Doctors In Training Are Dying, And We Are Letting Them Down

On most days of the year, major U.S. hospitals and medical systems are flooded with doctors in training, or residents, who shuttle from ward to ward, often in groups that resemble a pack of wolves.

The term “resident” signifies a doctor who has finished medical school, received his or her degree, and is in the process of completing three to seven years of subspecialty training. “Fellows” are similar, except they have already finished residency and have gone on to further specialize in a particular field.

Once a doctor graduates from a residency or fellowship program, he or she becomes a fully autonomous doctor, and is often referred to as an “attending physician.”

With the expanding reach of coronavirus throughout the world and the number of victims rising exponentially, all members of the healthcare system have been put under significant strain in recent months. However, those in training, residents and fellows, face unique challenges when compared to other types of healthcare workers in a hospital, or even people in other industries outside the hospital, for that matter.

It is well known that among hospital workers, residents and fellows work the most hours, for the least amount of pay per hour – all while shouldering large amounts of oppressive student loan debt. Many residents and fellows log 80 working hours or more in any given week. Those hours are spent doing everything from answering telephone calls from patients and operating to administrative tasks, and they see much more face time with patients than those who supervise them. At the major academic hospitals in this country, trainees are the workhorses that keep them running.

However, during the COVID-19 pandemic, conditions for residents and fellows have worsened immensely. Working regular shifts at the hospital now bear significant personal risks, as increasingly more reports of doctor deaths around the world continue to surface. This past week, several residents passed away.

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I’m a resident, and I interviewed multiple other residents and fellows from around the country for perspectives about working on the frontlines of the COVID-19 crisis. Unfortunately, many of the same themes emerged throughout each of those conversations.

Like all healthcare workers, trainees have been grappling with a widespread, dangerous personal protective equipment (PPE) shortage. Reusing masks and respirators is commonplace, and many have explored unique ways to sterilize used equipment or innovative methods to create novel ones on the fly.

In many hospitals, residents’ schedules and workflow have changed since the coronavirus outbreak started, to avoid healthy patients being exposed while also diverting supplies and workforce to higher-risk units, such as Emergency Departments and Intensive Care Units. Many surgical residents and fellows have been pulled from operating rooms and deployed to the frontlines of the coronavirus fight, where they not only risk their health, but also educational and training opportunities.

Additionally, numerous residents and fellows have reported sacrificing vacation and elective rotation time. Trainees have expressed frustration that they have not been included in many of the recent scheduling decisions and have been put at risk unequally compared to their senior counterparts. Some residents explained that some of their attending physicians had received preferential choice to cover non-COVID services, leaving residents and fellows more exposed.

Testing for COVID-19 is highly regulated from institution to institution. However, some trainees have said that there have been situations in which attendings were able to get tested for COVID-19 while trainees remained unable to gain access to tests.

When it comes to pay, residents and fellows are compensated with a modest fixed salary that is predetermined based on geographic location of their residency program and the years spent in residency. During the coronavirus pandemic, some attending hospitalists— who in some cases already get paid an order of magnitude more than their residents or fellows— have succeeded in negotiating for time-and-a-half payment for extra hours or for taking high-risk shifts.

In the same vein, some residents have lobbied for hazard pay, which is defined by the Department of Labor as receiving additional pay for performing hazardous duty or work that involves physical hardship. But residents and fellows have yet to be afforded any additional benefits, even as many retail companies like Walmart and Target have begun to increase hourly wages for hazard pay.

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Certainly many, if not all, residents and fellows in the United States want to serve patients where they are needed most and to be part of the force that is fighting against the coronavirus. However, the key term here is lack of control. Unfortunately, the way the residency and fellowship training systems operate is archaic and restricts many liberties in exchange for reliable medical training.

The culture of residency and fellowship programs also makes it difficult to remove oneself from the work pool without causing more work or hardship for colleagues, since everyone is, at baseline, stretched so thin. In many programs, residents and fellows have no control over the amount of personal risk they take on during the COVID-19 pandemic, and they are in a poor position to speak up about it. In the end, most trainees cannot walk away from their programs without causing significant damage to their career, even if they are literally putting their lives at risk by staying.

One resident was in her third trimester of pregnancy but chose to continue working because she was afraid to speak up or remove herself from clinical duty and place another co-residents in the line of fire.

The concept of unionizing was brought up with several of the residents I have spoken to, but to date, very few residency programs have successful unionized, likely due to fear of retribution and the intensely vulnerable position that trainees are placed in as soon as they finish medical school.

Some of these issues can be remedied. Above all, residents and fellows want protection with adequate PPE and they want equal ability to get tested for coronavirus if they suspect exposure.

They should also have some control over their schedules and rotations, as well as input into major decisions that affect their department and training. There needs to be a culture of transparency during the coronavirus crisis, as well as one of leniency, so that if trainees do not feel comfortable working, for any reason, they will be given opportunities to speak up or rearrange their work hours without punishment or judgement.

Hazard pay or even student loan forgiveness would help provide fairer compensation for trainees. And those that miss valuable educational opportunities, elective time or vacation time during the crisis should also, when possible, be provided with additional compensation.

All medical professionals have demonstrated enormous amounts of selfless work and perseverance during this pandemic. Residents and fellows are no different. They have dug in even deeper as they have been deployed to the frontlines. Appreciation and recognition are wonderful, but they should only be the beginning. Fair and equitable job environments will only be obtained once hospitals and national physician organizing bodies change the culture and system of how we train our doctors – especially in the midst of health care crises.

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