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We sit down with Audra King, a surgery resident, to explore the challenges and toxic environments that medical trainees often face during their residency. From instances of disrespect and workplace bullying to the emotional toll of navigating power dynamics in the hospital, Audra shares her personal experiences and insights. We discuss how these situations impact patient care, the importance of mentorship, and what needs to change in medical culture to better support residents. Join us as we delve into the realities of medical training and the resilience required to thrive in such an environment.

Audra King is a surgery resident.

She discusses the KevinMD article, “Diary of a resident: Dr. Punching Bag, MD.”

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Transcript

Kevin Pho: Hi and welcome to the show. Subscribe at KevinMD.com/podcast. Today, we welcome Audra King. She’s a surgery resident. Today’s KevinMD article is “Diary of a Resident: Dr. Punching Bag, MD.”

Kevin Pho: Audra, welcome to the podcast by KevinMD.

Audra King: Thank you. I’m glad to be here.

Kevin Pho: So you’re a surgery resident. Tell us a little bit about your story and journey.

Audra King: Yeah, absolutely. So I am currently a surgical resident in my third year of training at the University of North Dakota. I am originally from rural southeastern Oklahoma, a very small town. I ended up actually starting out at a community college because it was a little bit cheaper. I transferred to a public university and then ended up getting into medical school at OU. I did not really know what I wanted to do, you know, going into medical school. I definitely did not think I wanted to do surgery, but I fell in love with surgery on my rotation, and here I am.

Kevin Pho: All right. Tell us what about surgery appealed to you as a medical student.

Audra King: Yeah, I think it was just really the culture of it. Personally, I really enjoy working with my hands and doing procedures, and just being able to do that all day. You know, it is very fast-paced and constantly engaging. I find it more fun than sitting at a desk all day. I enjoy the environment and the go-go-go mentality.

Kevin Pho: So you wrote this KevinMD article about your surgery residency, Diary of a Resident: Dr. Punching Bag, MD. Tell us the events that led you to write this article, and then we will talk more about the article itself.

Audra King: Yeah, absolutely. So really, it started out as a venting session. I started journaling to kind of try to cope with stress, and that is how this article came together. I had had a rough day and just wanted to write everything out. As I kept writing, I got more and more of my frustrations out, and it eventually formed into this article. I think what makes it important is that I am glad I am able to share my story with other people because I think a lot of people do not understand the difficulties that residents go through on a daily basis.

You know, I think everybody is aware that we are underpaid and overworked. Coming into residency, I was ready for that. I was completely prepared for it. But what I was not ready for was the daily, subtle to more overt disrespect that residents typically get from a good portion of the hospital staff throughout the day, most days. It can range from people making you feel like your presence does not matter to more direct forms of disrespect.

Kevin Pho: Can you expand on what you mean by disrespect?

Audra King: Yeah, like I mentioned in the article, during my third year of medical school, my clinical rotations started off well during the first two years. But during the third year, I felt like I was treated pretty badly by some people in the hospital. They may not even realize they are doing it, but you constantly feel like you are in the way, and it is not a great learning environment a lot of the time. I hoped that when I started my intern year, things would change now that I am a physician, but that really did not happen. I found myself dealing with the same things—scrub techs treating me like it was my first day in the operating room, talking down to me, and just not showing respect for me as a professional.

I want to be clear: this is not just a problem with my specific program. I have been at OU for medical school, and I have talked to other residents at other programs. It seems to be a systematic issue, something like a nationwide problem. It is not just about my program because, at the University of North Dakota, everyone has been wonderful. The residents are supportive of each other, and the attendings are generally supportive as well.

Kevin Pho: It seems like these issues are widespread. Can you share an example or a specific story where you or another resident experienced this type of behavior?

Audra King: Sure. One of my friends, who is also a female surgery resident—so that might be a factor as well—was walking around on the floor, taking care of orders and checking on patients. One of the charge nurses rudely tried to get her attention by yelling, “Hey, surgery girl!” In my mind, that is completely inappropriate. Even a day-one intern is still a professional. They have an MD or DO degree. I just cannot imagine disrespecting someone in their workplace like that, but for some reason, people have decided it is OK to treat residents this way.

Kevin Pho: And to be clear, this is what you believe is happening nationwide when you talk to your friends and colleagues from hospitals across the country. This seems to be a universal phenomenon. Is that correct?

