Residents, attendings, and the physicians who remember training writing on KevinMD about residency: intern year, duty hours, supervision and autonomy, pay and unions, having a family during training, mistreatment, the Match for international medical graduates, and what physicians say should change about how residents are trained. Many contributors write anonymously, and many write while still in training. For a maintained record of what residents and attendings have said about residency itself on KevinMD since 2004, from intern year through the end of training, attributed by author and date and organized by question, see Residency: what residents and attendings say, in their own words. For what international medical graduates have said about the Match, visas, and being foreign in American medicine, see Immigration and medicine: what physicians say about immigrant doctors and immigrant patients, in their own words. Medical school itself is a separate record.
To whom it may concern:
I am writing to you with great sadness, but with relentless determination to ignite change. I am a doctor with a disability. Two years ago I began residency training in pediatrics. The privilege was overwhelming as I stood a doctor in the very halls where I had been wheeled in as a patient with a brain tumor. I couldn’t believe that I had actually made it, …
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A hospital bullies a physician and threatens termination for her disability
My mother-in-law died last week.
She’d single-handedly raised two sons on a social worker’s salary after the love of her life, her husband, died with metastatic melanoma. After her sons left home, she stayed alone on the farm in the middle of nowhere. When she turned 73 and felt the swell of grandmotherly love in her chest, she moved to the city to help raise her first set of grandkids, now …
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The inhumanity of medical residency programs
Exercise. Growing up I competed in multiple sports. The physical enhancement of the human body through movement sparked my interest in human physiology and kinesiology. Consequently, my interest in physiology ultimately led me to medical school. It only felt natural, when medicine became what felt like the bane of my existence, that I’d revert back to this pursuit’s humble beginning. Given the fact that time was a scarce resource during internship, …
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6 steps to overcoming physician burnout
Medical training in the United States is a long and tedious process. It begins in college, when one must complete the mandatory prerequisite curriculum and take a medical entrance exam; your score on which is directly compared to other applicants, immediately labeling you as a competitive candidate or not. The process of applying requires the completion of multiple comprehensive applications, the compilation of countless hours of research, clinical experience, letters …
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Is burnout inevitable during medical training?
“Please don’t spoil the movie with your own soundtrack.” Remember hearing this message before the beginning of a movie in a theater and how most people turn their devices on silent to watch the movie? The cost of the movie ticket is considerably less than the cost of medical education, but I wonder if learners consider this phenomenon when they walk into their classrooms. Is the habit of smartphones in …
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When medical students and residents are distracted by technology
Dear medical student, resident, or fellow,
You will one day forget something. We are currently in a systematic plot to have everyone forget something important. We are quietly unaware it is happening. We are asked to forget how we got here. I want to remind you. I want us all to remember.
You undoubtably were more mature than your peers. You undoubtably sacrificed to develop the persona that one day would impress …
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Welcome to the medical profession
It’s that time of year where upcoming fourth-year students are frantically preparing applications for their chosen specialties. Statements like “I LOVE psoriasis,” and “’I’m fascinated by the colon,” are heard from eager, smiling, seemingly-passionate faces when asking preceptors for a “strong letter of recommendation.’”
But what about you? You know, the one whose specialty decision-making process feels more like being tossed into an M.C. Escher lithograph than the instant, undeniable attraction …
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You don’t have to love your specialty. Here’s why.
I am blessed to love being a doctor. As the child of two physicians, and the fifth generation of physicians in my family, I had no choice but to go to medical school. But from the first day of medical school, I loved it. What a privilege, to know how the human body works! And I didn’t think medical school was particularly fun: I thought it was hard. The first …
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10 pieces of advice for new physicians
There’s no doubt physicians entering practice today leave their residency programs with a tremendous amount of medical education and training; what seems like a lifetime’s worth of knowledge crammed into just a few, intense years of instruction.
Unfortunately, all the time residents spend on rotations, lecture, journal club, and myriad other obligations leaves little opportunity for getting oriented to the more mundane, yet absolutely critical components of practice. As a result, …
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Residency doesn’t prepare you for these 7 important topics
A letter to my nephew, who is just starting residency.
There will be days ahead when patients will bring you their most prized and flawed possessions — their broken bodies, their flagging spirits, their waning hope. They will wonder: “Can I get back to my loved ones, my life, my dreams? Will you help me? Do you care?”
You will not have all the answers, though you will have read a forest …
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Sage advice to new medical residents
July is back, and clinical faculty at teaching hospitals have again braced for the annual deluge of new residents just beginning their specialty training. Unfortunately, our new doctors may be more unprepared than ever.
The gap between medical school (the four years leading to the MD degree) and residency (advanced training in a particular field) has widened over the past several years. Changes in the health care system, shifting patient expectations, …
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New doctors may be more unprepared than ever
Much is made of the date July 1st in the medical profession. Freshly graduated physicians begin their training career in medicine as interns. Although technically physicians, these interns are new to the clinical practice of medicine and all that comes with that. Much has been made of the experience of the new intern. Samuel Shem’s House of God is a renowned novel about medical training. Countless television series, chronicle the …
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On June 30th, I hope we remember the intern within us
Residency is a time of immense learning. You learn from your attendings, your patients, and your colleagues. Of all the teaching moments during my residency, one that frequently stands out in my mind now is the day when one of my co-residents told me about the “post-training phenomenon.” He had previously completed a different residency and practiced in that field for a decade prior to switching to our specialty.
“Once you …
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How do you define success after residency?
For many people in medical training, one period of time that they look forward to is the elective period. Most of the time, these periods are available for people to explore potential career opportunities, whether it is a certain subspecialty or a research opportunity. Usually, people are not on call and weekends are free, luxuries that are often sparse during the rigors of medical training. Most of the time, one …
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How violating trust during residency undermines patient care
On May 11, 2016, we lost another bright, young soul to suicide. Sean Petro was in his third year at the USC Keck School of Medicine and is the third tragedy at his school in the last two years.
On April 23, 2015, we lost Kevin Dietl to suicide just weeks before he was to graduate medical school. Kevin’s parents were so excited to attend their son’s graduation. Instead, they attended …
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Sign this petition to prevent medical student and resident suicides
A recent AMA Wire article highlighted the resident depression endemic and identified some strategies for improvement. The upshot: Too many trainees are unhappy with their jobs.
The most important tool used to gauge trainees’ satisfaction with their training programs is the ACGME survey. Since the ACGME is the organization that formally accredits training programs, …
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Medical trainees cannot live on grit alone
On my recent tour of residency programs, I had the pleasure of meeting many foreign medical graduates (a.k.a. FMGs; not to be confused with international medical graduates, who are U.S. citizens who go abroad for medical school).
Almost uniformly, they struck me as confident, mature and articulate. Many were older than me, some by as much as 10 or 15 years. Most had extensive research experience, and a few had even …
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Foreign medical graduates get a raw deal. Here’s why.
In a recent post, I wrote about the iCOMPARE research study that is comparing the effects of increasing medical residents’ consecutive duty hours with observing the currently prescribed limits on their shifts. According to the study protocol, the primary hypothesis of the research addresses the safety of patients: that mortality under the increased residents’ duty hours will not significantly exceed patient mortality under the current mandated standard for medical residents on …
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Why a study of medical resident hours was unethical
I start this article with a disclaimer: I am not here to comment on the decreasing salaries of physicians or the knowledge that I will never get paid the way the prior generation of doctors got paid. It is hard for me (and the American public) to feel bad for anybody making more than $200,000 a year when the median household income is in the mid-$40,000 range.
What this article is …
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The absurd cost of becoming a doctor
