Ten Reasons Why Residency Is Prison
Some say you can still have a life while training as a resident. I tend to disagree, and here’s why:
1. Pager Matrimony
As a resident you’ll be married to your pager. The only time you’ll be allowed to turn it off is when you’re post-call. Even rarely after you finish your “shift” (on non-shift dependent rotations) will you be able to completely detach yourself from that dreaded beep machine.
Have you ever been in a conference and watch as how everybody in the room will reach down for their pager when one goes off? That’s really all the proof you need. Answering pages is typically a first priority for residents, as higher up attendings do not like to wait by the phone for more than 30 seconds for the call back.
2. Call and More Call
Taking call? Forget about leaving the hospital. Most training programs have strict rules that will not allow you to leave the hospital for food or running errands, especially when on call. This is one reason medical students are all too often used as food runners for residents.
If you have a must-do appointment somewhere, you’ll probably have to get into contact with your chief resident and request the time off. The difficulty that residents have in doing normal day-to-day things really boggles my mind. It’s not their fault, either. They’re at the hospital before normal working hours and stay until after normal working hours. When else are they to do the typical daily tasks that need taking care of?
3. Salaries
Residents are underpaid. The typical starting salary for an intern is somewhere in the high $30,000 range to the low $40,000 range. The maximum allowable work hours is 80. This equates to roughly $9.14 per hour using an average salary of $38,000 per year and 80 hour work weeks. We all know that most residents work more than 80 hours, so this number is just an estimate.
I’m willing to bet that some high-school dropout with a GED is making more than that working at McDonald’s somewhere. Does the promise of high salaries after residency training mean that residents can be underpaid in a monopolistic training environment without competition to naturally increase salaries? Hell no. But, as long as the NRMP is allowed to dominate the post-graduate training market, I don’t see salaries moving upwards anytime soon.
4. Time Off
Time off as a resident is nearly non-existent. Post-call days don’t count, either. Training programs have brainwashed residents into thinking that going home at noon post-call day is a day off. That’s crap. You go home and do what? Sleep?
If you’re single and live for the hospital, this might not be such a problem for you. But, if you’re like most people and have a life and family, this cuts into your personal time like a hot knife through butter. More time off needs to be given to residents.
5. 80 Hour Weeks
80 hour weeks are bullshit. If you absolutely love what you’re doing, 80 hours per week is nothing. Ask yourself this though: How many residents do you know that absolutely love what they’re doing? A small handful, at most.
Sure, limiting the residency work week to 80 hours was a huge plus for residents. Some of those poor people were working 120+ hours per week. The new rule essentially bagged them an additional 40 hours of free sleep time.
You’ll still run across those old-school attendings that think the 80 hour week is too lenient. Coming from a more hostile training environment, they think that just because they did it you have to as well. It’s the “I suffered, you’ll suffer” mentality
6. The Hierarchy
I discussed the medical training heirarchy a long time ago. It’s similar to that found in other manager-employee relationships, but medical training has found a way to take it a step further. Not only will you have to deal with your day-to-day routines and long work hours, but you’ll also have to put up workplace politics on steroids as well.
7. Inefficiency
Medical training is as efficient as the manual assembly of computers. Large scale manufacturing and corporate big business is efficient. Government jobs and medical training is not.
More time is wasted than is actually spent doing work. All of that time residents spend doing crap that’s better left for someone lower down on the food chain could better be spent at home or in the form of free time.
8. Inbred Social Life
Without time to leave the hospital and carry on meaningful relationships with people outside of medicine, you’ll be forced to treat residency as your primary social outlet. This is a dead end. While others are out strengthening more meaningful relationships, residents are forced to interact with whom they work with.
I don’t know about you, but most residents are not what I’d call a close friend. But, there’s not much you can do about it.
9. Contractual Employment
Residents operate on contracts. A new contract is signed at the beginning of your intern year (actually, when you are offered a spot during the match), and then each year thereafter.
If program directors do not feel you are living up to their expectations, they can terminate your contract. A resident who’s had a contract terminated for whatever reason might be hard pressed to find another program that will quickly pick him or her up.
That’s a pretty big gamble by anybody’s standards. It’s the system.
10. Becoming Them
The medical training process produces more of the same. All too often I’ve heard from physicians that used to love patients and their work who are now completely unhappy and wouldn’t do it over if you paid them.
This is probably the most serious consequence of residency training, as it has possible permanent effects. Personalities are changed for the worse, and all of a sudden you become them. You become what you hated so much during your third and fourth year of medical school and throughout residency.
It’s part of the process, and is the reason why the trend continues.
Maximum Security Prison
If you’re a nice, conditioned medical student that has been beaten into submission by the system, you’ll most likely be defensive about this post. However, if what I said above didn’t have a speck of truth to it, you wouldn’t have a reaction to it at all.
It’s really tough to throw away four years of your life and hundreds of thousands of dollars in debt when you suddenly realize that this isn’t for you, which could be considered another example of imprisonment via educational debt.
No matter what you decide to do, just be nice to the warden so he’ll let you go outside.
Popularity: 7% [?]
