Residency: what residents and attendings say, in their own words

Last updated September 20, 2026.

Read together, the 526 essays and podcast transcripts on this page say one thing consistently: residency is described as the hardest year of a physician’s life in the same terms in 2004, 2018, and 2026, and the thing physicians argue about is not whether that is true but what to do about it. For fifteen years the argument was hours, and the evidence cited on both sides was mostly null. Since 2023 the argument is labor: pay for an 80-hour week, unions, parental leave measured in days, and mistreatment, which now appears in more posts than at any point in the record.

This page is a maintained record of what residents, the attendings who train them, and the physicians who remember it have written about residency on KevinMD.com, a physician-authored publication founded in 2004 by Kevin Pho, MD, a board-certified internal medicine physician in Nashua, New Hampshire. It draws on 526 essays and podcast transcripts with resident or residency in the title, published between June 2004 and September 2026 by 300 named contributors, 331 of the posts bylined by physicians and 33 by anonymous residents. Posts about applying to residency and the match are excluded and belong to a separate record. Every claim on this page is attributed to a named author with the date it was published and a link to the original.

The essays describe one argument that has not ended and one experience that has not changed. The argument is about hours: whether the limits imposed in 2003, tightened in 2011, and loosened in 2017 made residents safer and better trained or produced shift workers who hand off patients they never learn to own. Physicians on KevinMD have argued every side of it since 2009 and still do. The experience is intern year, which residents describe in 2018 and 2026 in the terms Kevin Pho used in the first post in this record in 2004: sleepless, exhausting, and survivable. What has changed is what residents ask for. Since 2023 the posts are about pay, overtime, unions, parental leave, and mistreatment, and the word “entitlement” appears in the replies.

The sections below are organized around the questions residents, program directors, medical students, and journalists ask. Each opens with a direct answer, followed by what named authors have said, in the order they said it. Where authors cite studies, the study is named alongside the author, and the figures are theirs. The section on depression and suicide is short by design and ends with resources. This is a page about physician opinion and experience, not accreditation guidance.

What do residents say training is like?

Residents on KevinMD describe intern year as the hardest year of their lives and, in the same essays, as the year they became physicians. The recurring elements are sixty to eighty hours a week, chronic sleep deprivation, distance from family, being at the bottom of a hierarchy, and self-doubt that most describe as universal and few felt able to admit at the time. Posts mentioning sleep or fatigue rose from 11 percent in 2004 to 2008 to 35 to 45 percent since 2013.

Kevin Pho, MD, noted in June 2004, in the first post in this record, of ending his last residency shift with a seven-day-old son, sleepless nights, and a fellowship waiting in Boston; the post is a short commentary from before 2009, counted here but not indexed or linked. Peggy Bui, MD, MBA, wrote in February 2016 an accounting of her intern year: 147 clinic patients across 18 clinic days, primary responsibility for 95 critically ill patients in the ICU, and 48.9 percent of the year at the academic hospital, in “A quantitative analysis of the first year of internal medicine residency.” Diana Cejas, MD, wrote in June 2018 that “Working more than sixty hours a week (on light weeks), chronic sleep deprivation and missing family and friends” combined with toxic interactions with supervisors and 12 hours of distance from home into “feelings of worthlessness, sadness, and pessimism,” in “Welcome to your intern year breakdown.”

Brian J. Secemsky, MD, wrote in September 2012 that residents have “a personal responsibility for their well-being but also an obligation to their patients,” to practice the behaviors they recommend, in “Medical residents need to be accountable for their own well-being.” Elisabeth Poorman, MD, wrote in July 2018, addressing residents’ families, that “depression and suicide are occupational hazards of medicine,” and that one in four medical students is experiencing major depression at any point, in “What I wish my family had known about medical residency.” Grace Faith Chao, MD, wrote in March 2018 that intern year is still universally hard and also universally great, and that “every day at 4 p.m. after a 24-hour shift, I have a little dry heaving episode,” in “Intern year is still universally hard. Intern year is also universally great.” Audra King, MD, a general surgery resident, wrote in September 2024 that “I had spent almost an hour comforting an anxious patient,” before a nurse asked, in front of the patient, whether she was cleared to do the procedure alone, in “Diary of a resident: Dr. Punching Bag, MD.” Lisa Sieczkowski, MD, a program director, wrote to her residents in August 2018 that they had “committed yourselves to sleeplessness and years of stress and study and near financial ruin for the privilege of taking care of children,” in “To my residents after a suicide.”

