Wednesday, August 9, 2017

Wrong Priorities

At the risk of sounding like an old fart, I have to admit that we attendings frequently talk about our residents critically when they're not around. One common observation is that residents and fellows these days really aren't that into education. Surgeons complain their residents would rather round, or even finish writing patient notes, than enter the operating rooms. IM physicians gripe about residents who are nowhere to be found when an interesting case shows up at 4:00 PM. In fact, the hospital halls are pretty bereft of trainees after 5:00. Where are all the bright, intellectually curious young doctors these days?

A new poll just released by Medscape illustrates this problem. A survey of over 1500 residents asked them what were their biggest challenges during their training. The results are rather disheartening for those who had high hopes for the next generation of physicians.

As you can see, the number one concern that residents feel they are facing is "Work-life balance". By comparison, the reason they are in residency to begin with, "Developing the clinical skills required for the specialty", is down at a woeful fifth place. Really? Are our millenial physicians really such snowflakes? Is the medical field doomed when attaining knowledge lags behind worries about having the time to binge watch Game of Thrones?

In an era when medical information is growing exponentially, shouldn't this next generation be more troubled by whether they can keep up with that deluge of data instead of hoping they can get out in time to meet with their personal trainer?

Let's remember why medical residents are called that in the first place. Back in the day, they practically lived in the hospital for days at the time, thus the title of resident. Taking every third or fourth night call was common practice. Work-life balance was something you only hoped to attain once residency was finished, not striving for during the training itself.

Now we notice that attendings frequently stay at the hospital longer than our residents do. Critical decisions are made when most of the team have already left the building. This is the sad future of medicine. Shift work is being ingrained into the mentalities of our impressionable doctors. The days when the caring physician will stay at the bedside through the night will soon be history as work-life balance takes precedence over patient care.


  1. The generation of physicians that you trained under likely said the same, tired old lines about your generation. The fallacy of subsequent generations sucking more than their priors is a self-fulfilling prophecy. The reality is that medicine is advancing more rapidly than it ever has, patients are receiving better care and better outcomes than they did 20 years ago. Is that because work ethic has changed? Probably not. The work ethic has probably changed because the training culture is slowly shifting to acknowledge the depersonalizing nature of residency. If you disagree, I encourage you to look at the resident physician suicide rates. You even argue against yourself here when describing why you switched out of your surgery residency to anesthesia--the culture was not one that gave a shit about acknowledging you were a human being. Furthermore, don't let a collection of bad apples spoil the batch. The assertion that every current, recent or soon to be resident isn't as committed as your generation was is a total farce you seem to tell yourself to stereotype and validate crap talking them. There are plenty of hard working, intelligent residents out there that you should acknowledge. Maybe your institution doesn't have the luxury of recruiting many of these people, but if that is the case maybe you should get away from training them if it bothers you so.

  2. I believe there was a recent study that showed younger physicians have less mortality for patients than older physicians. Sounds like older physicians may have a lot more to learn than they suspect.