Inside the toxic reality of surgical residency [PODCAST]

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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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This episode is cited in the KevinMD record on residency.

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.” 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. So tell us a little bit about your story and journey.

Audra King: Yeah, absolutely. So I’m currently a surgical resident in my third year of training at the University of North Dakota. I’m 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, transferred to a public university, and then ended up getting into medical school at OU. I didn’t really know what I wanted to do going into med school. I definitely didn’t think I wanted to do surgery, but I fell in love with surgery on my rotation, and here I am.

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

Audra King: Yeah, I think it was just really the culture of it. And I am personally a person who really enjoys working with my hands and procedures and just being able to do that all day, and go, go, go. I guess, to me, it’s more fun than kind of sitting at a desk throughout the day. I don’t know. I kind of enjoy the faster pace and the environment.

Kevin Pho: All right. So you wrote this KevinMD article about your surgery residency, “Diary of a resident: Dr. Punching Bag, MD.” So tell us the events that led you to write this article, and then of course we’ll talk about the article itself.

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

I think everybody’s aware: We’re underpaid. We’re overworked. And coming into residency, I was ready for that. I was completely prepared for that. But I think what I wasn’t ready for was just the daily disrespect, with a range from subtle to more overt, that residents typically get from a good portion of the hospital throughout the day, most days. A lot of people will make you feel like your presence just really doesn’t matter, and it really does.

Kind of like I mentioned in the article, during third year of medical school, your clinical rotations, the first two years probably went well, and you kind of get slapped with third year of rotations, and people treat you pretty badly. And it may not even be that they necessarily realize that they’re doing it, that you feel out of place. You constantly feel like you’re in the way, and it’s just not a great learning environment a lot of the time.

And I think for me, my hope when I started intern year was actually, “I’ve gotten my degree. I’m a physician. Maybe things will change now, and people will be a little more respectful.” And that really didn’t happen. I found myself dealing with the same things, with a scrub tech treating me like it was my first day ever in the OR and I didn’t know how to scrub in, and just kind of talking down to me. And the same kind of thing for nurses. It’s kind of the same story.

And I wouldn’t say it’s not an issue at my specific program. I’ve been at OU for med school. I’ve talked to other residents at other programs. It seems to be a pretty systematic issue. It seems to be kind of a nationwide thing. So it’s not for me to say that my program is the issue, because actually everybody’s been very wonderful at the University of North Dakota. Residents are very supportive of each other, for the most part. The attendings are supportive. I think the issue arises when these instances happen. Sometimes the attending’s in the room; sometimes they’re not. And nine times out of ten, they just don’t say anything. And I think that’s kind of what hurts more, just that they have the power to do something about that, whereas residents, we are more powerless.

Once you match into a position, you’re kind of stuck. If you get let go from that residency position, you really don’t have a lot of options. And when you’re $200,000 or more in debt, it’s terrifying to think about losing your job. So we’re taught to just keep our head down, take it, and push through. Don’t cause problems. Don’t make noise. And when the attending is in the room witnessing this, and you know that they could do something about it, and they don’t, it’s kind of purple to have that happen.

I really just want people to know what we go through. It’s hard, and I don’t know what the answer is to fix it, because I think it’s kind of human nature for a lot of people. When someone is powerless, they take that chance to be disrespectful, because what can you do about it? Nothing. And I don’t know how to fix that.

Kevin Pho: So what are some of the stories that you’ve heard where residents would be disrespected? It sounds like a lot of microaggression. So just tell us a story that you’ve heard, just so my listeners can really envision that scenario.

Audra King: Yeah, absolutely. Actually, one of my friends, she’s also a female surgery resident, so I feel like this is a factor in things as well, but that’s a whole other story. She was walking around on the floor, taking care of orders, checking on patients, and one of the charge nurses tried to get her attention by kind of rudely yelling at her, “Hey, surgery girl,” which is, in my mind, completely inappropriate. An intern is still a professional. They have an MD degree or a DO degree, and I can’t imagine disrespecting someone in their workplace like that. But for some reason, people have decided that it’s OK to do that to residents.

Kevin Pho: And to be clear, this is what you think 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. Again, and that’s what makes it so difficult, it’s not something that any single program can fix. It’s not something that any single person can fix. Really, what’s ultimately the solution would be to somehow even out that power imbalance that heavily disfavors residents, and I’m really not sure how to accomplish that.

Kevin Pho: So when you’re on the receiving end of these microaggressions and you already have so much on your plate, you’re waking up at who knows what time, starting rounds early, and spending the majority of the days in the operating room. Afterwards, you have afternoon rounds, I’m sure, and then you’re on call, and then you have to deal with the brunt of these microaggressions. So just give us a sense of what your mindset is when this happens to you.

Audra King: Yeah, I would say early on, as a student, I really just took it because I was honestly pretty anxious and just really tried my best to stay out of the way. But as an intern, I did have those higher expectations that I mentioned, and it made me angry. Early on, I got mad. I got mad, and I would do my best to respectfully call people out when they did these things. But what I found is that I only ended up getting myself in trouble.

Kevin Pho: I mean, what, did you get called into the program director’s office? What do you mean by that?

Audra King: Getting reported.

Kevin Pho: Oh, getting reported.

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

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

Audra King: I think so far, I feel like my program has had my back. They’ve listened to my side of things and haven’t just jumped to conclusions. But I think it puts you on a radar, even if your program’s got your back. I mean, when these things pile up, you start to feel a little more uncomfortable with your position at your job as you get more and more of these reports. So I don’t know. Eventually, a lot of us just stop caring. We just take it, keep our heads down, power through.