Did duty hour limits help? Physicians disagree.

The duty hour argument is the longest-running one in the record. The ACGME capped resident hours at 80 a week in 2003, limited intern shifts to 16 hours in 2011, and returned intern shifts to 24 hours in 2017. Physicians on KevinMD argued that the limits made patients safer and residents human, that they produced more handoffs and less continuity without measurable safety gains, that surgeons finished training unprepared, and that the rules encouraged residents to lie about their hours. Posts mentioning duty hours held at 30 to 36 percent from 2004 through 2019 and have fallen to about a fifth since 2020. The evidence cited on both sides has been mostly null.

Kevin Pho, MD, noted in March 2009 that the ACGME’s own chief executive acknowledged the problems with the 80-hour rule, and asked what could be worse than a training system that encourages doctors to lie because they want to be with their patient; the post is a short 2009 commentary, counted here but not indexed or linked. In November 2009 he carried an analysis concluding that “rates of surgical complications and reinterventions actually climbed after the rules were imposed,” in “Surgeons don’t receive enough training when resident work-hours are capped.” Vineet Arora, MD, wrote in March 2010 that the Institute of Medicine had recommended 16-hour shifts or a mandated five-hour nap, that “With shorter hours, there will be an increase in handoffs, with associated risks for patients,” and that residents given time off do not necessarily sleep, in “Patient handoffs limit residents work hour cap gains.” Danielle Ofri, MD, PhD, wrote in August 2010 that limiting residents to 80 hours “wasn’t as simple a panacea as it seemed,” and recalled being “on our own for the rest of the patients’ care, even if it lasted weeks,” in “The 80 hour resident work week balances fatigue and independence.” Robert Wachter, MD, wrote in August 2010 that concerns had been raised that “the regulations created a shift-work mentality among residents” and overemphasized hours over supervision, and hoped teaching hospitals would relieve residents of clerical tasks instead, in “Will the new resident duty hour rules improve patient safety?”

Skeptical Scalpel, MD, a surgeon, wrote in June 2013 that limiting training to 40 hours a week “would be a catastrophe for residents, their education and most of all, their patients,” in “Should medical resident training be limited to 40 hours per week?” Robert Centor, MD, wrote in June 2013 that the real failure was that workload had not been adjusted as work hours changed, in a short essay that is counted here but not indexed, and in December 2013 that “Becoming a surgeon (or any other physician specialty) requires deliberate practice” and that restricted hours reduce it, in “Restricting resident work hours decreases deliberate practice.” Richard Gunderman, MD, PhD, wrote in January 2015 that hospitalized Medicare patients cared for by physicians working shorter hours “experienced no improvement in mortality or readmission rates,” in “Duty hours restrictions may be doing more harm than good.” An anonymous orthopedic resident wrote in April 2016 that on weekends residents would “sign out your services inpatients to the call team and they would see your patients,” a team that did not know them, in “How duty hour restrictions are hurting residency training.” Michael Ward and Nicole Zagelbaum wrote in November 2016 that the 2017 proposal to return intern shifts from 16 to 28 hours came with a renaming of duty hours to clinical experience and education hours, since “some of the changes proposed by the ACGME involve changing or clarifying the language of specific regulations,” in “The new hour restrictions for residents: Stop with the manipulation.” Robert E. Harbaugh, MD, defended the change in April 2017, writing that after thirteen years it was important for the ACGME “to assess the impact those regulations had had on patient safety and resident training,” in “Defending the change in resident duty hour restrictions.”

What do physicians say about supervision and autonomy?

Alongside the hours argument runs a quieter one about autonomy: whether residents today make enough decisions on their own to be ready when they finish. Attendings on KevinMD describe supervision that has grown for reasons of liability, billing, and safety, and residents who arrive valuing autonomy and find less of it each year. Posts mentioning autonomy or supervision have held between 12 and 24 percent across the record since 2009.

Nicholas Fogelson, MD, wrote in November 2010 that residents who fail to seek supervision when they need it frustrate attendings, and that “through iteration of the supervision process” autonomy is reduced for a time, in “Autonomy versus supervision for residents is a fine line.” Paul Bergl, MD, wrote in February 2014 that resident autonomy has evolved accordingly, both in practice and as a concept, and that applicants to his program were “putting autonomy high on their list of values,” in “Will resident autonomy disappear completely in the future?” Skeptical Scalpel, MD, wrote in May 2017 of a JAMA Surgery study of more than 1,600 appendectomies that “The pre-2012 group included 548 operations performed by general surgery residents alone,” in “Residents performing surgery: Why can’t we reach a middle ground?” Robert Centor, MD, wrote in December 2017 after 38 years as a ward attending that “What distinguishes ward attending is teaching,” and that attendings have “a great responsibility to our learners’ future patients,” in “Lessons from 38 years of being an internal medicine ward attending.” Geeta Arora, MD, wrote in July 2021 that “residents have been entrained into believing they are unworthy of making money,” and that she now coaches residents on their first contracts, in “What we don’t teach residents.”

