Medical residents are abused more than Chinese factory workers

Medical residents have fewer labor protections than Chinese factory workers. While labor abuses at Apple’s factories make headlines, few people are as concerned about the lack of protections for doctors and medical students here in the United States. As a resident, I was subject to some of the worst abuses – intentionally misreported time sheets and gender-based discrimination – and after I complained, I was fired, so I sued the hospital and won. Through this experience, I learned that there are very few laws protecting medical residents, and that for all of the regulation pertaining to healthcare itself, there is little effort to protect the medical workers themselves. If medical reform is going to happen now, then there needs to be reform for medical education as well and laws to protect medical residents.

It should surprise no one that there is a lack of outrage about the abuses inherent in the medical residency system. Doctors have job security, earn a hefty salary, and frequently come from more well-to-do families. Furthermore, doctors are frequently criticized for not listening and keeping patients waiting too long. Truth be told, patients who express these complaints are not entirely wrong; however, much of the blame should not be placed on the physician, but rather on our medical system and training. Our current residency system is not designed to produce humane physicians; instead, doctors simply reflect the culture in which they have been educated.

The contrast between labor laws that pertain to medical residents and Chinese factory workers is stark. In 2003, the first regulations (for most states) — as opposed to laws with actual enforcement – went into effect, stating that residents could not work more than 80 hours per week. I began my internship that year and worked up to 160 hours per week, though I only reported 80 hours of my time due to the pressure by hospital administration and fellow residents. That year, a fellow intern, Tony, a compassionate doctor, was killed in a single car accident when he fell asleep at the wheel after working too many consecutive hours without sleep. I too have fallen asleep post-call at the wheel when paused at a stop light, only to be startled awake by blaring horns indicating the light change.

Meanwhile, just last month the Fair Labor Association published their recommendations for Foxconn, Apple’s major supplier in China, to address their current production practices. Included in this list was excessive overtime, which had been peaking at 60-70 hours per week, and is now capped at 49 hours per week total including overtime. Another problem cited was the 1.2 million Chinese workers who were not given all of their overtime pay. Complaining about this in residency would be laughable because there is no such thing as overtime pay for a resident.

My internship year was a particularly difficult one, and culminated in my being fired and successfully suing the hospital for labor abuses. Unwilling to be treated like an indentured servant, I complained to my administrators about the work abuses inherent in the program: excessive hours, falsified time sheets, and working too many consecutive hours without sleep. Additionally, as the only female in an internship class of 8, I was on the receiving end of exceedingly hostile abuse, because of my gender, from two male residents as egregious as it was relentless. Because I complained, I was fired. I decided to sue the hospital for wrongful termination, and shockingly, I won. It was a small monetary victory, but a great victory for other residents and interns suffering the same abuses. The program eventually closed. The experience allowed me to realize how little knowledge I had of the legal system. When I decided to sue, I was not quite sure even how to go about submitting a complaint. Fortunately, several excellent attorneys helped me through the process. I learned that there are very few laws protecting medical residents, all of which fall into a gray area that does not allow residents the usual rights of any typical American worker, even a worker in Foxconn’s Chinese factories.

Healthcare is a highly regulated industry, and currently undergoing tremendous change due to the Affordable Care Act and other efforts to reign in the worst abuses of the insurance system. I want to be at the forefront of this change and improve labor laws with regard to medical training. The best way for me to do this is to become more knowledgeable about healthcare law and to help reform laws relating to medical residency training.

In the future, I envision myself practicing as a physician while consulting medical residents on the side. By educating myself on healthcare law, I can prevent future residents from enduring what I experienced in medical training. Where there are no laws in place, I would like to help develop those laws. Additionally, I want to be able to provide medical-legal counsel to residents who are in similar circumstances as I was, protect them from experiencing what I endured, and if necessary provide them with a means to get justice. Medical residents deserve to have rights and labor protections, just as Chinese factory workers deserve to have rights and protection of those rights. Just as our healthcare system is being overhauled, so should medical training and labor laws protecting healthcare providers. As someone who has gone through this process of medical training, I can see clearly how these laws need to be written to prevent the abuses I suffered. Having knowledge of the law will enable me to play a leading role in shaping the future of labor protections for medical residents and interns.

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  • damitajo1

    I think you should spend a year in a REAL sweatshop and re-write this article. 

  • SaraJMD

    Residency is a temporary condition, sweatshop factory work may unfortunately be a long term plan for some. I wish I could say that I saw other significant differences between the two. But verbal abuse (and even physical abuse by patients), cramped inhospitable working conditions, and extended shifts without so much as a bathroom break were indeed a part of my residency experience. It’s not good when you find yourself answering to “f***ing white bitch.”  I agree that more should be made about the dangers of driving after extended shifts, too. Just about everyone who has been a resident has a scary post-call driving story.

  • elliocentric

    ugh. deleted. really, this essay isn’t worth it. BTW, was this at one time a law school admissions essay? Profoundly bad.

