Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Will resident autonomy disappear completely in the future?

Paul Bergl, MD
Education
February 18, 2014
48 Shares
Share
Tweet
Share

Recently, our residency program had the excellent fortune of hosting Dr. Bob Wachter as a visiting speaker. Dr. Wachter is considered a pioneer in the hospitalist movement and has built his career around inpatient quality and safety. During lunch with Dr. Wachter, some of our residents, and hospitalist faculty, we discussed the topic of resident autonomy in the hospital.

In the glory days of residency, I imagine that house officers experienced autonomy in its truest sense of the word: self-rule and utter independence. At least that’s the impression I have from Stephen Bergman’s (a.k.a Samuel Shem’s) House of God … a Lord of the Flies–like island inhabited by unsupervised and uninhibited junior physicians.

We all know that the 21st century’s inpatient environment leaves less room for such resident independence — and shenanigans, for that matter. Through regulatory and advisory bodies, patient advocacy groups, and our own recognition, we are now rightly focusing on other domains of hospital care. The main priority is not to “just let the doctors take care of patients how they want.” With this sea change, resident autonomy has evolved accordingly — both in practice and as a concept.

In case you haven’t heard, the quality and safety era is here to stay. Because true autonomy and “learning by doing” can potentially stand squarely at odds with quality metrics and the safest possible outcomes, I have to wonder:

  • Will resident autonomy disappear completely in the future?
  • How has autonomy changed already?
  • And how will trainees learn to practice independently with all of this change?

Anyone that works in graduate medical education knows that duty-hour reform fundamentally shook the resident learning experience and thus affected autonomy. Since the additional 2011 duty hours changes were enacted, teamwork has become the name of the game. Residents routinely are forced to pass off decisions or depart before the implications of their decisions materialize. Attending physicians now seemingly shoulder more of the clinical workload, too, when residents’ shifts are truncated by a requirement to leave the hospital.

There is also probably universal agreement that the imperatives to reduce hospital length of stay and to facilitate safe discharges affect resident independence. As an attending, I know the pressures that the hospital is under, and I often feel compelled to be very directive about making prompt discharge a reality.

I doubt that residents would feel that either of these changes has eliminated their autonomy completely. Often in medicine, there is no single correct way to achieve an end. For this reason, residents can still safely be given leeway in many clinical decisions. There is still some art in what we do, and autonomy lives to see another day. But there are looming changes on the horizon that might threaten resident autonomy even more. Those that spend time in the hospital training environment recognize that all participants in inpatient care will increasingly be measured by how well they do their jobs. It is hard to conceive of a system in which residents and the attendings that supervise their care will be spared from aggressive quality improvement.

The stakes are simply too high nowadays. Health care is expensive and still unacceptably unsafe and unhelpful. With mounting pressures to provide higher value care, residents’ decisions are likely to undergo more scrutiny. Why is resident A ordering more CT scans than resident B? Why are resident C’s patients staying in the hospital 2 days longer than resident D’s?

In my own experience as a chief resident, I know that residents still want autonomy. Heck, autonomy was my top priority in evaluating residency programs myself. As I have interviewed and met a number of applicants to our program during this residency match season, I sense that soon-to-be trainees are also putting autonomy high on their list of values. I like to tout my program’s emphasis on autonomy. I try to foster resident growth while attending on service by relaxing the reins. I know the term autonomy doesn’t mean what it once did. Yet I do have hope that we can still give residents the leeway to “learn by doing” while preserving the health of the patients we serve and the financial stability of our healthcare system and our country.

Paul Bergl is an internal medicine physician who blogs at Insights on Residency Training, a part of NEJM Journal Watch.

Prev

The high cost of "free," unnecessary medical equipment

February 18, 2014 Kevin 33
…
Next

Why hospitals should be scared of cyberattacks

February 18, 2014 Kevin 0
…

Tagged as: Residency

Post navigation

< Previous Post
The high cost of "free," unnecessary medical equipment
Next Post >
Why hospitals should be scared of cyberattacks

More by Paul Bergl, MD

  • a desk with keyboard and ipad with the kevinmd logo

    Teaching doctors: Learning to learn in new ways

    Paul Bergl, MD
  • a desk with keyboard and ipad with the kevinmd logo

    Prevention, detection, and treatment of cancer has become more nuanced

    Paul Bergl, MD
  • a desk with keyboard and ipad with the kevinmd logo

    How can we encourage medical residents to truly choose wisely?

    Paul Bergl, MD

More in Education

  • The secret to success in medical school: self-awareness and courage

    Kaelor Gordon
  • Is mandating pre-medical training widening disparities in the U.S. physician workforce?