What do residents say about pay, debt, and unions?

Residents on KevinMD have written about pay since 2009, but the argument changed in 2023. Earlier posts were about managing debt on a resident salary; the recent posts are about the salary itself, overtime for 80-hour weeks, and unionization, and they answer the charge that organizing is entitlement. Posts mentioning debt or loans peaked at 24 percent in 2017 to 2019; posts mentioning unions reached 7 percent in 2023 to 2026, their highest.

Vivek Datta, MD, MPH, wrote in January 2016 that a resident who graduated in 2014 had a median debt of $180,000 and a median salary of $51,250, and that up to 40 percent of residents in reviewed studies reported depressive symptoms, in “The key to preventing depression in residents? Value young physicians.” Taison Bell, MD, wrote in March 2017 that residents “endure up to 80 hours (wink, wink) per week of grueling work” during the years when financial habits form, in “It’s time to teach residents money management skills.” Altelisha Taylor, MD, MPH, wrote in April 2019 a six-step plan for loans in training, noting that standard repayment “monthly payments are probably more than you can afford on a resident salary,” in “6 steps to tackle student loan debt in residency.”

Deepak Gupta, MD, and Sarwan Kumar, MD, wrote in March 2023 that “The annual wages of residents could also be equalized by paying them based on their annual work hours,” in “Equalizing the future of medical residencies: standardizing work hours and wages.” Ali Duffens, MD, wrote in January 2024 that residents “may legally work up to 80 hours weekly” without overtime pay, while physician assistants with comparable duties earn an average of $120,000, in “A call for equity: fair compensation and overtime pay for resident physicians.” Paz De la Torre, MD, wrote in March 2026, answering a JAMA viewpoint, that the argument “perpetuates a harmful dichotomy: that having a family or being older legitimizes the motivation for unionization,” while implying that younger trainees should endure in silence, in “Why residents unionize: systemic reform, not entitlement.”

What do residents say about having children during training?

Residents who became parents during training describe the same gap across a decade: leave policies measured in days, call schedules that do not bend for pregnancy, and the sense that asking is a mark against them. Surgical residents describe it most sharply. Posts mentioning pregnancy, mothers, or parents rose from 2 percent in 2004 to 2008 to 27 percent since 2023.

Jasmine Almeida wrote in November 2014 that “For many, the long hours of residency come hand-in-hand with a new challenge,” becoming a parent, with six tips for surviving it, in “Having children during medical residency: 6 tips to survive.” Lauren A. Umstattd, MD, wrote in October 2019 that her department’s policy stated “Each new parent will be granted three days of maternity/paternity leave,” and asked “How was I going to operate for 12-plus hours while 39-weeks pregnant?” in “Advice to a pregnant surgical resident.” Eric Bressman, MD, wrote in February 2020 that “Nearly 40 percent of surgical trainees” reported considering leaving residency during or after pregnancy, and that new parents “suffer from chronic sleep deprivation on par with any 24-hour call,” in “Medical residents need parental leave.” An anonymous resident wrote in June 2026 of being “bleeding and pregnant and alone in a call room at 21 weeks” after working weeks of nights, in “Pregnant resident discrimination nearly cost me everything.”

What do residents say about mistreatment?

Mistreatment is the newest theme in the record and the one growing fastest: posts mentioning abuse, bullying, harassment, or humiliation rose from none in 2004 to 2008 to 13 percent in 2023 to 2026. Residents describe humiliation on rounds, hostility from nurses and attendings, and, for international graduates, isolation that several authors connect to suicide risk.