Audra King: Yes, absolutely correct. That is what makes it so difficult. It is not something that any single program can fix or any single person can fix. What is ultimately needed is a way to even out the power imbalance that disfavors residents.

Kevin Pho: So when you are on the receiving end of these microaggressions, and you already have so much on your plate—waking up early, starting rounds, spending most of the day in the operating room—how do you cope with it all?

Audra King: Yeah, early on, as a student, I just took it. I was honestly pretty anxious and tried my best to stay out of the way. As an intern, I had higher expectations. It made me angry early on, and I would do my best to respectfully call people out. But I found that I only ended up getting myself in trouble.

Kevin Pho: What do you mean by that? Getting reported?

Audra King: Yeah, getting reported. A lot of these people are very happy to report residents.

Kevin Pho: What are the consequences if that happens to you?

Audra King: So far, I feel like my program has had my back. They have listened to my side of things and have not jumped to conclusions, but it puts you on the radar. Even if your program has your back, when these things pile up, you start to feel more uncomfortable in your job.

Eventually, a lot of us just stop caring. We just take it, keep our heads down, and power through. But it is detrimental to resident mental health and contributes to burnout. Everyone talks about burnout, but people want to solve it with wellness talks and modules, which is not how you solve burnout. A lot of us are burned out because, for one, we are underpaid and tired. And then to have to go to work, just wanting to do your job, and deal with this every day—it really grates on your self-esteem.

Kevin Pho: When you talk about this with your attending physicians, mentors, or program directors, what is their normal response?

Audra King: It depends on who it is. I am lucky at my program that they have listened to me. A lot of times, after explaining my side, they brush it off, like, “Oh, it is fine.” It still bothers me that it even happened. Even though my program has my back and listens to my side, the fact that I even have to go meet with them—it is still going to bother me.

One of my attendings recently had my back. We were in the emergency department, and I butted heads with an emergency department physician who did not agree with my management of things. He did not trust what I had to say because I was a resident. But my attending came in, listened to me, and talked to that physician. It was nice to know that someone had my back for once. I think that is how we can try to solve this issue. I am not a medical student anymore, but I look out for the medical students. When they are on rotations with me, I tell them to come to me if anyone treats them badly, and I will help them deal with it.

Kevin Pho: Is this something that is seen primarily in surgery residencies, or do you see the same disrespect happening in other specialties?

Audra King: No, this is pretty universal, regardless of specialty or hospital. It is a cultural thing. I feel like health care itself has the tendency to be toxic, and when you put powerless residents in the mix who cannot defend themselves, it is a recipe for things to get even worse.

Kevin Pho: Let’s talk about some paths forward. I know some residency programs are unionizing to advocate for better work environments. Do you think that is a solution?

Audra King: I think it is a good first step. It is one of the few things we can do because we do not have much control over our pay or the hours we work. Along with that, we should have each other’s backs. I think a big thing is for attendings not to forget what it was like after they graduate residency. I want this to stop. I do not want to see more residents behind me go through the same things I have gone through.

Kevin Pho: Where do you turn to for support?

Audra King: Definitely my co-residents. It is always good to have someone to vent to. I have great attendings I feel comfortable with, and my husband is very supportive. I always tell him my job is hard, but I feel like he is going through this whole thing with me. It is hard on the spouse too, and sometimes it feels like we are getting through this stage in life together.

Kevin Pho: For medical trainees who may be listening or reading your article, what advice can you share with them?

Audra King: It is hard to get rid of that fear of getting in trouble or reported, but there is a respectful and professional way to stand up for yourself. The more of us who do that, the better things will get. If you do not feel comfortable, talk to a resident on your team that you feel safe with. We have got to stand up for each other and for ourselves.

Kevin Pho: Audra King is a surgery resident. Today’s KevinMD article is “Diary of a Resident: Dr. Punching Bag, MD.” Audra, let’s end with some take-home messages you want to leave with the KevinMD audience.

Audra King: Yeah, absolutely. I want people to be aware of what residents are going through on a daily basis. Often, from the time they are a third-year medical student to graduating residency, their self-esteem takes quite a beating. It is important for both health care workers and people in the world to be aware of that. The first step toward changing something is awareness, and we have got to have each other’s backs.

Kevin Pho: Audra, thank you so much for sharing your story, perspective, and insight, and thanks again for coming on the show.

Audra King: Absolutely. Thank you for having me.