Are resident doctors unhappy? Why?

In a New York Times “Upshot” piece on December 7, 2017, Dhruv Khullar notes that “Being a doctor is hard. It’s harder for women”. I do not doubt it, especially the second part. Dr. Khullar goes through a host of reasons for why it is harder for women, most of them related to sexism (including internalized sexism) such as having children, having the bulk of the responsibility for maintaining a household, being seen as less smart or competent by supervisors and colleagues, and on and on. The idea that “being a doctor is hard” is also one I can agree with. However, Dr. Khullar’s piece focuses mainly on residents, medical school graduates who are in specialty training. He opens it with a parody of Tolstoy’s Anna Karenina: “Happy medical residents are all alike. Every unhappy resident would take a long time to count.”

This is where I take issue, at least a little, with his perspective. Mainly this is because I do not remember being unhappy as a resident several decades ago. Tired, often, but not unhappy. I liked the work I did, as a family medicine resident at Cook County Hospital in the late 1970s, both caring for patients in the hospital on a variety of specialty services and in our hospital and community-based outpatient practices. I liked my colleagues, in family medicine and in other departments, and liked working with them. I learned a lot from them. I don’t recall most of my colleagues being unhappy either, and checked with a few with whom I am still in touch, and they also do not recall being unhappy. One, indeed, said he wasn’t even that tired, as he slept through most noon conferences!

There were not only fewer women residents and medical students, but they were (in my  experience) less likely to be married and have children. A small minority of students in my medical school class were married, but now it is common. I married (another resident) and we had our first child during residency, but when I was a program director, the majority of my residents were married by the time they started (I remember a year when five women started the program with different last names than they had interviewed with).

Yet several studies do tend to support Dr. Khullar’s assertions about residents in general being unhappy, as well as feeling overworked, and I think my experience as a family medicine program director and that of one of my colleagues (and former wife) as an internal medicine program director, support the idea that more recent residents seem unhappier, at least compared to us, then, at that hospital. There could be many reasons for this, including the possibility that memory is inaccurate, and distance dulls the pain, but I don’t think that this is the main one.

Another reason could, theoretically, be that the work was less or easier back then. Indeed, at Cook County Hospital in the late 1970s most residents had every-fourth-night call, a direct result of having a residents’ union in the hospital that negotiated working conditions. Dr. Khullar asserts that “The structure of medical training has changed little since the 1960s, when almost all residents were men with few household duties.” I think that he is wrong about this. Residents who trained in the late ‘60s and early ‘70s, before me and the union, often had every other night call (yes, work all day and all night and the next day, then go home and crash and come back to work). There is a reason that these doctors in training are called “residents” and “interns”; Cook County had a residents’ residence, where many actually lived and all had “call rooms” where we could get, maybe, a couple of hours rest. Although call was every 4^th night, there were no other “hours rules”; Cook County had 16 medical services, with 4 taking call every 4^thnight and taking every 4^th admission, and the two interns on each service thus taking every 8^th, but this could easily be 10 or more patients per intern per night. And one didn’t get to go home the next day at a certain time even though other services were on call. One specific example was CT scans; Cook County Hospital didn’t have one then, but the private hospital across the street, Rush, did. We could take our patients there, but only at night, when they were finished with their routine scans, and the patients had to be accompanied by the Cook County intern caring for them. Often at midnight, the night after they had been admitted. Residents also did most of the work; attending physicians were not in the hospital at night, and in the day had time only to round on new admissions and those who were very sick. Even having every 4^th night call was a big change from every other or 3^rdnight, but I do not think we had less work than most residents have today.

My point is not to try to disparage the tiredness or unhappiness of more recent residents by citing the “bad old days” when things were worse and we had to walk to school in the snow uphill both ways (although the weather was worse in Chicago then, thanks to global warming, and it was possible in winter to arrive and leave in the dark, and thanks to the system of tunnels under Cook County never see the sun). It is simply to note that workload is not the sole, or main, determinant of whether residents are happy or not. And here I can just speak from my limited experience. Many of us who were residents at Cook County Hospital were there for a reason. From the several Chicago medical schools and those further afield, we came because we were committed to providing the best possible care for people who were poor, underserved, and often ignored. We knew, and daily had reinforced, that our best efforts could not make up for the impact of poverty and discrimination; that despite the fact that the hospital did not charge patients, even for outpatient medications (although they had to wait hours for their prescriptions to be filled) the obstacles to their health were enormous. But we, most of us, cared, and tried to do our best. Our residency was not just a step on the path to a career as a successful physician, but an opportunity to work with and try to help people who had real need. We had a mission, not necessarily in the religious sense (although many who came as residents to Cook County were inspired and motivated by their religious convictions).