Samer W. Cabbabe, MD, wrote in September 2017 that 29 percent of residents in one study “suffered from significant symptoms of depression,” and that with 2,300 patients per physician “more than a million Americans will lose a physician to suicide this year,” in “Stop exploiting medical students and residents.” Todd Rice, MD, MBA, wrote in May 2018 of a resident told she would be terminated for a weak knowledge base who did not know “what her rights are, or what due process is required,” in “Medical residents and academic due process: Know your rights,” and in June 2020 that programs “are under no real obligation to renew a resident’s contract annually,” in “Understand your resident contract: What you don’t know may hurt you.” Geeta Arora, MD, wrote in July 2021 of “the fear of not knowing something when an attending was pimping you after being on call for over 24 hours,” the humiliation, and the sleep deprivation, in “What we don’t teach residents.”

An anonymous international graduate wrote in June 2024 that “Violations of my due process rights occurred at every turn,” with the hospital stripping “my job, pay, and resident status without following fair legal procedures,” in “Resident struggles: How hierarchical health care systems impact IMGs.” An anonymous author wrote in June 2024 that “In 2020-2021, at least three residents died by suicide at this institution,” all international medical graduates, and that programs do not see the isolation such trainees face, in “Suicide risks for international medical resident trainees.” A surgical resident said on The Podcast by KevinMD in October 2024 that “One of the charge nurses rudely tried to get her attention” by yelling hey, surgery girl, in “Inside the toxic reality of surgical residency [PODCAST].” Fereshteh Kagar Bafrani, MD, wrote in September 2025 that “categorical exclusion of IMGs remains an open secret” behind selection committees’ doors, in “An IMG’s story of exclusion in U.S. residency.”

What do physicians say about resident depression and suicide?

Residents and program directors on KevinMD have written about depression and suicide in training since 2011, and the figures they cite have been stable: roughly a quarter to 40 percent of residents with depressive symptoms in the studies named. The authors’ argument is that stigma and licensing fear keep residents from care, and that programs answer with wellness modules rather than time. Posts mentioning depression or suicide peaked at 16 percent in 2013 to 2016 and have held near 13 percent since.

Ashley Maltz, MD, MPH, and colleagues wrote in June 2016, supporting a petition on medical student and resident suicides, that “no medical organization is tracking these suicides,” in “Sign this petition to prevent medical student and resident suicides.” Katie Fortenberry, PhD, wrote in November 2017 that educators should not be residents’ clinicians, but “we can help residents to embrace a proactive stance,” toward mental health, in “How do we best handle the health concerns of our residents?” Daniel Orlovich, MD, PharmD, wrote in August 2020 of sighing at being “only 12 percent done with the modules” assigned to address it, in “It’s time to rename resident burnout.” Claire Bise, MD, MPH, wrote in February 2025 that “This stigma often prevents physicians-in-training from seeking the help they need,” and that it was time to advocate for residency reform, in “First, do no harm: Now is the time to fight mental health stigma and advocate for residency reform.”

If you are a resident or physician in crisis, the Physician Support Line at 1-888-409-0141 is staffed by volunteer psychiatrists and is free and confidential. The 988 Suicide and Crisis Lifeline is available by call or text in the United States.

How has the residency conversation changed since 2004?

The corpus shows the argument moving through hours, then wellness, then labor. From 2004 to 2012 the posts were about the 2003 and 2011 duty hour rules and their unintended consequences. From 2013 to 2019 KevinMD published 26 to 38 residency posts a year and the subject widened to sleep, depression, autonomy, debt, and parenthood. 2020 was the peak, 60 posts, 45 percent of them about the pandemic. Since 2023 the vocabulary is pay, unions, mistreatment, and, in 24 percent of posts, AI in training.

Term 2004 to 2008 (57 posts) 2009 to 2012 (72 posts) 2013 to 2016 (108 posts) 2017 to 2019 (111 posts) 2020 to 2022 (93 posts) 2023 to 2026 (85 posts)
Duty hours or ACGME 30 percent 36 percent 35 percent 32 percent 19 percent 22 percent
Sleep or fatigue 11 percent 29 percent 38 percent 45 percent 26 percent 35 percent
Burnout 0 percent 7 percent 12 percent 25 percent 11 percent 39 percent
Depression or suicide 2 percent 7 percent 16 percent 15 percent 8 percent 13 percent
Abuse, bullying, or humiliation 0 percent 6 percent 7 percent 9 percent 10 percent 13 percent
Pay, salary, or union 5 percent 19 percent 24 percent 31 percent 33 percent 31 percent
Debt or loans 5 percent 8 percent 7 percent 24 percent 22 percent 8 percent
Autonomy or supervision 5 percent 22 percent 24 percent 14 percent 12 percent 21 percent
Pregnancy, mothers, or parents 2 percent 8 percent 15 percent 26 percent 18 percent 27 percent
EHR or documentation 0 percent 1 percent 8 percent 8 percent 6 percent 28 percent
COVID 0 percent 0 percent 0 percent 0 percent 37 percent 4 percent
AI 0 percent 0 percent 0 percent 0 percent 0 percent 24 percent

Term frequencies are the share of posts in each period using the term at least once, computed on the September 18, 2026 corpus of 526 posts.

