On Demand
The First Grueling Year of Being a Doctor
Thursday, January 17, 2008
80-hour workweeks, exhaustion, mental and moral challenges: the first year of medical residency is one of the most harrowing of a doctor’s professional life. Dr. Sandeep Jauhar writes about his own difficult residency at a busy New York City hospital in Intern.
Event: Sandeep Jauhar will be speaking and signing books
Thursday, January 17 at 7 pm
Barnes & Noble in Manhasset
1542 Northern Boulevard, Manhasset, NY
Weigh in: Do you think it’s a good idea for medical residencies to be so intense? How do the long hours and fast pace affect patient care?
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Comments
It's a bit of a misleading contrast to over-emphasize the "first year" when talking about this topic. While internship is a hard adjustment, unfortunately the long hours and the high stress don't end there and don't really change into the remaining years of residency.
This is a topic that really deserves discussion, but it's not like there is some sort of 12-month trial by fire that then suddenly ends.
As a phsycian married to a physician I have seen how the Libby Zion case and the ensuing Bell Commission have done a terible disservice to medicine and to the American public by creating a generation of doctor's who view themselves as shift workers. "At 5:00 times up and I'm leaving." This was never the attitude of doctor's before. This combined with the everyfalling reimbursement to doctors for their work make doctor's view of their own role ever more degraded. If you saw the Bell Commission almost fascist style of interviewing residents to see if they worked even two minutes over the allowed hours you would be horrified. Secret interviews in an attempt to trap hospital residency directors is the norm. What a shame for all of you; doctors and the public
I left the USA to do my internship and residency at McGill University in Montreal.
We worked very hard there working 12 hours a day six days a week. But we had night call only every four or five nights.
We learned a tremendous amount and the work was very satisfying. The esprit de corps was great. Unlike New York City hospitals which I observed with horror, there was no hazing of interns and students and no brutality to patients in Canada. No one was getting charity care.
Residents in NYC would leave interns on the hospital wards alone to make their inevitable mistakes. In Montreal, the internal medicine residency lasted four years, and the function of the fourth year resident was to supervise all the house staff. By my fourth year, I knew the ins and outs of the hospital, and knew where the logjams were. I would help the medical student and assign the patients in a rational manner. No one felt overwhelmed.
As a result, the mistakes were really at a minimum.
These years were the best years of my life.
I went on to get a management degree at Harvard since I was so perplexed as to why two hospitals could function so differently.
Bohdan A Oryshkevich., MD, MPH
In fact, MArc is correct. Residents do very little and actually responsible for almost nothing in hospitals these days compared to twenty years ago when they had to take responsibility and learned very fast what taking care of people was all about. This doesn't exist now and we are all going to suffer dearly for it.
Not only does residency cost hours but many of them on top of the long hours have to moonlight for such poor pay!
Why are we only focusing on the 1st year? Long hours, low pay, disrespect from colleagues - this goes on for years! I don't know about these other comments above, but there is no magical hour after which we leave. We stay until our work is done! Maybe this is the difference between the medical and surgical specialities.
I'm sorry but this author should have seen the amount of work done in the "days of the giants" years ago. Interns and residents are so coddled and have so little actual responsibility that they should be paying the hospitals for learning rather than being paid for working.
Had our second child at St. Luke's Roosevelt a few months ago.
Terrible experience. Why?
A roomful of arrogant, completely out-of-water interns who were so useless (we only wanted to know the steps of the epidural and if there were any we could skip!) we literally had to kick them all out. Unfortunately the OBGYN's associate doctor was also too young/arrogant and the middle aged Jamaican nurse, our only savior, was then at lunch.
My wife postponed her birth 3 hours for her own experienced OBGYN to get on shift.
Every intern says when they get to be a resident/attending they won't be as abusive as those who hazed them, yet we still have a world full of harsh/abusive residents & attendings
To be specific, they were young doctors with clipboards being led by another young (under 27 I'm sure) doctor. I assumed they were interns but can't say for sure (they did not introduce themselves of course).
This doctor is justifying/apologizing for a dehumanizing system that kills and injures patients and de-spirits doctors.
Would it really be such a terrible thing for patients and doctors if we had twice as many doctors earning half as much money and working far fewer hours?
How about public financing of medical school so these folks don't start their lives half a million bucks in debt?
Jauhar just referred to new interns as "naive" for showing human concern! What a shame...
PS (before you delete/censor this comment, save it and please send to your boss....and their boss etc, thanks! ;-)
The points/questions raised by others here are wonderful!!!
It's great that y'all give authors a chance to freely hawk their books with softball "interviews"....but it sure would be cool if on occasion, you actually allowed listeners to ask serious and challenging questions. (That might even sell MORE (good) books!)
Isn't WNYC supposed to be about PUBLIC radio as opposed to being personality driven commercial/conventional?
Nick will soon get what he wants. The top the class will soon all go into finance. The bottom of the class will go to Medical School. The American doctor will be as smart as thet stupidest kid in your elementary school class. You get what you pay for. Twice as many docs, half as smart.
marc, do you really think that there is a shortage of intelligent individuals in the USA? Did you read the post by the Canadian trained MD above, Bohdan A. Oryshkevich?
Obviously, this isn't "simple stuff". But a system that isn't based on fear, greed, elitism and raw status just might work better for all concerned. The status quo is clearly broken for all but the super rich.
Check out "Sicko"; better yet visit http://www.pnhp.org/pnhp-ny/ and attend some of the free talks given by physicians.
Be well!
In 1964 as a first yr med. student I read The Intern by Dr. X (Dr. Jauhur’s book has already been written). The Intern was an expose of the hard times of a surgery intern. I was overwhelmed by the notion of what I had to look forward to upon graduation. In fact, my surgery internship at a prominent Eastern teaching hospital made the life of Dr. X pale in comparison to my year, but I loved every minute of it. I viewed the year as an opportunity to jump from the text to real life and so I sucked up every grueling on-call hour. The exposure that I had during that year and the mentors that I had made a lasting impression upon my practice style to this day. Young physicians should jump in , suck it up and appreciate the opportunity which they have been given.
I have done 1.5 interships seperated by 2000 miles and 8 years. It has not gotten any better with time or a change from the south to NYC. If we treated people who fixed our cars like we treat our doctors we wouldnt have any repair people... and so it will go for doctors... already an impressive number are from other countries. Mostly these Docs are great and dedicated to the Art but many are begining to return or not even bothering to come... and smart US students are turning there back on medicine just as many many and ever increasing rate of docs are retiring or turning to other more stable fields... Eventually the market will demand more and better trained docs and offer better everything to get them... Expecially if the US becomes even more Zenophobic. So for those of you who think the past was better... Wrong.. those who think the present stinks... mostly wrong the past was worse in some ways but the present is worse in others.. and those who think it can only get worse... wrong It will have to get better... people and the market will ensure that they do.... The true question is.... how long will that take?
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