Physician residency is a training program required in all 50 states before medical school graduates are allowed to practice medicine. Residency programs last from three to seven years depending on the specialty. Medical residencies are apprenticeships, where recent medical school graduates care for hospital patients under the direct and indirect supervision of senior doctors who train them.
It’s no secret that graduate medical training is something of an initiation, a right-of-passage of sorts, where recent medical school graduates work up to 80 hours a week and sometimes spend additional hours at the hospital on call in case they’re needed. The following is an explanation from Wikipedia:
As per the rules of the Accreditation Council for Graduate Medical Education in the United States of America, residents are allowed to work a maximum of 80 hours a week averaged over a 4-week period. Residents work 40–80 hours a week depending on specialty and rotation within the specialty, with residents occasionally logging 136 (out of 168) hours in a week. Some studies show that about 40% of this work is not direct patient care, but ancillary care, such as paperwork. Trainee doctors are often not paid on an hourly basis, but on a fixed salary; in some locations, they are paid for booked overtime. Limits on working hours have led to misreporting, where the resident works more hours than they record.
So basically, residents are limited to 320 hours every 4-weeks. However, those hours can be concentrated (officially ) in the first three weeks of the month. The last week of the month residents are apparently encouraged to show up for another 100 hours but forget to clock in.
Why do residents work so many hours? Because they have no other choice. They match to a residency of which there are more applicants than positions. Once matched to a residency they are essentially stuck in that position for three to seven years. They can’t leave like typical employees. They cannot apply for a different residency with better working conditions. Teaching hospitals and supervisors know their trainees can’t quit so physicians in training are at the mercy of their superiors. Residents are often required to be present for the start of every shift, even if they’re not working that shift.
Another factor is that long hours have been the standard for decades. There is a pervasive culture among physicians who survived their initiation that those who don’t work (or on call) for 20 hours a day during training have not experienced the hazing those in the medical guild are expected to endure. There is also the fact that doctors in training have a lot to learn during residency. Working 80 hours a week is essentially twice the training as 40 hours a week.
Similar arguments are used to explain why interns at prestigious employers work long hours. Also, why newly hired associates at big law firms, large accounting firms and other highly selective employers work long hours.
With 80 hour work weeks becoming the new standard in 2011, there is little wonder why medical residents are unionizing due to the arduous demands placed on them.
More medical residents across the country are joining a union known as the Committee of Interns and Residents (CIR).
They want a stronger collective voice in advocating for a safe and healthy training environment as they move toward being fully fledged practicing physicians.
“Residents at Penn and across the country are unionizing because unions provide residents the means to advocate collectively for better working conditions and support systems,” Dr. Chioma Elechi, an emergency medicine first-year resident at the Hospital of the University of Pennsylvania in Philadelphia, told Fox News Digital.
Residents want more reasonable work hours and breaks, fair pay and improved employee benefits, such as health insurance and access to mental health resources, Elechi also said.
The Committee of Interns and Residents is affiliated with 76 residency programs across nine states. The union is growing fast and now represents 25,000 members. Besides complaints about the long working hours (and sometimes verbal abuse), there is the low pay. Physicians in training are paid a stipend, but it is sometimes low enough that some residents take out student loans to cover a portion of their living expenses.
Advocates for physicians in residency training argue that long hours and sleep-deprived trainees are not just a needless initiation, but also a health hazard for the patients they treat. High stress and sleep deprivation also makes learning more difficult. However, it remains to be seen how much collective bargaining can help residents, considering few residents would risk their training by going on strike. Furthermore, there is also the problem that there are more applicants for residencies than residency program slots. The most desirable residency programs are highly competitive, so the program directors have a stronger bargaining position than their trainees.