    Deepak Gupta, MD and Sarwan Kumar, MD
  • Equalizing the future of medical residencies: standardizing work hours and wages

    Deepak Gupta, MD and Sarwan Kumar, MD
  • From studying to baby kicks: Navigating motherhood in medical school

    Natalie Eichner-Seitz
  • The power of advocacy: a medical student’s journey to helping an uninsured immigrant

    Fabiola Plaza
  • From AI to love: the key to a better future in medical education

    Stevan Walkowski, DO
  • Most Popular

  • Past Week

    • The untold struggles patients face with resident doctors

      Denise Reich | Conditions
    • Physicians are a finite resource we need to protect

      Jack Resneck, Jr., MD | Physician
    • Beyond pizza and pens: National Doctors’ Day should be about saving lives

      James Young, MD | Physician
    • From clocking in to clocking out: the transition to retirement

      Debbie Moore-Black, RN | Conditions
    • Collaborating with occupational therapists: a game-changer for behavioral health [PODCAST]

      The Podcast by KevinMD | Podcast
    • Telemedicine in the opioid crisis: a game-changer threatened by DEA regulations

      Julie Craig, MD | Meds
  • Past 6 Months

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • It’s time for C-suite to contract directly with physicians for part-time work

      Aaron Morgenstein, MD & Corinne Sundar Rao, MD | Physician
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
    • The untold struggles patients face with resident doctors

      Denise Reich | Conditions
  • Recent Posts

    • Collaborating with occupational therapists: a game-changer for behavioral health [PODCAST]

      The Podcast by KevinMD | Podcast
    • Breaking the cycle of failure in modern medicine

      Kortney West, MD | Physician
    • ChatGPT: the Napster of the AI world?

      Harvey Castro, MD, MBA | Tech
    • The missing piece of physicians’ financial plans

      Daniel B. Wrenne, CFP | Finance
    • Counterfeit drugs: a hidden danger lurking in your medicine cabinet

      Emily Kahoud | Meds
    • How understanding cultural backgrounds can lead to better patient care [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 3 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • Is Surgery Riskier After a COVID Infection?
  • The Best Medicine for Healthcare Workers: A Living Wage
  • Meat Consumption and UTIs; Air Pollution's Effects on Health
  • 'Early Birds' With Sleep Apnea May Get More CPAP Benefits
  • Mental Health Care Goes Beyond Just the Patient

Meeting Coverage

  • VTE Risk in Recurrent Ovarian Cancer Increases With More Lines of Chemotherapy
  • Obesity's Impact on Uterine Cancer Risk Greater in Younger Age Groups
  • Oral Roflumilast Effective in the Treatment of Plaque Psoriasis
  • Phase III Trials 'Hit a Home Run' in Advanced Endometrial Cancer
  • Cannabis Use Common in Post-Surgery Patients on Opioid Tapering
  • Most Popular

  • Past Week

    • The untold struggles patients face with resident doctors

      Denise Reich | Conditions
    • Physicians are a finite resource we need to protect

      Jack Resneck, Jr., MD | Physician
    • Beyond pizza and pens: National Doctors’ Day should be about saving lives

      James Young, MD | Physician
    • From clocking in to clocking out: the transition to retirement

      Debbie Moore-Black, RN | Conditions
    • Collaborating with occupational therapists: a game-changer for behavioral health [PODCAST]

      The Podcast by KevinMD | Podcast
    • Telemedicine in the opioid crisis: a game-changer threatened by DEA regulations

      Julie Craig, MD | Meds
  • Past 6 Months

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • It’s time for C-suite to contract directly with physicians for part-time work

      Aaron Morgenstein, MD & Corinne Sundar Rao, MD | Physician
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
    • The untold struggles patients face with resident doctors

      Denise Reich | Conditions
  • Recent Posts

    • Collaborating with occupational therapists: a game-changer for behavioral health [PODCAST]

      The Podcast by KevinMD | Podcast
    • Breaking the cycle of failure in modern medicine

      Kortney West, MD | Physician
    • ChatGPT: the Napster of the AI world?

      Harvey Castro, MD, MBA | Tech
    • The missing piece of physicians’ financial plans

      Daniel B. Wrenne, CFP | Finance
    • Counterfeit drugs: a hidden danger lurking in your medicine cabinet

      Emily Kahoud | Meds
    • How understanding cultural backgrounds can lead to better patient care [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today iMedicalApps
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Will resident autonomy disappear completely in the future?
3 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...