My reflection on this starts on this late evening of a summer night here in the midwest, reading this trending article by Dr. Pamela Wible about those lovely resident physicians who died in a span of one year during their residency program, two of suicide and one “accidentally”.
The response to this article is full of love and compassion, but among those pleading voices to fix this broken system, some were just so preoccupied with the quotation marks that the author placed on the word “accidental”, they argue that Dr. Bo’s death was ruled out as an accident, not suicide, and her insinuation is not welcomed and some went to calling it outright malicious. Those voices were not as loud to criticize the current dogma of taking advantage of our aspirations to become physicians to staff an understaffed hospital in the midst of the biggest pandemic in our lifetime. Some of those physicians that criticized the article are mostly attendings, some finished residency a long time ago, a lot still fantasizes and fetishizes the long grueling hours they had to go through during their term, it’s the norm, and anyone who tries to interject and attempt to voice concern to help move the needle on fixing this issue is not welcomed.
How and where did things get so wrong?
Residency is under the umbrella of the Accreditation Council for Graduate Medical Education (ACGME), and only they can determine and enforce the maximum work hours a resident can do in a week. The current weekly work hours are capped at 80 hours/week and no more than 28 hours continuously.
Stop and think about these numbers. Let’s do the math here, there are 168 hours in a week, assuming residents sleep for 7–8 hours a night (can we let them do that at least?), which leaves 112 hours a week for us to work with. Now take away those 80 stressful and scarring hours, you end up with 32 hours a week and 4.5 hours a day. As a resident, you have to squeeze in commuting to the hospital, preparing and eating your meals, go shopping, take care of your family and loved ones, and study.
Squeeze the rest of your life in 4–5 hours a day for 3–5 years depending on which specialty you chose, and if you want to subspecialize further which takes away more and more years.
And yeah, by the way, you still get paid almost nothing, close to the minimum wage for this.
DOES THIS SYSTEM MAKE SENSE TO ANYONE?
Well, it does to everybody in the medical field. You see, it is a compromise now for a far better and brighter future. Sadly, some of us don't even make it to that future, others carry life lingering scars that we can hardly shake off.
Physician exhaustion, burnout, and moral injury are rampant among medical trainees and physician attendings alike, almost 3 out of 4 physicians report depression or depressive symptoms. Suicide is much higher among physicians compared to the general population, both on the male and female sides, with females having higher numbers. Let's not forget about substance abuse, doctors have higher rates of alcohol abuse compared to the general public, as if drowning our sorrow in alcohol works, but that’s the statistics for you.
We need better protection for our residents and fellows, and I don't believe ACGME is the one to deliver this protection, as no amount of extra “ping pong” tables or resident lounges would be enough to cover the pain and loneliness we face.
I want to extend my words of condolences to the residents who passed in this lonely and unjust world. Let our voices rise and echo across this dark and empty space to fill it with their names. We need to be better, we need to talk about this more.