The second year of residency training can be a highly stressful time for physicians in training. Exclusive AMA research shows second-year residents may report higher rates of burnout, something those who have been there say can be at least partially due to the radical change in responsibilities from PGY-1.
AMA member Lauren Crowther, MD, is now in fellowship training in allergy and immunology in Southern California. But she remembers being a PGY-2 well. She said she experienced plenty of stress as she took on the responsibilities of a senior resident but also discovered that the second year of residency offered welcome changes.
“As a first-year resident, you’re just learning how a hospital runs, how to write a good note, how to put in orders for medicines and how to call in consults on other services. But by the time you get to your second year, you have a lot of that down and you can focus on the big picture,” Dr. Crowther said.
In interviews with the AMA, Dr. Crowther and two other AMA members—Victoria Gordon, DO, and David Savage, MD, PhD—offered a wealth of hard-won wisdom for interns starting PGY-2. Foremost among them: Consider the transition an opportunity to reconnect with yourself and what drew you to medicine.
No one expects you to be an expert
“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.”
At Dr. Crowther’s internal medicine residency program, each intern was responsible for about eight patients, and each second- or third-year senior resident oversees two interns. That amounted to 16 patients per senior resident, a number that seemed daunting to Dr. Crowther when she started her second year of residency.
“I was thinking: Oh my gosh, I'm going to have to know what to do with every single patient's problems,” she said. “I was having a lot of imposter syndrome. I remembered my senior residents and how much they knew, and I thought: How am I going to amount to that? But it's a very natural thing to have that feeling looming in the back of your mind.”
Instead of demonstrating an encyclopedic knowledge of medical conditions and treatments, PGY-2s 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.”
As the leader in physician well-being, the AMA is reducing physician burnout by removing administrative burdens and providing real-world solutions to help doctors rediscover the Joy in Medicine®.
Your role will see a shift
Dr. Gordon, now a medical education fellow in Houston, found her second year of emergency medicine residency to be a bit less difficult than intern year. Nevertheless, she found the stresses of PGY-2 to be related to an increase in responsibilities.
“You are carrying a larger patient load,” said Dr. Gordon, echoing Dr. Crowther’s point. “Let’s say you are an intern and your cap is 10 patients. The next day you’re a PGY-2 and that grows to 15 patients. So you are immediately expected to see this bigger load of patients.”
Additionally, there’s a role shift. PGY-2s have a more senior role on the care team and often have a first-year resident working with them, which can decrease efficiency.
“You have this larger workload to start with and then every few minutes someone is asking who to write a note or about workflow,” she said. “It’s adding a lot of work before you are comfortable with your own workload.
In this AMA news article, medical students, interns and PGY-2s will get more great advice, including:
- How you get to think more broadly as a PGY-2.
- The importance of understanding your bandwidth in the second year of residency training.
- Why PGY-2 is an opportunity to start anew.
- Why it is critical to give everyone the attention they need.
- Why it is so vital to ask for help when needed.
- The value of delegating as a PGY-2.
- Why there is light at the end of the tunnel of the second year of residency.
