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

Stop exploiting medical students and residents

Samer W. Cabbabe, MD
Physician
September 13, 2017
3K Shares
Share
Tweet
Share

Approximately 300-400 physicians commit suicide annually. Given that a typical doctor has about 2,300 patients under his or her care, that means more than a million Americans will lose a physician to suicide this year.

In a study of six medical schools, almost seven percent of students said they had thought of ending their lives in the last two weeks. In another recent study, 29 percent of residents suffered from significant symptoms of depression. And those symptoms escalated within a year of starting training.

Medical students and physicians are raised in a culture where they are not allowed to show weakness or ask for help. In addition, to visit a psychiatrist can be professional suicide, meaning that they risk loss of license and hospital privileges and professional stature among peers and patients. This could easily be considered borderline abuse and it begins in medical school and continues through residency.

A 1990 JAMA article reported on a survey of the incidence, severity and significance of medical student abuse. Approximately 46.4 percent of all respondents stated that they had been abused at some time while enrolled in medical school, with 80.6 percent of seniors reporting being abused by the senior year.

Despite implemented reforms in the 1990s, according to a 2012 study in the Journal of Academic Medicine, more than half of all medical students still said that they had been intimidated or physically or verbally harassed.

According to a 2014 study from the Journal of Academic Medicine, the nature of mistreatment differed between students interested in primary care and those interested in a subspecialty. It appears that faculty and residents are biased against certain specialties that differ from their own and may embarrass or criticize students who express interest in those specialty areas.

Between 1996 and 2017, the median cost for tuition at a private medical school increased 130 percent while resident salaries during the same time period increased only 60 percent. Graduating medical student debt in 2014 averaged $180,000 6.7, according to a report from the Association of American Medical Colleges.

In 2002, Paul Jung, MD, and two other physicians filed a class action antitrust lawsuit against the National Resident Matching Program (NRMP) or the “The Match.” They alleged that the NRMP is “a computerized processing system that assigns graduating medical students a single, non-negotiable employment opportunity. A rider, sponsored by Senators Edward M. Kennedy (D-Mass.) and Judd Gregg (R-N.H.), was attached to a pension act, the Pension Funding Equity Act, which President George W. Bush signed into law in April 2004.

That provision states that the maintenance of or participation in the residency match does not constitute an antitrust violation, as long as there is no outright price fixing. It also says that the Match cannot be used as evidence in an antitrust case, the issue that Judge Friedman cited as the primary factor in his decision.

Compounding this issue is the fact that 1,059, or 5.7 percent of allopathic U.S. seniors did not match. If you include international graduates, osteopathic graduates current and recent U.S. graduates, that number approaches 8,281 representing 23 percent of total applicants. In 1997, the Balanced Budget Act effectively cut the number of residency slots available by reducing the reimbursement allocated to hospitals involved with resident education for patient care.

Meanwhile, with a nationwide shortage of 90,000 physicians projected by 2020, U.S. medical schools are on track to increase their enrollment by 30 percent. However, without more residency slots available, it will be difficult to increase the number of practicing physicians despite increased medical school enrollment. In 2013, two bills were introduced into the U.S. House, the Resident Physician Shortage Reduction Act and the Training Tomorrow’s Doctors Today Act. Neither bill passed.

As a result of the current physician shortage, nurse practitioners and physician assistants are filling the void and now seeking independent practice. Organized medicine continues to seek legislation to oppose independent practice of mid-level providers and to expand the number of residency positions available to medical students.

One anonymous physician has stated: “Medical residents have fewer labor protections than Chinese factory workers.” In 2012, the Fair Labor Association recommended capping workers at 49 hours per week including overtime and paying 1.2 million workers overtime they deserve. Residents, however, work well over 50 hours a week and furthermore, receive no overtime benefit, meals or gas mileage reimbursement for call duties.

The usual bullying culprits of residents are the attending physicians. In a 2016 meta-analysis article by BioMed Central, the most frequently noted form of mistreatment was verbal abuse, with the most common perpetrators being fellow physicians of higher hierarchical power.

