For resident physicians, moving from internship to PGY-2 represents a significant change in responsibilities and expectations.
PGY-2s move into a supervisory role and are often the most senior physician in a clinical setting throughout much of their shift. Second-year resident physicians also take on new responsibilities as educators and learners.
The change in role can be a pain point in residency for many physicians. How can it be done successfully? Two physician fellows whose PGY-2 days are not so far behind them offered their insights.
Understand your bandwidth
Second-year residents often enter the year with more clinical competence. But that progress comes with a new wave of responsibility—and often, a harsh realization about the demands of residency.
“When you become a PGY-2, you are more confident,” said AMA member Victoria Gordon, DO. “You sort of know what you are doing because intern year is your greatest growth curve. You feel like you have your sea legs, then all of a sudden … you have all these new responsibilities, you are still getting comfortable with them, but you also have just enough time to realize how difficult residency really is.”
Dr. Gordon is an emergency medicine resident at HCA Houston Healthcare Kingwood. HCA Healthcare is part of the AMA Health System Member Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
Second-year residents feel increased job stress and are more susceptible to burnout, according to exclusive data compiled as part of the AMA Organizational Biopsy®. The 2024 version of the report, which featured responses from more than 3,600 resident physicians across the U.S., found that reported program satisfaction dropped from 91% in PGY-1 to 81% in PGY-2 and 80% in PGY-3. Reported burnout, likewise, showed increases from 29.3% during intern year to 40% for PGY-2s and 44.9% for PGY-3s. The burnout figures sharply decline after the third year of residency.
If your workload is daunting, some things may fall by the wayside. For Dr. Gordon, there was institutional support for putting less emphasis on teaching. But it’s not an easy thing to simply ignore.
“You feel like you want to help the interns,” she said. “You want to be there for them. You were just in their position. And you want to be supportive.”
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Remember you’re still training
AMA member Lauren Crowther, MD, is an internal medicine resident in San Diego. While responsibilities increase for PGY-2s, there are still safeguards and resources that you should lean on.
“The biggest thing I always want to tell everybody entering PGY-2 is you don't need to know everything—you’re still in training,” she said. “You're safe. There are attendings who want to help you. You can lean on them.”
Instead of demonstrating an encyclopedic knowledge of medical conditions and treatments, every PGY-2 should prioritize knowing where to look for guidance, she noted.
“It’s not about knowing immediately on your own how to manage any particular condition,” she said. “You want to know who and when to ask for help and to start building your own confidence as a physician.”
The AMA Thriving in Residency series has guidance and resources on navigating the fast-paced demands of training, maintaining health and well-being, handling medical student-loan debt, and other essential tips about succeeding in graduate medical training.
Delegate
As an internal medicine intern, David Savage, MD, PhD, spent much of his time on documentation and filling orders. When he moved from his first year of residency to his second, he realized quickly that he could free up time by appropriately delegating those tasks to others.
“You have to shift your mindset to that of a supervisor,” said Dr. Savage, now an assistant professor and melanoma and sarcoma specialist in New Mexico. “Rather than feeling personally obligated to put in all the orders and write all the notes. You will quickly realize that somebody else is taking on that task.
“You have to be comfortable with delegating,” he added. “Your interns are going to do those things. You also have to realize what their limitations are at first. You have to double check things, but you don’t have to do it for them. After a few weeks, you’ll find they are getting the hang of it, and you spend much less time checking their work.”
Rely on your peers
For Karen Dionesotes, MD, MPH, the transition to PGY-2 represented a total change in both role and setting. In the first year of her psychiatric residency, she spent her first year at a different hospital working on a number of rotations related to internal medicine.
“As an intern, I always had a senior resident and usually an attending to run things by,” said Dr. Dionesotes, now a geriatric psychiatrist in New York. “Then you go to a setup where if you are on call overnight—you are essentially running an entire psych hospital. That was a huge shift.
“From that first day of my second year, our group resident chat was always talking about what was happening. Your co-residents and your classmates are a resource. I also knew that when things are toughest, I could rely on my chiefs.”
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Solicit feedback
The role a second-year resident takes as an educator and a leader is oftentimes new. To do it effectively, Dr. Savage said the best way to understand his strengths and weaknesses in those areas was simply to ask.
“There’s going to be a lot of trial and error. If you try to teach in a method that works, hone in on that and stick with it,” Dr. Savage said. “If you teach in one way and you find people are zoning out, and they find every excuse not to sit down with you for a half hour because they don’t find it effective, you can ask for feedback from your interns and medical students.”
In such cases, PGY-2s can ask their learners:
What am I doing that is not working for you? What can I do to make these interactions better for you?
“These are questions that will help both you and your trainees. Because of that, they’ll probably be willing to provide real-time feedback.”
When it came to honing his skills as a leader, Dr. Savage said he would have conversations with his attendings about their observations of his ability and areas for improvement.
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Build relationships
While Dr. Savage may have seen the portions of his day dedicated to administrative tasks become less frequent as a PGY-2, there were new responsibilities. Among them: Working with other members of the care team.
“Because you are the more senior person on the team, now there’s a lot of people that are going to want to talk to you. The social workers, the case managers, the consultants for the specialists you work with. You have to create time for all these other people that are also very important for patient care. They need to speak with a senior physician to know what’s going on with the patients.
“It’s important,” he added, “to form these cohesive relationships with your pharmacists, your social workers and case managers, and making time to speak with them is [an] important part of the role.”
Know the stakes
While you might be the most senior physician in a patient-facing setting for long stretches of time, it’s OK to have questions and to turn to someone more senior under most circumstances.
“A big part of medicine culture is that you are not supposed to call to wake your attending up,” said Dr. Dionesotes, an AMA member who recently finished her term as an alternate delegate to the AMA-RFS. “But I’ve had several attendings on the first day of a rotation say to me, ‘I don’t care about what time it is, call me whenever you have a question.’
“In the end, you are a trainee who is still growing. … We are talking about people’s health. It’s not worth not reaching out.”
More on transition in med ed
The AMA’s Facilitating Effective Transitions Along the Medical Education Continuum handbook looks at the needs of learners across the continuum of medical education—from the beginning of medical school through the final stage of residency. This publication is from the physician experts who are part of the AMA ChangeMedEd Consortium.
The learner sections help medical students and resident physicians acclimate to the various settings and expectations in the medical training environment. The faculty sections then provide blueprints for transition programming, as well as resources to help students and residents navigate challenges in transitions. Download the handbook now (PDF).
