As I am nearing the end of my second post-graduate year (PGY2) residency in Ambulatory Care, I frequently take time to reflect on the ups and downs of my time as a resident. There is much to learn from reflecting on the journey as a new practitioner navigating one's way through the demands of residency while attempting to maintain a steady (and hopefully healthy) work-life balance.

Yesterday, an article came through my feed that caught my attention: Rates of depressive symptoms among pharmacy residents, published by Williams and colleagues in the March 2018 issue of the American Journal of Health-System Pharmacy (AJHP). The results are unsettling and come just days before "rank list" submissions are due for those students in their final year of pharmacy school (APPE students) and those PGY1 pharmacy residents who are pursuing a residency for the following year.

"In a nationwide survey, pharmacy residents self-reported levels of depressive symptoms higher than those reported among medical residents and likely indicating a rate of depression higher than rates reported in the U.S. general population." [emphasis added]

The results also suggest that the rate of severe depressive symptoms increased as the residency year progressed. I am not at all happy that this is the reality we live in as pharmacy residents across the United States, and so I feel it is my duty to take advantage of the timing of this study's published release, and use this platform to reach as many candidates as I can between now and the official rank list due date.

I am well aware all candidate interviews are completed and many of you have your rank lists solidified already. Regardless, I genuinely urge you to briefly revisit your list to reflect on and consider intangible factors in your decisions. If you haven't already, at least give the following three factors a little more weight when ranking your programs:

The "vibe(s)" you had on your interview and how you "connected" with everyone at the program. This may sound obvious to some, but you would be surprised how many students I have talked to who "brush off" bad interactions/vibes during an interview day as not a big deal. Did you mesh well with them? Think about it: if you got a bad/uncomfortable/unsettling vibe in the 6-8 hours at your interview (the day the residency is putting on their best face for their candidates, & vice versa), can you imagine 365 days of that "bad vibe" environment? What about the toll that can have on your happiness and mental health? How supportive the director and preceptors are of residents and their interests. If you felt that the residency program director (RPD) and the preceptors did not care about your interests during your interview day (or through other interactions), then what makes you think they are going to care any more about those interests and your career next-steps during the busy workdays? Seek out programs where the RPD/preceptors you interact with take the time to be supportive. Unlike APPE year you do not have any "off-months" during residency, so imagine going through the application/ interview/ PhORCAS/ Match process all over again, but this time working more than a full time job and having the stressors of residency on your plate: how essential would it be for you to be surrounded with supportive preceptors and mentors? Similar question for those PGY1 residents pursuing a PGY2: unlike the past two years where you have had such a structured process for your next steps, there is no PhORCAS/Match for real life. How important do you think it will be to have supportive colleagues and mentors in your residency who can help you navigate a career search process that you have likely never embarked on before? The culture of work-life balance. You may be thinking "oh, it's only one year" and you are correct, but residency should create an atmosphere of learning and should not be just extensive "cheap labor". Do not get me wrong, long hours are expected in residency no matter what and service to your institution is a beneficial and essential part of your residency experience. However, there are RPDs and program coordinators out there who truly care about and prioritize a resident's balance and do their best to help schedule required items (e.g. staffing, projects) in a beneficial and positive manner.

An additional factor worth considering: programs where you would have at least one co-resident to share in the residency journey. This definitely depends on the person, but for the most part I feel that everyone could use a buddy to joke with and vent to throughout the PGY1 or PGY2 year! (Quick shout out to my co-residents from PGY1 and PGY2 - sharing laughs during the stressful times has meant the world to me! Thank you all for everything!)

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For those choosing to pursue a residency, realize that no matter what program you end up in there is going to be stress, long hours, etc. Therefore, if you do not prioritize programs on your rank list that value intangibles, like the three I mentioned above, you are doing yourself a disservice. Every program can not and will not be perfect in all of those items I mentioned, and that's okay. Rank them holistically.

Lastly, I'll address the difficult question that has been lingering in some of your minds for the past few minutes: Yes, it is perfectly okay and acceptable to not rank a program that you interviewed at. In fact, if you have a program on your list that is negative or lacking in many or all the items I mentioned above, I would urge you to reconsider ranking that program at all. By prioritizing the intangibles, you are making yourself and your mental health a priority. A program might still be a good program, just not a good program for you... and that's okay!

Trust your gut and value your mental health, your future self will thank you!

Best of luck,

Jangus Whitner, PharmD





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Reference: Williams E, Martin SL, Fabrikant A, Wang A, Pojasek M. Rates of depressive symptoms among pharmacy residents. Am J Health-Syst Pharm. 2018 Mar;75(5):292-7.