  • http://profile.yahoo.com/HSIMVPNZYT67UBE42HDLN2EHHA Joyce

    Bucking any system that has incorporated hazing into the system is bound to result in yet more hazing. I’m not sure how residents qualify under labor law, are they salaried or hourly employees? I can’t imagine any physician goes into residency years not knowing what’s coming in terms of work load, hours and conditions and I think it’s going to take group action to change the system. Must have been some trick getting another residency! 

    Yes, I agree, the system is six kinds of broken, just like the rest of medicine in the United States.

  • http://pulse.yahoo.com/_R5CPY65K6YS2FDLMNZIE7NP6BI bobclyde

    There are only 168 hours in a week, so if you were working more than 160 hours you, presumably, went without any sleep that week since you need to devote some time to other functions beyond sleep.  I think your post is mostly angry hyperbole, and that you probably are not really suited for a career in medicine.  There are other worthwhile things in life that don’t require the commitment of medicine.  Seek out something else, like law.

  • http://www.facebook.com/profile.php?id=590257633 Pablo Rengifo

    That kind of situation doesn’t happen just in USA. Here, in Perú, it’s the same. Interns and Residents work too much and get low wages. They are who make the 65-70% of medical work in hospitals, it’s not fair. This slavery system MUST change!!! 

  • caduceusblogger

    It sounds as if there were no protections when you were working as a resident. During my last years of training the 80 hour work rules were just going into effect, and indeed there was pressure to report less than 80 hours. If you did report more than 80 hours you got a mandatory meeting with the program director asking why you went over your hours. Most people would simply report less than 80 hours to avoid this. That being said, residents today have alot more protection . . . besides total weekly hours restrictions, they have minimum amount of time that needs to be spent away from the hospital and even required nap time during a shift. While I agree that residents need to be protected as they are at the mercy of their supervisors, I think the pendulum has swung too far in the other direction. When these doctors go into practice they will be going into an environment of no protection whatsoever of their time. Many physicians in private practice are on call 365 days a year, particularly in rural areas. The way  healthcare reform is going (pay for performance) tomorrow’s physicians will be working harder for less money with alot more regulatory oversight and pressure to increase their performance.  Will today’s residents with their required nap times be ready for this?

    • http://pulse.yahoo.com/_GJCNF5QLKW7ROYAZZGB7HFH57Y jamesp

      Speak for yourself!

      The BIG diff. is, an attending has a choice re- being on call. A resident does NOT!

  • TexasHeartDoc

    really?  the 80-hour work rule went into effect my last year of fellowship, and my concern was then, and is now, that the time and comittment it takes to become an independent fully capable physician requires the type of dedication and committement which the 80-hour rule seeks to curb.  The physician’s we hire now coming out of training have nowhere near the medical experience or knowledge, or the plain ol guts, to be able to handle the demands of the job.  The dangers of too little sleep are well known, but so are the dangers to our patient’s of not being able to function when called upon to do so, or engineering a system wherein there is no one to take responsbility of the patient’s conditions because we are all just shift workers reporting to management and eager to get home as quickly as possible.   Your gender-based abuse has no place in modern medicine, and for that reason alone your law-suit was indicated, and it’s probably good the program closed.  But don’t confuse the legitimate demands of the job, and the need to make sure that the physician’s coming out of training programs are able to handle those demands, with gender-based abuse. 

    • http://pulse.yahoo.com/_GJCNF5QLKW7ROYAZZGB7HFH57Y jamesp

      There are probably more programs that should close. Program directors, like sweatshop bosses, have a far too easy time abusing their underlings. The good is the enemy of the best. There is a reason the US healthcare “non system” is broke. 

  • Breathing

    I have always wondered why there is a shortage of physicians, shortage
    of residency slots because of Medicare, and low pay for residents. At
    the same time Physician Assistants have less education, they are paid
    more, there is no cap on the number of Physician Assistants, and they
    will never become physicians. If residents could spend more time working
    80 hours and learning about medicine instead of getting a bachelors
    degree that has nothing to do with medicine it would give residents more medical experience without adding additional years of education.

  • http://twitter.com/JewishPhysician Craig Brenner

    I hope you are able to or have been able to finish your residency.  Many programs are abusive environments from the work hours to simply experience you have regarding your own performance or your inability to be in four or more places at the same time. 

  • http://twitter.com/LittlePatient Haleh

    I understand the need to work long hours beyond 80 hours per week to become proficient in an area.  Here is my question-  what about changing how one gets a medical degree?  What if someone who wants to be a doctor, declares as soon as they leave high school and enters medical school at that point for 8 years?  Residency could then be for a much longer period of time with better hours. Thoughts?

    • http://pulse.yahoo.com/_GJCNF5QLKW7ROYAZZGB7HFH57Y jamesp

      That is how other nations do it! Heaven forbid “american exceptionalists” would approve of that approach!!

      I.e.   I agree, but we are in the minority! Who will employ those english, arts and humanities professors?

  • frustratedMD

    Disappointing, although telling, that this physician needs to remain anonymous.