The earliest posts are Kevin Pho’s, beginning with his own last shift in June 2004 and running through the 2009 posts on hour caps and lying; they are short commentaries, not indexed, and counted but not linked. From 2010 the attendings took over the hours argument: Arora, Ofri, and Wachter within six months of each other in 2010, Skeptical Scalpel and Centor in 2013, Gunderman in 2015, the anonymous orthopedic resident and Ward and Zagelbaum in 2016, Harbaugh defending the rollback in 2017. The 2016 to 2019 posts widened the subject: Datta on debt and depression, Bui’s accounting of intern year, Cabbabe on exploitation, Cejas and Poorman on intern year and family, Umstattd on operating at 39 weeks, and Sieczkowski writing to her residents after a suicide. In 2020, 45 percent of residency posts were about the pandemic: Maggie Connolly, MD, wrote in May 2020 that her program’s role “quickly transitioned to fully-staffing a pop-up COVID ICU” while articles reported residents dying in other cities, in “How are the residents doing during the pandemic?,” and Bea Leal, MD, wrote in June 2020 of her first suspected case in mid-March “amidst the stress of having to fight for PPEs,” in “COVID-19: a medical resident’s tale of sign-outs and ID bands.” Since 2023 the record is Duffens on overtime, De la Torre on unions, King on being the punching bag, and the anonymous accounts of international trainees and a pregnant resident.

The KevinMD residency corpus by the numbers

The figures below describe the set of KevinMD posts this page draws on, as of September 18, 2026. They are counts of what KevinMD has published, not survey data.

Measure Value
Posts with resident or residency in the title, excluding match and application posts 526
Date range June 17, 2004 to September 5, 2026
Named contributors 300
Posts bylined by an MD or DO 331
Anonymous posts 33
Short posts by Kevin Pho, 2004 to 2011 82, median 110 words
Podcast episodes with full transcripts 26
Posts in the corpus that are not indexed, counted but not cited 87
Total words About 399,000
Peak year 2020, 60 posts
Most frequent contributors Skeptical Scalpel, MD (14); Altelisha Taylor, MD, MPH (8); Lisa Sieczkowski, MD (5); Robert Centor, MD (5); Vineet Arora, MD (5)

How this page was built and how it is updated

The corpus was assembled by searching KevinMD post titles for the stem “residen,” which matches resident, residents, and residency, and by adding title searches for “duty hours” and “intern year.” Posts about nursing home residents, presidents, and other unrelated uses of the stem were removed, as were posts about applying to residency, interviewing, and the match, which belong to a separate record. Term frequencies were computed against the full text of each post on the corpus assembled for the September 18, 2026 build; this page was converted to the current standard on September 20, 2026 without rebuilding that corpus, so the counts and figures are as of September 18, 2026. Posts are counted whether or not they are indexed; citations on this page are limited to posts that are indexed and can be verified at the link. Eighty-seven posts in the corpus are not indexed: Kevin Pho’s 2004 to 2011 commentaries, a handful of short essays, and eight podcast episodes without transcripts. They are counted but not cited. Quotations are taken verbatim from the original posts. Author credentials are as they appeared in the byline at publication. Kevin Pho’s posts from 2004 to 2011 were short commentaries on news and are counted separately above. Every source is linked in the sentence that cites it, and the full list appears at the end of the page. The complete feed is at the Residency and Medical Training archive. Related records: Medical school: what students and physicians say, in their own words, Physician burnout: what physicians say, in their own words, Women in medicine: what women physicians say, in their own words, and Physician suicide: what physicians say, in their own words.

This page is updated as new residency essays are published on KevinMD. When it is updated, the date at the top changes, the counts in the tables are recomputed, and new named claims are added to the relevant section. Nothing is removed unless the original post is removed. An author who believes a quotation on this page misrepresents them can write to Kevin Pho and the page will be corrected.

To cite this page: Pho K. Residency: what residents and attendings say, in their own words. KevinMD.com. Updated September 20, 2026. https://kevinmd.com/residency

The 45 KevinMD posts cited on this page, in order of publication