The average week for a medical resident training in Mexico can easily exceed 90 work hours. Mexico is a country that takes pride in offering full health coverage for 100 million citizens. This is a new policy and free public medical care is being pushed to the limit. The situation is simple, the work load in outpatient clinics, operating rooms, the wards and emergency rooms across the country is dramatically increasing as more and more citizens claim their “Popular Insurance” coverage. However, the number of working residents has not increased.
Most Mexican residents are burned out very early during their internship. Nights on call 3 times a week, with full shifts the day after, are translated into 32 hour long workdays. These occur 3 times a week with non on-call days being filled with 8 to 10 hour shifts. We live in a health work culture where the resident has responsibilities that are not exactly of the medical kind. These range from social work tasks to drawing blood samples. In such a scenario a 32 hour shift is often not enough to complete the resident’s never-ending “To-do list.” With so many physical and administrative chores for the medical trainees, there is seldom time for academics. Few programs in the country are concerned about providing real and substantial academic value to their curriculums, and the resident sadly becomes cheap labor in a system doomed to collapse. I have the privilege to work in a program where academics are of great importance. Nevertheless, the gargantuan amount of work blocks most attempts to open a book or article and just read.
Monetary retribution is a whole other topic, equally anguishing for Mexican residents. The average pay is around 11,000 US Dollars a year. With 90 hour weeks, that could be simplified into 2.35 US Dollars per hour. With such a scanty income, most residents are not able to become fully independent and are an unceasing burden on their parents. Payment for residents comes from the Mexican federal budget and it’s considered a scholarship instead of a salary. This emancipates the government from moral or fiscal responsibility over the squalid wage.
Mexican residents demand a change in working conditions, work hours and payment. The main obstacle we face is the close-mindedness of health authorities and bureaucracy. Common answers to legitimate demands are: “When I was a resident, I worked even more hours,” or “How do you want to learn if you don’t practice.” More and more evidence is being published every day regarding the negative effects of long exhausting shifts for patients and residents. However, the decision makers in our country refuse to embrace these ideas tagging them as a “lazy caprice.” Very few programs around the nation have addressed this topic properly. A drastic change in mentality will only come when a new generation of evidence-based and patient committed physicians climb up to health authority positions and look back to their resident days.
Cesar Lucio is a pediatrics resident in Mexico.
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