One of the head-scratchers about American culture is that anxiety, depression, unwanted weight gain, and a soaring prevalence of lifestyle diseases clearly plague our society. Yet, the primary metric we use to measure our country’s “success,” GDP, doesn’t even account for this suffering.

Society has a variety of needs that must be met to be truly successful, not just economically productive. As Senator Robert Kennedy memorably said, “GDP measures everything except that which makes life worthwhile.”

In medical school and subsequently residency, hours spent in the hospital are our “GDP.” The workload of medical students and residents often thwarts their outside goals, passions, and, quite often, basic needs in lieu of time spent in the hospital. As a matter of fact, medical school deans have even said that the standard medical school workload requires that [unpaid] students work 60 to 80 hours per week.

For a place where young people enthusiastically go to learn to heal others, medical education ironically (and sadly) often forces students and residents into needing to heal themselves. After all, medical students and residents alike are 300 to 400 percent more likely to be depressed than their age-matched counterparts in the general population.

Yet, medical and graduate medical education continue to uphold long work hours, long work hours that have been fortified in scientific literature as harmful to our well-being. Leaders in medical education are no strangers to the literature: long hours can worsen family relationships, contribute to alcohol abuse, and lead to the euphemism “burnout” or “emotional exhaustion and depersonalization.”

Please pause and consider those two describers in their literal sense – depersonalization and exhaustion of your emotions. Now ask yourself, how would you like it if your spouse or family member came home in that state every day?

Despite these crushing consequences for medical students and residents, it’s common knowledge in medical education that the rationalization of trading the well-being of students and residents for distressing work hours is not grounded or sensical. Rather, it is rationalized based on what I would argue is ethically flawed pragmatism and delusional idealism.

From the pragmatic perspective, it stands that long work hours in medical school are to prepare medical students for those in residency. From the idealist perspective, it holds that long work hours allow medical students and residents to absorb every opportunity to experience medicine they can. Note: The long hours in residency have a larger component involving economic forces that is beyond the scope of this article.

Let’s begin with the pragmatic perspective on justifying long work hours for medical students. I understand the temptation to consider excessive work hours now as preparation for excessive work hours in residency. However, this is misplaced virtue. It attempts to make a right with two wrongs, where instead, we should focus on reducing medical student and resident work hours.

Why is it wrong to begin with? Well, resident burnout is associated with reduced patient satisfaction, poorer health outcomes, increased health care costs from physician turnover, and increased medical errors. Maintaining work standards where the majority of physicians experience burnout is, in no uncertain terms, unethical – to physicians and to patients who are more likely to be put at risk by medical errors.

Now for the delusional idealism that medical students across the nation will tell you they’ve heard touted by their institution’s leadership – that excessive work hours are important for maximizing the opportunity for students to experience medicine.

On its surface, I sympathize with this rationalization – this is the time in our lives when we can observe the intricacies of numerous medical specialties with the privilege of asking to be taught virtually anything we’d like to know. Of course, that is a privilege I value, and I imagine it’s safe to presume it is something valued by anyone who has decided to exchange so much of their life to be filled with matters of medicine.

In both acknowledging that privilege and disagreeing with the supremacy bestowed on it, there is an obvious argument for the quality of learning over the number of hours. If that wasn’t enough, a growing body of literature has documented increased productivity among workers when they are balanced and happy. 

The delusional component assumes that maximizing the opportunity for students to experience medicine is what we all universally value. This rationalization disregards different people’s different ideals for their lives. Some people may feel that dedicating as much time as possible to matters of medicine is a virtue well worth adopting. I would gamble that these same individuals are more likely to become leaders in medical education and perhaps propagate this dogma to the next generation of medical students.

While that ideal is admirable, there are a diversity of ways that we can bring richness to each of our unique lives while still being a great medical student, resident, or doctor. Certainly, not everyone agrees with the ideal of prioritizing work at the logical, predictable, and documented expense of work-life balance.

If we are reaching our goals and expectations for our professional development within the hours of a standard US workweek, let trainees choose if they wish to spend more time studying or in clinical settings. By instead forcing trainees to work excessive hours, what are we doing for students who find richness and inspiration in other areas of life? In the face of the mounting rates of burnout within the profession, we’re delusional if we think we’re helping them.

Until the ACGME considers revising its guidelines on 28-hour call and 80-hour work weeks in residency, which place residents and their patients in unsafe conditions, residents and medical students will continue to suffer. Instead of addressing the root cause of burnout, the ACGME has taken pride in releasing a “robust Well-Being Tools and Resources page.” I invite you to ask any medical student or resident if they’ve ever even heard of this page. The ACGME disappoints further in a video made in collaboration with Mayo Clinic that gaslights physicians, placing the onus of preventing physician suicide on physicians themselves, and notably not on the entity permitting the propagation of excessive work hours and burnout – the ACGME.

As medical students and residents, we should not sit back and accept this burden. These conversations need to become commonplace. We are not weak or unsuitable for this profession by advocating for change when excessive work hours in medical training have been shown to have a dose-response relationship with depression.

We should not continue to accept a system with work conditions that leave us with little to no time for what we do to feel good, for adequate sleep, for fitness, for time with our spouses, for time with our families, for time with our children … in conditions where we are four times more likely to become depressed, in conditions where we are 2.5 times more likely to consider suicide, and in conditions that we know don’t have to be this way.

Suffering should never be a prerequisite for a job in the United States in the year 2023. Our generation of doctors and those to come deserve ethical and humane work hours, making our jobs safer for our patients and us.

Douglas Sirutis is a medical student.