Kevin Pho: And does that have a detrimental effect on patient care?

Audra King: I would say, at least on our end of things, it hasn’t, that I’ve witnessed. It’s detrimental to resident mental health. It contributes to burnout. Everybody wants to talk about burnout. It seems people want to solve it with wellness talks and modules, but that’s not how you all burnout. A lot of us are burned out because, well, for one, we’re underpaid, we’re tired, and then to have to go to work, and you just want to do your job. I just want to go to work, and I just want to do my job. And having to deal with this every day, kind of grating on your self-esteem, and disrespect, it just makes things hard.

Kevin Pho: So when you talk about this with your attending physicians, your mentors, program directors, and this issue comes up, what is their normal response to address something like this?

Audra King: Yeah, that’s a good question. Depending on who it is. As I said, I’m lucky at my program that they’ve listened to me, and a lot of times, after explaining my side of the story, they kind of brush it off like, “Oh, it’s fine.” But it still bothers me that it even happened. Even though my program has my back and listens to my side of things, the fact that I’m even having to go meet with them, I think it’s still going to bother me. So for the most part, they’ve been very supportive.

Actually, one of my attendings really had my back the other day, where in the ED we kind of butted heads, and the ED physician didn’t agree with my management of things. I was just trying to do my job, but because I was a resident, he didn’t trust what I had to say, so we kind of had an issue there. But my attending came in, and he listened to what I had to say and talked to that physician, and I felt like it was nice to know that somebody had my back for once.

I think that’s really how we can try to at least somewhat solve this issue. I’m not a medical student anymore, but I look out for the medical students when they’re on rotations with me. I tell them to come to me if anybody treats them badly, and I will help them deal with it, and I truly believe that makes them feel better, just to know that somebody has their back. And in the same way, I think, as a resident, knowing that there’s an attending out there who would do the same for me, because they have more power than I do, just like I have a little bit more power than a medical student. I think just knowing that they’re there for us and have our back if it comes down to it.

Kevin Pho: Is this something that’s seen primarily in surgery residencies? Are you seeing the same disrespect happening outside of surgery, internal medicine, or some of the other non-surgery specialties?

Audra King: No, I would say this is pretty universal, regardless of specialty, regardless of the hospital you’re at or program. It’s just a cultural thing, because I feel like health care in itself has the tendency to be toxic, and then when you put powerless residents in the mix of that, who can’t defend themselves, it’s just a recipe for things to get even worse.

Kevin Pho: So let’s talk about some paths forward. I know that there are some residency programs that are unionizing to advocate for better work environments. Do you think that’s a solution? If you were in charge, what would you do?

Audra King: I think it’s a good first step. I think it’s one of the few things that we can do, because there really isn’t a lot. We don’t have much control over our pay. We don’t have control over the hours we work. I think that’s a great first step, along with just, we should have each other’s backs.

I think a big thing would be for attendings, after they graduate residency, don’t forget what it was like. Because I feel like once people get through it, a lot of people just stop caring. It’s not their problem anymore. But personally, I want this to stop. I don’t want to see more residents behind me go through the same things that I’ve had to go through. I don’t want medical students going through the same things that I had to go through. And I think we should always be striving to make this a healthier work environment for everyone.

And a lot of attendings, they’ll say, “Oh, things were way worse when I was a resident.” But I think that’s beside the point. I think just because things were worse back then doesn’t mean we shouldn’t be trying to make things better for the future right now.

Kevin Pho: And where do you turn to for support? Do you turn to your fellow residents? What are some resources for you whenever your mental health is stressed like this because of what’s going on?

Audra King: Yeah, definitely my co-residents. It’s always good to have somebody to vent to. I feel like that’s half of our conversation, co-residents. I’ve got some really great attendings that I feel comfortable with, and my husband, he’s very supportive. And I always tell him, “My job’s hard, but I feel like you’re going through this whole thing with me,” because it is. It’s hard on the spouse too. It kind of feels like my husband and I, at times, we’re just kind of getting through this stage in life together.

Kevin Pho: Now, for those medical trainees who may be listening to you on this podcast or read your article on KevinMD, and of course they may be going through similar microaggressions or similar scenarios to what you’re describing, what kind of advice can you share with them?

Audra King: Yeah, I think it’s hard. It is hard to get rid of that fear of getting in trouble, of getting reported. But absolutely, there is a respectful and professional way to stand up for yourself, and I think the more of us who do that, the better things will get. Med students, if you don’t feel comfortable, talk to a resident that’s on your team that you feel safe talking to, because usually you can find at least one on a team. So we’ve got to stand up for each other, and we’ve got to stand up for ourselves. And I just think we all need to understand that there is absolutely a professional and respectful way to do that. And if you still get reported, you know that you did the right thing. You know that you stood up for yourself, and you have nothing to be ashamed about.

Kevin Pho: We’re talking to Audra King. She’s 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 that you want to leave with the KevinMD audience.

Audra King: Yeah, absolutely. Again, I want to stress that, besides the long work hours and the low pay, I want people to be aware of what residents are going through on a daily basis, that often their self-esteem, from the time they’re a third-year in medical school to graduating residency, takes quite a beating. And I think it’s important for health care workers and just people out in the world to be aware of that. The first step toward changing something is awareness, and we’ve 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.

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