can really help you with skills to better manage your emotional health.
I want to find out more
Chat with Hannah – http://hannahpaskintherapy.co.uk/book-now/
2. The impact of shift work
Shift work doesn’t just make you tired. It messes with your ability to sleep well, it throws out your routine and eating schedule, and can impact your ability to cope. When you’re tired, your tolerance to uncertainty and risk drops, your ability to switch off reduces, you become more irritable, your worry thoughts get louder, and your motivation can be impacted too.
Shift work can also make maintaining a social life and relationships really challenging, feeling like you’re passing ships in the night with those you live with, and feeling like you’re missing out with things you want to be a part of. It can also feel quite lonely to be awake at hours many around you are asleep for, you can’t ring someone for a chat, you can’t make plans after work etc.
Many doctors approach night shifts as being something to just get through, and often try to make up for it on their days off, which then can leave you without the needed recovery and even more tired.
Therapy can work with you on how to manage the shift in routines, and how to limit the emotional impact.
3. The F1/F2 years
The foundation years are a big psychological jump. In F1, you move from being a student to being responsible for patients. The learning curve is steep, the pace is fast, and the consequences suddenly feel very real.
F2 brings different pressures. You’re more experienced, but you’re also expected to make decisions about your future while still rotating. Many people feel pulled between trying to get through the day-to-day workload and worrying about applications and career direction.
During these 2 years, rotations every few months mean you’re constantly adjusting to new specialties, new colleagues, new wards and new systems. Just as you start to feel settled, you move again. In most jobs, people start to feel settled at around 6 months in, yet you’re moving every 4 months. It’s not surprising then that you feel a bit wobbly at times. You don’t get to stay quite long enough to feel like you know what you’re doing comfortably. Then there’s all the practical bits – figuring out the parking/bus routes, working out where the nearest food options are, trying not to get lost when you’ve got the bleep and so much more. You can also end up in rotation placements that are far removed from areas of interest for you, feeling even more outside your comfort zone, as well as at times having placements that have a long commute. It’s a lot.
A lot of F1/F2 doctors can develop worries at this stage, questioning if they know enough, if they are going to make the wrong decision, wanting to check things, seek reassurance etc.
4. Exam & portfolio stress
Exams and portfolios are a huge source of ongoing pressure for junior doctors. You’re expected to keep on top of clinical work, while also studying, logging evidence, chasing sign-offs, and preparing for assessments that can feel pressured to pass.
This creates a constant sense of being “behind”. Many people feel there’s always something else they should be doing. Rest starts to feel undeserved. Even when you’re not actively studying, part of your head is telling you that you should be.
In therapy, we work on how to relate differently to these demands. That includes challenging unhelpful rules about productivity, reducing perfectionistic standards around portfolios and exams, exploring setting realistic schedules for yourself, and building in proper mental off-duty time so your brain actually gets to rest.
5. Junior doctor burnout
Burnout in junior doctors is really common. In the UK National Training Survey, around 39% of junior doctors report high or very high levels of burnout, and over half report feeling emotionally exhausted by their work. These aren’t small numbers.
Burnout feels like you’ve hit an energy wall, like you’re emotionally exhausted, like just engaging in life is too much. You feel disconnected, overwhelmed, and knackered. There’s lots of other physical symptoms that can come up too – migraines, insomnia, IBS, hair loss, skin rashes, panic attacks, and much more.
There’s lots of factors that influence why burnout develops and why we might keep ignoring it. If you want to understand more, read my article on Burnout in Doctors here: hannahpaskintherapy.co.uk/burnout_in_doctors
Therapy helps you to understand the root of your burnout, teaches you how to recognise the warning signs, helps you to break the patterns that keep you stuck in burnout, and how to challenge some of the ways of thinking that feed it. The aim with therapy is not only to help you to recover from burnout, but for you to understand how to prevent future episodes occurring.
I want to find out more
Chat with Hannah – http://hannahpaskintherapy.co.uk/book-now/
6. Imposter syndrome, confidence wobbles & feeling the responsibility
Imposter Syndrome
Imposter syndrome is the gap between our knowledge and skills, and the belief we have in ourselves. And ironically, the further along we go in our career, often the more of an imposter we feel. I’ve heard many doctors say “I don’t feel like a real doctor” – as if that isn’t exactly what they are. But being a doctor doesn’t mean knowing everything, that’s not realistic for a junior doctor, you’re still training and learning. You can be impressing your superiors, and have good patient satisfaction, whilst simultaneously still learning and developing. You don’t have to know everything to be good enough.