And, as a result of this shared mission we were each others’ greatest support, personally as well as medically. Medically, the 4 services with 4 residents, 8 interns, a chief resident, and medical students, shared an “admitting ward”, as so we were all together, to consult, to review x-rays, and help with procedures. But personally, we could reinforce each others’ beliefs, and provide support, succor, and even inspiration. I think that was the biggest part, for me at least.

Certainly, my experience at Cook County may not have been typical for residents of the era (indeed, that is part of why I chose it). Certainly, there were unhappy residents then, and uncommitted residents then, and women residents who were burdened with the care of the household and children. And, as certainly, there are now and have been ever since, happy and committed and inspirational residents. I guess “if you’ve seen one, you’ve seen one”. But I am pretty sure that a commitment to something greater than yourself and your self-interest helps a lot, as does training in a place where many of your colleagues feel the same way. And maybe that’s a lot of what we need as doctors, not just residents.

And as people.

Matthew Freeman Social Justice Lecture and Awards 2015 at Roosevelt University

The 2015 Matthew Freeman Social Justice Lecture and Awards at Roosevelt University in Chicago were given and presented this year on March 26, 2015. The lecture was given by Carlos Javier Ortiz. Mr. Ortiz is a highly-honored photographer and photojournalist, and his presentation was therefore much more visual than many previous lectures.  Based on the photographs from his book and gallery display “We All We Got”,the images and accompanying talk focused upon the lives of poor people of color in Chicago, particularly those of families of young people who had been killed, often as incidental victims. Ortiz developed long-lasting relationships with some of these families, and his photographs document that, even with these losses, life goes on.

But it does not go on smoothly or easily. Affixed to the back cover of his book is a fold-out list, by year, from 2007 to 2014, of the hundreds and hundreds of Chicago Public School students who have been victims of gunshots and stabbing deaths. In his talk, Ortiz notes that in more affluent suburban communities, such premature deaths are rare and often kept from young people, while on the south and west sides of Chicago grammar school classes may be taken to the funerals and wakes, such as that of Siretha White in 2006 pictured below. Diane Latiker and her husband are building a memorial, brick by brick, to young people lost to violence. Begun in 2007, it has more than 370 stones, and Ortiz tell us, is behind by more than 200.

We who are not part of these communities may see them as apart; indeed one mural depicts downtown Chicago as separated from their neighborhood by almost-impassable mountains (there are, in case you wondered, no mountains in Chicago). Our news media nationally cover tragedies involving the death of white young people as at Columbine and Sandy Hook; local news may cover the accidental killings of young Black girls such as Siretha White, but the deaths of young Black men, who may have been linked to gangs, is not news. But their families, and communities, suffer, as does our whole society which affords them no future.

This theme is tied to that noted by Richard E. Wallace, one of the amazing Roosevelt students to receive the Matthew Freeman Award. Wallace, who is a father and labor organizer while maintaining a straight-A average, works with day laborers. These people awake at 4am every day to be in line to be picked up so they can work for minimum wage doing tasks from backbreaking physical labor to shipping your Amazon packages so that they can provide at least minimal housing, food, and water for their families. With this life of constant work for barely subsistence wage, they have no hope of getting out or advancing, recalling the lives of ante-bellum slaves in the South. He is one of the founding members of the Stop Mass Incarceration Network at Roosevelt, and the professor who nominated him said “I have probably learned as much, if not more, from Richard Wallace as he has learned from me.  I think he is one of the brightest and best embodiments of the university’s mission that we have seen.”

 

Danielle Cooperstock, the other reward recipient, is also amazing. She “is majoring in Social Justice Studies with a minor in Women’s and Gender Studies. In 2012, Danielle connected with PIRG through a transformational learning course on educational and economic inequality issues. She continues to work with this community organization and many others to this day. For the past two years, Danielle has worked as a student disability and peer mentor at the Academic Success Center. Additionally, she is a crucial leader of two Roosevelt activist groups, RISE and RU Proud, both of which motivate other Roosevelt students toward social justice goals.”

These are two incredible young people, and I had a desperately-needed sense of hope and optimism on meeting them and hearing what they have done. And I thank Roosevelt University for its explicit social justice mission and its nurturance and support of students like these two. Should you have the capability, it is certainly worthy of your support.