Within her first month, she crumbled under the pressure. After she went to visit the hospital counselor—sobbing through the appointment—a few of her fellow residents told her to suck it up. Feeling frazzled and helpless just comes with the first year territory, they said. It’s a rite of passage. In his memoir Intern, the New York cardiologist Sandeep Jauhar describes residency as “brutal, like a kind of hazing.”

Choosing whether or not to share these concerns with supervisors can be difficult, says a resident in family medicine at a New England hospital. She cites a common fear among residents: that their honesty will lead more senior doctors to write them off entirely. “They don’t want you to show any weakness,” she says. “You almost need to be a robot.” Her anxiety is affecting her daily work. “I’m exhausted because of the existential crisis playing out in my head every minute.”

Two centuries ago, aspiring physicians in the U.S. could just hang a shingle and begin cutting people open with little formal training. As the skeleton of America’s medical-education system emerged—medical schools, exams, and residency and fellowship programs—physicians had to follow a standardized procedure to become licensed. And as much as this system teaches them how to be doctors, it also teaches them how to operate within the medical profession—a lesson that can leave new doctors crippled by fatigue, emotional stress, and self-doubt, affecting their abilities to take care of themselves and their patients. Some in the medical community believe that there must be a better way to do it.

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When they graduate from medical school, newly minted physicians are prepared to recall minute details about a litany of illnesses—but not necessarily confident managing the symptoms. In his memoir The Real Doctor Will See You Shortly: A Physician’s First Year, Matt McCarthy describes the “tectonic shift” from laboratories to hospital life: Throughout much of his rotation in general surgery at Massachusetts General Hospital, where he practiced suturing banana peels back together in his free moments, McCarthy felt unprepared to deal with the onslaught of diseased bodies.

If he had been asked to “recite pages from a journal article on kidney chemistry or coagulation cascades, I could’ve put on quite a show,” he writes. “But I hadn’t learned much of the practical business of keeping people alive, skills like drawing blood or putting in a urinary catheter.”

Many brand-new doctors are painfully aware of the gaps in their knowledge—and in fact, that recognition can be paralyzing. Jauhar refers to his first year of residency as a “disillusioning time.” He writes, “I spent much of it in a state of crisis and doubt.”

Feelings of hopelessness appear to be fairly widespread among medical students and early-career doctors. The worrying combination of plummeting self-worth, and emotional fatigue has reached “epidemic levels,” according to a survey conducted at the University of North Carolina, Chapel Hill. Researchers found that approximately 70 percent of residents met the diagnostic criteria for burnout.