The life of a medical resident in Mexico

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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  • Anonymous

    Don´t forget human rights issue. We are not either workers nor students. They treat us like they like whenever the condition suits them. It´s time to raise our voice. Basic

  • Nereyda Rodriguez Lopez

    completely true.  for something burn out is becoming more and more common…

    • César Lucio

      Burn out is a measurable entity! I encourage you to measure it in your hospital!

  • Regina DCA

    They may have worked more hours, but they didn´t had the amount of patients we have today. Patients were glad to listen to the doctor, and trusted them. Now they are prepared to complain, and even to sue, right from the start. 
    When they finished their work, they could read and study, and practice. We don´t have time to study, so we have to use our sleeping time to gain knowledge. As they had to go to the library, there weren´t a lot of assignments, but because we have tecnology we have to know everything in a minute. The country wasn´t in the same kind of economical crysis. They didn´t had to waste hours in traffic. It isn´t about to make the young ones suffer for what they suffered. It is about empathy, to understand life now, and to wish that every doctor has a better life quality than the one we had. Because a healthy, happy doctor, will do a perfect work and cure more patients. 

    • César Lucio

      Our situation is very different indeed. I have tried to approach different health authorities but the common denominator is lack of empathy and bureaucracy. I believe we must keep fighting for better working conditions for Mexican residents. I’m sure the social media will be of huge help in doing that!

  • Dee Norman

    I know I’m only a Drama teacher but in my 6th grade advisory 2 weeks ago we talked about the amount of sleep needed to be fully productive and I know that none of these interns get anywhere near the Doctor-Researched suggestions.  There is an irony to the job–Doctors (interns specifically) work long, strenuous hours to eventually do research that says that their work habits are detrimental to themselves and those they treat.  If I were sick I sure wouldn’t want the doctor in hour 31 of a 32 hour shift, I would want the doctor who had been on 2-3 hours.  Better or worse, the doctor who hasn’t been on as long will be fresher and have a clearer mind!!  I hope that for your safety and the patient safety this changes!!! 

  • Anonymous

    Needless to say, frustrated physicians who were badly treated during residency or realize their medical perspectives didn’t cope with their initial “dreams”, not only mistreat patients or their own colleagues, but badly seek to overcome emotional, social and economical deficiencies through mediocre attitude and constant criticism. Looking for authorities’ help alone might be the beginning, but again proof of selfishness and big egos in medical profession is our lack of group or teamwork efforts which make authority’s response uncaring or as you stated, an inherited indifference ( I used to work more hours, my shifts took place every other day or worst, I had to suffer, you too should ). Why aren’t we really united? Why do we keep on doing this if we complain? (Nobody nowadays really forces us). Why should medical profession be still seen as only humanitarian without thinking we also have needs or are family providers? Life is so different after training, when you find out patients aren’t really expecting your service “patiently” in a waiting room you had to pay for without almost nothing, or you face medical consultation being charged for a dollar or two, eagerness for a third party to pay for your own medical update, lack of accountability from other health professionals or institutions… Those long days without eating, showering, sleeping, studying properly, ideally, shouldn’t be regretted (again nobody forced us- hopefully) if we neither feel accountable nor DO something and propose.
    Y finalmente, esto está pasando en México, ¿Por qué discutirlo en inglés?

  • Alberto Herrera

    Sad but true…

  • Damián Áncer

    The sad truth is that this is what awaits me unless I start thinking about taking the USMLE Steps. I am currently in my third year of medical school at the Universidad Autónoma de Nuevo León. Much can change in my last three years of medical school, and for my sake, and many, many more, I truly hope it does change. There is nothing more I would love than to practice medicine in Mexico. However, I feel as if I am being pinned-up against a wall. Unfortunately, the only solution I see for my problem is the USMLE Steps. Thank you for posting this enlightening article. We need to raise more awareness about this subject if we ever want to attain even the slightest form of change. 

  • Francisco Alonso

    Last year during the certification process, all residents had a meeting with the directing board of the hospital.  The meeting was about reducing the mistakes in patient care. A cardilogy resident showed some articles about the increase in accidents when working shifts of more than 80 hours a week. The response was that they are not going to change the shifs. 

  • L

    As a Canadian woman who has gone through the process of childbirth two times in Mexico, I can think of an easy fix to reduce the workload of some Mexican doctors and nurses, especially those at public hospitals. During both of my pregnancies I had my own private ob/gyn and he took very good care of me. Despite this, I was forced to visit the public hospital five times per pregnancy in order to qualify for the government-funded maternity leave pay. My private doctor’s word on my being pregnant and eligible for the mat. leave pay was not good enough, this despite the fact that he is the head of his department at a reputable hospital. So I took up valuable doctor time at the public hospital needlessly, just so I could have a public health care doctor vouch for the legitimacy of my pregnancy. If private doctors could vouch for a woman’s pregnancy and eligibility for mat. leave pay that would remove a lot of ‘busy work’ visits from the public health care system, because it isn’t just foreigners who would have to do this to get their mat. leave pay, it’s everyone.

  • Carlos

    Alehaddad tiene un buen punto, ¿por qué discutir en ingles si esta pasando en México? La 1a respuesta que se me ocurre es: para compartir con el resto del mundo esta información y generar opiniones internacionales, como la de la sra. L, canadiense.
    A 1 año y medio de haberme graduado del mejor sistema de residencias del país, comparto mi punto de vista.
    Estoy seguro de que me va a tocar, tal vez no a corto, pero si a mediano plazo, ver una revolución en cuanto a los entrenamientos de especialidad. A corto plazo sería tomando en serio la MBE sobre el aumento en el número de iatrogenias asociado a turnos mayores de 80 horas a la semana. Pero, lo más probable es que hasta que truene una gran bomba, o un “niño gigante caiga en un gran pozo”, este se va a querer tapar.
    Otro comparativo simple, policía mal pagada casi igual a policía delincuente. Residente mal pagado casi igual a… complete con el silogismo preferido.

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