    Also of note is how so many comments bash doctors.  That sort of attitude, without attendant kindness, nuance, or understanding, only gets worse after residency.

  • http://www.facebook.com/RebeccaCoelius Rebecca Coelius

    We need to stop equating commitment with a willingness to suffer absurd work hours and abuse. Perhaps a commitment to being accepted into the cult that is medicine, but this has nothing to do with whether somebody is committed to providing quality medical care and their patients. 

    If the hospital systems that we are trained within couldn’t count on residents to work absurd hours in highly inefficient environments that treat them like unskilled labor a great deal of the time, they would be highly incentivized to get their acts together as delivery systems.

  • jleong

    If you’re not pretty you can’t be a supermodel and you’ve got to be tough to be a doctor.  I’m sorry your program was malignant, but please don’t assume that the grueling years of residency are globally wrong for all of us.  Since the 80 work rules, few interns see their patients through from admission to discharge – I think its a shame to have hand off over hand off over sign out etc. It’s a few short years, really, and you’re like twenty-five years old.  If you think training is hard, wait until you become an attending…

  • GentlyCurved

    Ever wonder why so many internists and family practice docs barely know how to tie their shoes, much less take care of anything more complex than a sore throat?  It’s because of this new attitude by “anonymous” whiner.  I did 8 years of residency, am double board certified, and my patients are the beneficiary.  The new wave of residents started filtering in as I was finishing my surgery residency……they disgust me to say the least, as does this whiner.

  • DFDMD

    Change is inevitable and the dinosaur “I survived therefore you must go through the same” attitude shall pass.  While there is no question that more experience is better than less and that being with the patient long enough to see the evolution of an illness aids understanding, learning CAN occur in stages and segments.  The ACGME is SERIOUS about work hours.  Several high-level institutions have programs that have been threatened with loss of accreditation (Hopkins and Mass General General Surgery, for example) based on work hours violations.  In New York State, there is state regulation on top of ACGME requirements.  Any Program Director who believes that false work hour records won’t eventually become known (whether through some whistleblower, through the annual anonymous resident survey conducted by the ACGME, or through conversations with residents during an ACGME site visit) must have his or her head examined!!!  As mentioned in an earlier post, gender issues should not occur – and discrimination in the workplace based on gender, race, ethnic origin, etc., IS against Federal law.  An employer who allows a hostile work environment to persist in today’s legal environment is simply inviting a lawsuit.
    Do the dinosaurs want their commercial airline pilot flying without sleep?

    • GentlyCurved

      Nonsense…..residency is rigorous for good reason. Were we tired sometimes? Yes.  So what!  We still did what we had to AND LEARNED WHILE DOING IT!  It’s not so much the fewer hours that will prove to be detrimental, but the pervasive and insidious mentality wherein residents begin to feel they shouldn’t have to work hard to prevail.  I’d say 30% of practicing physicians are incompetent these days and never should have been allowed to leave residency……just my opinion, but an educated one.

  • jomcdowell

    Sounds like sour grapes to me.  She was unhappy and sued.  What about trying to mediate through the system?  You didn’t mention why you were ostracized.   Do you take responsibility for anything?  I did a General Surgery internship year so I know what a difficult internship year is.  We, as residents are expected to learn our craft in 3-5 years.  You are expected to become a doctor delivering safe and excellent care to people who put their lives in your hands.  You either learn or you don’t. 

  • GentlyCurved

    160 hours a week?  Liar.  Even when I was on call every other night during my transplant rotation did I ever work close to that amount……but had I been required to, I would have done it without a complaint.  Clearly, the majority of physicians on this board are a bunch of whiny internists of the ilk we all made fun of during residency.  As surgical residents we handled EVERYTHING the medical residents did and then operated on patients all day and night.  Septic shock, renal failure, ARDS, metabolic derangements, arrhythmias, etc……all an afterthought to get to the OR on time.  We were called all hours of every day to bail out medical residents……I can’t recall even one incident of needing a medical resident for anything other than babysitting some insignificant nonsense.  I don’t care about being PC…..I trust about 10% of non-surgeons out there to know anything.

  • MeredithKendall

    Not particularly a fan of comparing residencies to sweatshop labor, but I see what you’re getting at. 
    You cannot remember things if you cannot pay attention. You cannot pay attention if you fail to sleep. Or so said a former neuropsychiatrist (who I’m sure had to put up with similar practices). 

    Medical students are required to forgo sleep in order to study, but studies on undergraduate students have shown lack of sleep does little for learning. There is also a study or two floating around on residents who make significantly more mistakes on lack of sleep. No amount of prescription amphetamines or Provigil can make up for missed hours (I don’t doubt atleast one of you reading this has taken a pill to help stay on task once or twice). 

    Medical students are driven, and I certainly appreciate that. But even 80 hours a week is insane. It’s not healthy for the physician, and it’s not healthy for the patient. Taking an extra year to learn to “make up for lost time” would not be a bad thing. It would likely be more effective.