But don’t forget, you’ve completed a medical degree, you’ve already proven yourself. You’ve already succeeded in a competitive market. You’re not a newbie that knows nothing.
Confidence wobbles
Confidence wobbles are normal when the responsibility keeps getting stepped up, or when you keep changing placements. But it’s important that we can separate what is reality versus what are thoughts and emotions we have (which are basically lying). Everyone else does not have it sussed. Everyone else isn’t more confident that you. You’re not behind. You’re not a bad doctor. We also don’t want to act like these things are true – avoiding decisions, seeking constant reassurance, double checking, avoiding putting yourself forwards, avoiding disagreeing and more.
Feeling responsible
Alongside this, many people carry a heavy sense of responsibility. You feel responsible for the pain and suffering your parents experience, making it your responsibility to fix/prevent. Yet there’s many limits in what services and systems allow you to provide. There’s limits on what the human body and mind is capable of with recovery. Even if you did your best days work, it can have the most tragic patient outcome.
In therapy, we work on separating what is genuinely yours to carry from what sits with the system. That doesn’t mean becoming uncaring. It means carrying responsibility in a way that doesn’t slowly grind you down.
7. Overthinking & difficulty switching off
Overthinking is really frustrating and has a big impact. It sucks your energy, disrupts your sleep, kills your appetite, steals your joy and much more. You’re replaying decisions, imagining worst-case scenarios, constantly planning next steps in your head, checking back in your memory for if you made a mistake or missed something important.
Being a doctor is filled with uncertainty. Most of the time you’re making a best fit guess based on the limited information you have, giving it a go, and reviewing. For many, best guest feels uncomfortable. You don’t know for sure that’s the explanation, or that the treatment plan will work, but you still have to move forwards anyway. And sometimes you don’t get to find out the outcome, you don’t get to find out it was all okay.
If you struggle to switch off, you might find yourself
* Checking work emails on your day off
* Regularly working late to get everything finished before you leave
* Ringing colleagues to check in on patients
* Putting off taking annual leave
* Mentally reviewing cases and your actions when you get home
8. Depression
High-functioning depression doesn’t look like classic depression. You’re still going to work, you’re still doing the basics you need to. But you’re feeling flat, disconnected, hopeless. Outside of work, things aren’t going great. Your life admin and chores are behind. You’re doing less of your hobbies, your socialising and spending more time mindlessly scrolling on your phone.
On top of withdrawing from life, depression often has lots of negative thinking as part of the package deal. Feeling like others don’t like you, that you’re not good enough, that you’ve disappointed people and much more.
Therapy can help you to get back on track with living your life, and learn to shut down those self critical thoughts.
9. Therapy for Junior Doctors
Therapy for junior doctors focuses on better equipping you to deal with the realities of the job.
Therapy can help with depression, anxiety, workplace stress, sleep problems, confidence problems, worrying and overthinking, implementing boundaries, switching off from guilt and so much more.
10. Therapy with me & next steps
I’m a BABCP-accredited CBT therapist and I work privately with doctors across the UK, online and in Cheshire. I specialise in working with people who are doing well on the outside but struggling on the inside. My approach is straight-talking, practical, and focused on change.
Read more about Hannah – http://hannahpaskintherapy.co.uk/about-hannah-paskin-therapy
I offer private therapy for self-funding clients.
I also provide limited availability for funded therapy under the Practitioner Health scheme (via OneBright). Message me to find out more.
Next steps
1. Book a free discovery call (this is optional)
2. Book your therapy assessment appointment
http://hannahpaskintherapy.co.uk/book-now/
Links for 5 more articles in the series
- Burnout in Doctors – http://hannahpaskintherapy.co.uk/burnout-in-doctors
- Therapy for Doctors – http://hannahpaskintherapy.co.uk/therapy-for-doctors
- Decision-making anxiety & managing uncertainty – http://hannahpaskintherapy.co.uk/doctors-with-anxiety
- PTSD in doctors – http://hannahpaskintherapy.co.uk/doctors-with-ptsd
- Return to work support for doctors – http://hannahpaskintherapy.co.uk/return-to-work-doctors
