Medical Residency

The past two weeks, Marcus has really been slammed at the hospital. He normally doesn't work Saturdays, but he was at work all day this Saturday, and will be again next week. In addition, a series of frustrating events has left him feeling very discouraged at work of late. So I've been mulling over the uniqueness of residency as a work environment, and here's what I've come up with:

(1) Residents endure frequent changes in job description. Radiation oncology residents rotate under different attendings (doctors who have completed residency and are employed at a teaching hospital) for periods of 4 months in length. Each attending specializes in a certain type of cancer. While a resident is working with that attending, he is expected to be an expert on that type of cancer. He will be responsible for planning and implementing treatment plans for patients on a daily basis, so his knowledge during those months must have a breadth and depth that enables him to do that well. The pressure is enormous to make no mistakes in word or deed. And then the rotation changes and the resident must adopt an entirely new area of expertise.

(2) Hand-in-hand with changing job descriptions goes multiple bosses. Expectations vary widely between the dozen or so "attendings", who are all direct superiors of each resident. One attending may spend an extensive amount of time with treatment planning. He wants all of the T's crossed this way and the I's dotted this way, and it is the residents job to carefully observe all of the preferences of this attending and then adjust his own habits accordingly. I remember this process very well from when I was working outside the home: know your boss, find out what he expects, and then do it well. But this process is exacerbated by the fact that a resident doesn't have just one boss. Any request made by any attending is a request made by a "boss", but as is easily imagined, these attendings are not communicating with each other about the volume of tasks that are laid on a particular resident, so there are times when residents are completely swamped with things to do. And sadly, nobody even realizes the extraordinary amount of effort being demanded from the resident.

(3) Another difficulty is the inequity between required qualifications to become a resident and the financial compensation that is provided during the years of residency. After completing eight years of fulltime education (undergrad & med school) and acquiring a license to practice medicine, a resident is paid about $11-$15 per hour (before taxes). Residents are paid a standard amount which is determined in the state in which they work, but the hourly amount varies based on how many hours are worked, usually between 60 and 80 per week. This amount is very low compared to the "hourly rate" of almost all other salaried professions. (One exception is some university professors, who are also underpaid for the education required.) But overall, the pressure, time and education requirements on a resident are not adequately compensated.

(4) Maybe the most difficult aspect of being a medical resident is the general lack of respect and appreciation due to the context of residency. A resident is often treated like someone who is hired from a temp agency. Everyone knows that residents are transient, so the general social deferences that are often afforded a longterm employee are often ignored by medical support staff. In addition, residents recieve regular "360-degree reviews." This means that every nurse, tech, therapist and dosimitrist who works with Marcus will regularly review his performance. So in a weird way, he is sort of subordinate to everyone he interacts with and has to be on his toes at all times. Keep in mind there is no recipricol review process for residents to evaluate the other employees. And there is little recourse for a resident to appeal an inaccurate evaluation (even if it was made by a lazy tech who actually got him confused with another doctor.) And on top of everything, a resident cannot (or at least very, very rarely) "quit" his job. So higher-ups need not be overly concerned about morale, though of course it looks bad for the department when a resident has a mental breakdown, so they do try to minimize those occurances.

All in all, residency takes a psychological toll that few people outside the system are aware of. Unfortunately, many doctors become very disillusioned in the process, and some go on to become active perpetuators of this good-old-boy system.