Did you enjoy this post? If so, consider subscribing to my full RSS feed and adding MSH to your Technorati Favorites.
TJD said
April 13 2007 @ 2:18 pm
Reasons why residency is not like prison:
I’m pretty sure there are laws that mandate prisoners have to be able to get a set number of hours of sleep every night.
Hoover said
April 13 2007 @ 3:52 pm
TJD, that is priceless.
CobraComander said
April 13 2007 @ 9:54 pm
TJD, you are 100% right. Sleep deprivation is considered inhumane treatment. If they did what they do to residents to prisoners of war, they’d be violating the Geneva Convention.
Zuwie said
April 13 2007 @ 11:04 pm
Speaking of which, I heard someone defend sleep-depriving prisoners on TV by saying: “Oh, come on, 24 hours without sleep? Our medical residents endure more than that”
Blank said
April 13 2007 @ 11:07 pm
Great website! Just discovered it myself.
The Buff said
April 13 2007 @ 11:25 pm
Just got a good laugh out of a piece on ABC news tonight. I guess the FDA is up in arms becuase air traffic controllers are allowed to work 8 hours on, 8 hours off, 8 hours on, “leaving little time for sleep”. I don’t know, sounds like the life to me.
The Buff said
April 13 2007 @ 11:26 pm
…and of course by FDA, I meant FAA.
Hoover said
April 13 2007 @ 11:40 pm
And if employees of “regular” jobs had to work like medical residents do, they’d be protesting before you could shake a stick. Residents put up with too much bullshit, and part of the reason is the vice grip on their balls.
Someone interested in medical student and resident education said
April 14 2007 @ 11:00 am
although, i agree with most of what you say, i will have to make some points about residency and some of the changes that have been made for many programs. and those who have never been in the previous system will not notice that change as much as those who were previously in the system. you previously posted the ACGME study was completely true. it is also 2007 and the data was from 2003-04 initial implementation. may things have change and many programs have been sited and/or placed on probation when they were reviewed by the RRC. most residency programs have began to adapted to the hours. although not perfect, i may add.
as far as the 10 points of residency being a prison, let’s talk about them:
1. Pager Matrimony
resident is attached to his/her pager; the attending is attached to his page (for me cellphone). have your own practice, and you may always be on call. residency is not any different than regular practice, unless you are in a shift work specialty.
for many programs, lecture time is “supposed” to be protected time and therefore, attendings should not be calling during this time. many times the pages are for patient care. in our program, many of the attendings attend the lectures as well or begin cases and clinic by themselves. these are some of the rules coming down from ACGME and RRC.
2. Call and More Call
call is a part of medicine. to accommodate the 80 work week and particular the 30 hr rule, many programs have gone to the night float or home call (if they can). and if you were in house, eating should never be an issue unless you are continuously busy, someone always delivers.
errands are never easy, in a practice or in residency; this is really no different the normal physician life. this is the same for appointments and normal day-to-day life things. in practice you don’t check with your chief resident, you check with your office manager; you may have to cancel a day of clinic or switch a call schedule or cancel OR cases. this actually can be more difficult than in residency because you effect more than just people you work with but also patients lives and schedules. if i cancel a 1/2 day clinic, 35 different people have to adjust. so i try to do things on my day off.
and call, i take more call than my residents (they have home all). i am schedule for 15 days of call in april (regular, adult trauma, peds trauma, and spine)
3. Salaries
can’t really argue this point. salaries are low. but, something that may change things is that there is an initiative for stop medicaid from paying for resident education (i originally thought all came from medicare, but i guess not). this will really change things for resident education. the number of residency spots will most definitely decrease and be replaced with mid level provides. the resident’s salary may increase and the hours decrease, but the number of spots will decrease.
4. Time Off
again, rules are rules, time off is a 24hr period. if a program is not allowing this, they are in violation. in our program, the residents make the schedule. if they don’t have time off, it is their fault. we don’t check to make sure they have the time off.
5. 80 Hour Weeks
i can say that in our program, we are well under the 80hr work limit. it actually is not that hard. the only people who end up working 80’s are the chief residents on the trauma service. lots of trauma.
6. The Hierarchy
again, this is set up for a reason. i am on the surgical end. if an error occurs and the resident makes it, who is at fault? i am. i don’t agree with making it a stuffy “you must salute me” or “you are not of the rank to speak directly with me” but there is a chain of command. intern to chief (or upper level resident), chief makes decision and relays decision to attending, attending’s job is to agree or disagree and advise.
7. Inefficiency
if you have a suggestion on how to make it more efficient, i would be glad to hear it. truth is when i have may clinic that i run by myself, i fill out all the paperwork, FMLA, school notes, prescriptions, place most of my own casts. when i was in my private practice, i wrote all my own notes, changed the dressings, did discharge summaries, etc. when you get into practice, there are many things that you have to do that have nothing to do with medicine. tell me, when do you learn how to do that? when do you learn the politics of getting a patient to rehab or an extended care facility? who teaches you how to fill out the dreaded 10 page FMLA or workman’s comp paper work. who educated you on how to give a deposition? who educates on how to speak with the other care providers (PT, OT, respiratory therapists, ect) in a way that doesn’t make you sound like an idiot?
