The Dark Side of Residency: What Our Survey Revealed About Death Thoughts, Anxiety, and Leadership Failure.
The issue of death thoughts among resident surgeons is far more widespread than most healthcare leaders want to acknowledge. In a wellness survey I conducted with my husband, Dr. Tim Riegel, burn and reconstructive surgeon, we asked residents specific questions about death thoughts and suicidal ideation. The responses were deeply troubling. Many residents reported thinking about death three to four times per month, and 75% rated their anxiety levels as mid to high. Even more concerning, 54% felt that their boss “hated them”—a clear reflection of emotional distress, fear-based culture, and the absence of psychologically safe leadership. These are not minor red flags; they reveal a systemic failure within residency programs to support the very people we rely on to become the next generation of surgeons.
Our findings point to a much larger cultural problem within Canadian residency programs. Residents are often stripped of the dignity, mentorship, and human respect that every other healthcare worker could expect to receive. Leadership development is rarely part of their training, even though surgeons are expected to lead teams the moment they complete residency. Instead of being taught how to navigate conflict, communicate effectively, or build healthy team culture, residents are exposed to coercive structures and outdated hierarchical norms that increase anxiety, isolation, and emotional pressure. This culture does not create stronger surgeons; it creates exhausted ones. And it may be an overlooked contributing factor to why more Canadian surgeons are transferring their practice to the United States.
The difference in cultural perception between the two countries is significant. In Canada, surgeons are often viewed primarily as a financial liability within a constrained system—an expense line item connected to political pressures, waitlist management, and capped operating budgets. In contrast, American healthcare systems tend to view surgeons as assets—drivers of revenue, innovation, and clinical productivity. It is no surprise that U.S. hospitals actively court Canadian surgeons, and equally unsurprising that many Canadian surgeons are willing to leave. The appeal is obvious: higher earning potential, dramatically lower or zero state income tax depending on location, increased professional respect, more administrative and clinical support, and the ability to practice with fewer bottlenecks or restrictions. In a fee-for-service environment, surgical expertise is valued, rewarded, and respected, creating a practice environment where surgeons feel appreciated rather than constrained.
Still, many surgeons choose to remain in Canada for reasons that go beyond financial calculation. Family roots, cultural identity, and community ties are powerful anchors that keep people connected to their home country. Many Canadian surgeons also feel a deep commitment to equitable care and believe strongly in the principles of the public healthcare system. But even with these reasons, the question remains: how long can loyalty compete with emotional exhaustion? If residents are expressing monthly death thoughts, chronic anxiety, and fear of leadership during training, the long-term consequences for the surgical workforce are self-evident.
True solutions will not come from “wellness initiatives” that place responsibility on residents to cope with broken systems. The answer is not mindfulness seminars, yoga mats, or resilience workshops. The answer is cultural reform—real leadership, real mentorship, real support. Resident surgeons need psychologically safe environments, training in communication and conflict navigation, freedom from coercive educational tactics, and leaders who understand that emotional safety is not a luxury but a necessity. Until the culture changes, death thoughts among residents will not disappear, and the migration of Canadian surgeons to the U.S. is likely to continue.
Blog written by Nancy Riegel, Harvard Healthcare Economics Cert., Certified Executive Coach, MAIS (Candidate), Certified Life Coach, Lominger/Korn Ferry VOICES 360 and Leadership Architect Certified.
Survey conducted by Dr. Tim Riegel, FRCSC, Burn and Reconstructive Surgeon, and Nancy Riegel, Harvard Healthcare Economics Cert., Certified Executive Coach, MAIS (Candidate), Certified Life Coach, Lominger/Korn Ferry VOICES 360 and Leadership Architect Certified.
If you would like to conduct a surgical group survey, please reach out to Nancy in the link below for my information.