From the Front Line: Trainees’ Perspective on Providing Care During COVID-19 Pandemic

Many psychiatry residents and fellows have already been reassigned to medical and ICU services to provide care for patients affected by COVID-19. Other residents and fellows are placed in “backup” teams with the understanding that they can be called in at any minute to provide medical care. In addition, most residents and fellows, if not all, continue to provide necessary psychiatric care to people who are directly or indirectly affected by COVID-19.

Being on frontline duty is a rewarding experience, but it comes with its own challenges. I would like to cite examples of what some of the trainees have shared. I am keeping the identities of some of them confidential to protect them.

The organizational push to meet the demand for care for COVID-19 patients has put some residents and fellows at increased risk of burnout. Some residents and fellows are operating under conditions violating duty hours and even in situations where there is not enough personal protective equipment (PPE) for them. Other residents, who are at heightened risk due to their own medical illness, are not getting the adequate precautions they need. From a trainee’s perspective, at times it may feel that we are dispensable. With the current system we have, trainees are on the power imbalance, and this may deter them from speaking up against adverse consequences.

Being a person of color, especially one who identifies as black or African American, carries its own extra concerns given the disparities in health care. Some states have already started to notice the worrisome trend that black Americans are dying at a much higher and rapid rate compared with Americans who are not black.

Dr. Michael Mensah, a PGY-3 psychiatry resident at UCLA, shared his experience: “It is one thing to read, study, and analyze racial health care disparities, and another to see, feel, and be part of a training behemoth maintaining an inequitable status quo. But my darkest, most morally injurious moments are when a patient in a hospital bed somehow makes me imagine my sister, mother, or father being hospitalized. It is hard not to wonder if they will receive the care they deserve, especially during this pandemic.”

Dr. Niesha Voigt, a PGY-2 psychiatry resident at NewYork-Presbyterian-Columbia, wrote: “Even before the pandemic, people from my community were not getting the care they need. It is frustrating to see that happen over and over again.”

This devastating issue equally impacts trainees in other medical specialties as well. Dr. Josh Johnson, a PGY-2 general surgery resident at NewYork-Presbyterian/Weill Cornell Medical Center, said, “I grew up in and around the underserved communities I now treat as a physician. I also work in well-resourced academic and private care institutions. The stark contrast in access and quality within hospitals and communities that are only a few miles apart is a cataclysmic failure of the health care system. As a system at large, we seemed unwilling to rectify the disparity gap even before the virus emerged. Now, the pandemic has shown just how ill prepared even the most well-equipped hospitals are, and the communities in which I grew up have suffered devastation. Unfortunately, the losses have become personal for me.”

We also need to be sensitive to the challenges that are being faced by residents and fellows of other minority ethnic groups during this pandemic. Some who identify from Asian American ethnic backgrounds face blaming remarks about “bringing this virus” to this country (see America Faces Recovery From Two Epidemics). What about the residents and fellows who identify as Hispanic or Latino and whose communities might also be affected by health care disparities?

The challenges faced as a result of this pandemic raise the question of how we can support and engage our residents and fellows. It is critical during this time for trainees to continue to advocate for themselves. I am impressed by our resident leaders, some of whom have already started collaborating across different residency programs in the country. Dr. Miranda Greiner, a PGY-4 psychiatry resident at New York-Presbyterian-Cornell and chair of the APA Public Psychiatry Fellowship, initiated a list serve for resident leaders across the country to communicate and advocate. The advocacy letters created as a result of this group effort addressed important topics such as converting nonemergent outpatient psychiatric visits to telehealth services, allowing trainees to conduct telehealth visits from home, keeping the number of trainees in inpatient units to the minimum necessary, rapid placement of protections such as paid sick time and child care services, access to appropriate PPEs, and many more.

I urge all leadership and administrative staff to continue to advocate for their trainees, know what they are experiencing, and listen to their suggestions. It is prudent to recognize the tragic impact of health care disparities on our own trainees, especially those of minority and marginalized backgrounds. Providing a safe and supportive space is the holding environment we all need to get through this together. APA has released guidance on deployment of psychiatrists and trainees during the COVID-19 crisis that can be used as a tool for resident advocacy to ensure adequate supervision and resources to trainees who get redeployed (see Guidance From APA on Deployment of Psychiatrists, Trainees During COVID-19 Crisis.)

After all, saving lives, including our own, is our shared goal. I am proud of all the residents and fellows out there as they heroically step in and provide care to persons afflicted by COVID-19. ■