You are exhausted, you are being shouted at, you have not eaten since yesterday, and everyone tells you this is what makes a doctor.
Doctors in training have among the highest rates of burnout, depression and suicidal thinking of any profession, and Nigerian house officers and residents face an unusually severe version — long calls, chronic understaffing, an entrenched hierarchy, delayed or disputed pay, and a culture in which admitting you are struggling is treated as unsuitability for medicine.
The load, named plainly
The rota. Calls that run far beyond any defensible limit, in units where there is nobody to hand over to. Sleep deprivation at this scale is not a rite of passage — it measurably impairs judgement and reaction time, which is a patient safety matter as well as a personal one.
Understaffing. Doing the work of several people because several people have left. Every departure increases the load on those remaining, which increases the incentive to leave. Everyone inside the system can see the loop.
The hierarchy. Teaching by humiliation is still normal in many Nigerian units — public dressing-downs on ward rounds, questions designed to expose rather than instruct. Some consultants are excellent. The system does not require them to be, and there is little recourse when they are not.
Pay and strikes. Delayed salaries, disputed allowances, industrial action. Financial insecurity in a role that consumed a decade of your life produces a particular kind of demoralisation.
Death, constantly. Losing patients you could have saved with equipment or drugs the hospital does not have. That is moral injury — distress from being prevented from doing what you know is right — and it is different from ordinary stress. It does not respond to rest, because the problem is not depletion.
The hidden curriculum. Nobody says exhaustion is a virtue. Everything about how the system runs communicates it. The registrar who never went home is the model.
What it looks like when it goes wrong
- Exhaustion that days off do not touch
- Cynicism about patients — referring to people by bed number or condition, irritation at their questions
- Dreading the ward before you arrive
- Errors creeping in, then hypervigilance about errors, then more exhaustion
- Emotional numbness, at work and at home
- Drinking to come down after call
- Guilt about outcomes that were not in your control
- Thinking you should never have entered medicine
The specifically medical difficulty is that doctors are poor at accessing help. You know too much to be reassured easily, you fear disclosure will follow you professionally, and the culture treats needing help as weakness — a belief you would never apply to a patient with the same symptoms.
Our piece on burnout in Nigerian helping professions covers the sector; the training years are a distinct and sharper version of it.
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The japa question
A large share of Nigerian doctors in training are actively planning to leave, and it dominates conversation in most call rooms.
Two honest points.
Leaving is a legitimate response to conditions that are genuinely poor, and nobody owes their health to a system that will not fund a functioning oxygen supply. Guilt about “abandoning” Nigerian patients is heavily promoted and belongs more to policy failure than to any individual doctor.
But relocation is also frequently framed as the solution to burnout, and it is not reliably that. NHS and North American training carry their own burnout rates, plus isolation, racism, revalidation and being junior again in a new system. People who leave while unwell often arrive unwell. Our pieces on japa stress, settling in abroad and coming home after japa cover all three stages.
Treat your mental health as something to address now, not after the exams, the visa, or the flight.
What helps while you are still in it
Sleep whenever it is available, without guilt. Post-call sleep is medical care for yourself. Protect it in a darkened room with your phone off.
Eat and drink on call. Basic and routinely skipped. Hypoglycaemia and dehydration will convincingly imitate anxiety and worsen every decision you make.
Debrief after bad outcomes. Ten minutes with a colleague, deliberately. Unprocessed deaths accumulate, and the accumulation is what produces the numbness.
Separate what you controlled from what you did not. Moral injury attaches personal guilt to systemic failure. You did not choose the budget, the staffing or the stock levels. Working out where your actual responsibility ended is a task worth doing properly, ideally with someone else.
Find your two or three. The people you can say the true version to. Colleagues in the same position are the most useful support available and the most underused.
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Keep one thing outside medicine. People whose entire identity is the job have nothing to fall back on when the job goes badly.
Watch the drinking. Common after call, and it degrades the sleep you desperately need.
On getting treatment as a doctor
Two objections come up, and both deserve a straight answer.
Confidentiality. Sessions with a licensed therapist are confidential. Your hospital, your consultant and your college are not informed. Is online therapy confidential in Nigeria? sets out exactly what is and is not shared, including the narrow limits.
Time. Video sessions in the evening or on a post-call day remove travel entirely. You can filter for availability in our directory.
Get help now if you are dreading every shift, if your sleep is broken even when you have the opportunity, if you feel nothing for your patients, or if you are drinking more. And immediately if you are having thoughts of harming yourself — doctors have elevated suicide rates, you have knowledge that makes those thoughts more dangerous, and our helplines are free. Read coping with triggers of suicidal thoughts today.
One thing to hold on to
You would not tell a patient with your symptoms to push through until the next posting. The standard of care you extend to everyone else applies to you, and the fact that the culture around you disagrees does not make it wrong.
Frequently asked questions
Is burnout normal in medical training?
It is extremely common, which is not the same as acceptable. Doctors in training have among the highest rates of burnout and depression of any profession.
Will getting help affect my career?
Therapy with a licensed practitioner is confidential and is not reported to your hospital or college. See is online therapy confidential in Nigeria?
What is moral injury?
Distress from being prevented from doing what you know is right — for example losing a patient for lack of equipment. It differs from burnout and does not resolve with rest alone.
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Will relocating abroad fix my burnout?
Not reliably. Training systems abroad carry their own burnout rates plus isolation and racism. Address your health before the move rather than after it.
How do I find time for therapy on a call rota?
Evening and post-call video sessions remove travel. Filter by availability in our directory.
