Recently, I read an online post complaining about the sacrifices residents make while training to be a doctor. These include working weekends, holidays, nights, and long hours, often for low pay. I found myself in an odd position: sympathetic but also cringing.
I am a firm and committed believer that we must reform residency education, and compensate residents fairly, but I am also someone who thinks that we are incredibly lucky and privileged to be physicians and should be careful when we complain publicly. How do I reconcile these views?
First, let us be clear: there is a large gradient between a July intern and a final year fellow in medical training. The former is a medical student with a longer coat, and the latter is an attending. On one end you have someone whose clinical experiences are limited; judgment, a work in progress; and knowledge base still building; and on the other end you have a highly capable and field-tested individual, lacking only the confidence that comes with time and independence.
I think we must acknowledge that the system we have is not optimized for educating and compensating trainees fairly. The intern may do the work of several mid-level providers and ancillary staff, yet is often paid less than even one of these jobs. The final year fellow may do the work of an attending and a half (due to volume of service), but is often compensated far less. I strongly think we should pay these folks fairly.
At the same time, we must reassess what we ask of trainees. The types of tasks we demand of interns appear to be optimized to maximally exploit their labor. Endlessly doing paperwork and scheduling calls can be taught in 2 weeks, but we add on another 50 weeks to round out intern year.
Meanwhile, learning medicine becomes a byproduct (not goal) of this year. I believe every bit of medical training should move us towards the goal of training great independent doctors. Intern year fails my test. It's an extended course in tedious tasks.
For these reasons, the two reforms for graduate medical training I favor are (a) change the scope of activities to focus on teaching people how to be a doctor, not how to be an efficient (and overworked) hospital paperwork expert. And, having done so, (b) the pay should be commensurate with the benefit these trainees actually provide the hospital.
Finally, I support efforts to bring hours in line with civilized, western nations like the United Kingdom. I think this must be done while ensuring trainees get enough cases, patients, and volume of care to develop their skills.
Now, having said all this, I bristle when I watch doctors-in-training complain online about working on Thanksgiving or Christmas or on Saturday or overnight. Having to work at these odd times is not a burden, but a reminder that our profession is needed. What we do matters, and that means: yes, you will occasionally miss dinner with someone special, or a weekend with a family member because we cannot control when folks fall ill.
The blessing and curse of this job are that people actually need you. In an era of work from home and Zoom meetings, I cannot tell you how glad I am to be a doctor.
Despite the pain and frustration of medical training, at the end of our training we enjoy some of the of any profession in America. I have occasionally heard some physicians lament that a classmate who pursued finance makes far more money, but the most amazing thing about medicine is not how much the most successful doctor makes, but that the least successful doctor is still handsomely compensated. Law or business does not provide this safety net.
Our profession is a pleasure. Our task combines objective science with the eternal emotions of being human. People confide in you, trust you, care about you, and value you. Our job requires emotional and cognitive intelligence. Few tasks are as fulfilling.
I worry when we complain openly that we forget there are many other jobs in this country that require odd hours and hard work but are never compensated as a doctor is. When we complain, we should do so with the humility to know that folks who work at a grocery store may also work on holidays and weekends and nights, and often for minimum wage. When they finish 4 or 6 or 8 years, they don't have a six-figure job and certain employment.
We can reform medicine without asking for pity. We can identify deficits and gaps in our institutions without claiming to be martyrs. We can acknowledge that we can improve the path and course of becoming a doctor, but that it is still a wonderful thing to practice medicine.
That's why I'm sympathetic to the need to reform, but also cringe when I hear criticism that misses why we do what we do.
is a hematologist-oncologist and associate professor of medicine at the University of California San Francisco, and author of .