New Rules on Residents Shirk Realities of Medicine

June 7, 2011

It’s no wonder that physicians have such a difficult time achieving work-life balance. We were brought up in a system that defies the very concept.

I was talking to my hairdresser at a recent appointment about a documentary he had recently watched called “The Doctor Diaries.” He was impressed, appalled, amazed, and a bit horrified by the process medical trainees endure in order to graduate residency. This program, which I haven’t seen, apparently follows a group of physicians from medical school through residency and into post-residency practice.

My hairdresser described tearful residents, broken by long hours and low-man-on-the-totem-pole working conditions. I regaled him with tales from my own training - breaking down in tears in my program director’s office because a senior physician chastised me for a decision made by my attending, tales of falling asleep on the countertop at the labor and delivery nursing station 30 hours into my 36-hour shift (and actually feeling embarrassed to be so “weak”), and of working 100 hours to 110 hours per week for months at a time. I explained to him that there is a bit of machismo in medical training. Physicians are not only brilliant and empathic human beings, we are also superhuman in our ability to go days without sleep, hours and hours without a bathroom break, and avoid meals in favor of pieced-together selections from the vending machine and the nurse’s station snack drawer. While this may make us tough, I’m not sure it makes us resilient.

On the flip side, in my personal opinion, the Institute of Medicine and the American College of Graduate Medical Education have erred in the other direction. By making medical training into a protected haven free from many of the physical, emotional, and psychological stresses that I and generations of physicians experienced, they have removed some crucial “hardening” that I believe is necessary to the development of professionals who, in all honesty, are often called upon to ignore their own basic biological needs in order to meet emergency demands. Furthermore, by promoting more work-life balance in residency without funding or providing for additional man-hours elsewhere, the new residency work hours requirements have just off-loaded exhaustion, overload, and excessive demands onto the attending physicians. This is part of the reason I left academic medicine. Having already completed my own residency training, I wasn’t ready to take over call responsibilities from residents so that they could have eight unbroken hours of sleep.

It’s no wonder that physicians have such a difficult time achieving work-life balance. We were brought up in a system that defies the very concept.