8. Inbred Social Life
you are exactly right. making relationships outside of the office is something that you have to work at. out side interests have to be worked on and relationships sought out.
9. Contractual Employment
yes you can break the contract and try to find another spot. in some specialties this is hard. it is a supply and demand thing. in medicine, rather easy to do. in say plastics, not so much.
10. Becoming Them
this is a choice. we are all shaped by our own experiences. we choose what will will incorporate into our own practice in personality. see something you don’t like and choose not to do it. how will things change if people who want to change thing do not stay to change them. i have chosen to stay and help make changes. may have not and just complain. i look at it as voting, if you didn’t vote, what right do you have to complain. i recommend to all of my residents, if they are interested, stay in academics and make a difference in medical training.
Maximum Security Prison
ahh, not so much. but it does sound good. it definitely is better and constantly changing. seeing things from the other end i can say things are getting better and the mentality changing slowly. it’s like moving a aircraft carrier.
you make a lot of good points. many are points that have been complained about for years by residents. things are changing and the mentality of the med student and resident is changing. there is more of a sense of entitlement and less patient care. this saddens me. and this has nothing to do with the 80hr work week.
Joe said
April 16 2007 @ 12:07 pm
Residency is prison. Look at the surgery resident on:
http://surgicalsurvivor.blogspot.com/
They never sleep. It makes me not even want to graduate from med school. Look what i’ve got to look forward to.
Panda Bear said
April 16 2007 @ 1:04 pm
I reject the phrase “sense of entitlement” especially as it is thrown around by physicians who trained in an era when the doctor was king and billed for whatever he wanted and nobody, not insurance companies or patients, said “boo.” Not to mention that the malpractice and uncompensated care situation has gotten a lot worse in the last 15-or-so-years.
Also not to mention that the financial commitment for medical training has increased significantly (in real dollars) since the days when the old-school trained. It’s not unusual to be a quarter of million in debt by the end and, for some specialties, have given up almost a decade of some of the most productive years of your life as a low-wage slave.
Not to mention still again that nobody knows what the future will hold and whether, in ten years, physicians will be just another group of low-payed civil servants.
Also, medicine is no longer a monastic profession full of eager, young, socially dysfunctional white guys who waited until they were done with training to marry their trophy wife. In a society whose principle pathology is the collapse of the family, how on earth can we do anything but admire people who place a value on their families (and want to spend time with them) as opposed to the old days where the physician was expected to be the absentee father.
So this crap about needing more than 80 hours a week to train anybody for anything is just that, crap. It’s a result of the ossified thinking of the old school who are so set in their ways that they just can’t see how inefficient and frankly, idiotic, most of residency training is. The very idea that you need to deprive a young doctor of most of his sleep and family time to have him performing low-skill paperwork tasks that a motivated high school student would do if you paid him a little bit more than you pay the residents is laughable.
Here you have 80 hours a week, that’s a six-day work week of 13-hour days and twice what most people work and I’m expected to believe that a surgery program can’t schedule enough procedures (even those that are semi-emergent) to train their residents?
One day the work hour rules are going to be a law with civil and criminal penalties for their violation and then you’ll see how fast things will get efficient.
Someone interested in medical student and resident education said
April 16 2007 @ 2:04 pm
ah dr. bear, you reject the sense of entitlement. that term itself actually can directly from a forum on SDN http://forums.studentdoctor.net/showthread.php?t=389223 . i myself did not come up with that term. and as for the 80 hr work week (as i said) i do not think that is the issue. we like to talk about it as being the cause, but my opinion is the decrease in hours is not the cause of any of the problems. i do feel that when physicians start worrying more about their “shift” than patient care that is an issue.
personally being of the gen X, a generation hated by old school attendings (usually baby boomers), i have not personally been blessed with the financial benifits of the past, or the prestige.
i can say, looking at residency as a whole, things are better. does that mean changes don’t need to be make, no. there is a move in the right direction. as far as prison, not so much. it may feel like it, but it is not. the resident has more power than you think. educators, in and out of medicine, are pressured to pass people. if you look at grade distributions now a days, B is the new C; C is well like a D. to fail someone we need to have justification and can be assured that our grades will be challanged. the same goes for residents. if we feel that a resident is sub par, there are a number of steps that have to be done before we decide to let a resident go. it can take 1-2 years to go through the procees. a majority of the time the thought is why even bother. the juice ain’t worth the squeeze.
overall there are changes in the right direction. the attending has less “power” than you think. truth is, i end up doing more myself just to make sure it is done right.; because in the end, i am responsible. i am a stickler for the rules set down from HCFA, the ACGME, and the RRC. i chose not to test the waters and risk the fines.
Comment RSS · TrackBack URI
Leave a comment
Add to
Hell's Most Popular
Recently in Hell
Recommended Reading
Categories
Archives
Meta
RecentEntries
MyLinks
ElseWheres
© 2005-2008 Med School Hell | Akismet has protected Med School Hell from 37,685 spam comments.
Home About Archives Contact Contribute