Nurses are known to be involved in the act of bullying resident physicians. According to a 2014 study in the Journal of Surgical Education, surgical residents had experienced each of 22 negative acts (11.5-82.5 percent) surveyed, most commonly being ignored/excluded or treated in a hostile manner.

We should always be aware of physicians’ needs and never ignore their cries for help. Never assume a physician will be able to deal with every problem on their own. Physician wellness programs with 24/7 access to psychologists skilled in physician mental health should be available in all areas. Moreover, just as our health care system is being overhauled, so too should medical training and labor laws protecting health care providers.

Furthermore, indirect medical education from CMS should be used to increase residency positions and organized medicine needs to continue to advocate for this. Finally, we need to realize as physicians that many students will choose their desired specialty based on whom they consider to be a role model to them. If we want the best and brightest to follow in our footsteps, then we should set a positive example for them to follow and give them the positive attention and respect they deserve.

Samer W. Cabbabe is a plastic surgeon and can be reached at Cabbabe Plastic Surgery.

Image credit: Shutterstock.com

Prev

Health care reform: A free-market solution works in other countries

September 13, 2017 Kevin 14
…
Next

A resident deals with being a wife, mother, and doctor

September 14, 2017 Kevin 1
…

Tagged as: Hospital-Based Medicine, Medications, Residency

Post navigation

< Previous Post
Health care reform: A free-market solution works in other countries
Next Post >
A resident deals with being a wife, mother, and doctor

More by Samer W. Cabbabe, MD

  • The medical profession has a bad reputation. Here’s why.

    Samer W. Cabbabe, MD

Related Posts

  • It’s time to recognize the rights of medical students and residents

    Thad Salmon, MD
  • Advice for first-year medical students

    Jamie Katuna
  • Physicians and medical students: Unlearn helplessness

    Jamie Katuna
  • An open letter to graduating medical students

    Lilian White
  • Advice for graduating medical students

    R. Lynn Barnett
  • How medical education fails minority students

    Shenyece Ferguson

More in Physician

  • Heartwarming stories of cancer patients teaching us about life and the human spirit

    Johnathan Yao, MD, MPH
  • We need a new Hippocratic Oath that puts patient autonomy first

    Jeffrey A. Singer, MD
  • The meaning of death in medicine: the role of compassionate care in end-of-life patient care

    Ton La, Jr., MD, JD
  • How can there be joy in medicine if there is no joy in Mudville?

    Arthur Lazarus, MD, MBA
  • Physician entrepreneurs offer hope for burned out doctors

    Cindy Rubin, MD
  • The hidden factor in physician burnout: How the climate crisis is contributing to the erosion of well-being

    Elizabeth Cerceo, MD
  • Most Popular

  • Past Week

    • A patient’s perspective on the diminishing relationship between doctors and patients

      Michele Luckenbaugh | Conditions
    • How chronic illness and disability are portrayed in media and the importance of daily choices for improved quality of life

      Juliet Morgan and Meghan Jobson | Physician
    • The hidden factor in physician burnout: How the climate crisis is contributing to the erosion of well-being

      Elizabeth Cerceo, MD | Physician
    • Why affirmative action is crucial for health equity and social justice in medicine

      Katrina Gipson, MD, MPH | Policy
    • The power of coaching for physicians: transforming thoughts, changing lives

      Kim Downey, PT | Conditions
    • Unlocking the secrets of cancer conferences: an end-of-life counselor’s journey among pharmaceutical giants

      Althea Halchuck, EJD | Conditions
  • Past 6 Months

    • “Is your surgeon really skilled? The hidden threat to public safety in medicine.

      Gene Uzawa Dorio, MD | Physician
    • It’s time to replace the 0 to 10 pain intensity scale with a better measure

      Mark Sullivan, MD and Jane Ballantyne, MD | Conditions
    • Breaking point: the 5 reasons American doctors are dreaming of walking away from medicine

      Amol Shrikhande, MD | Physician
    • Unveiling the hidden damage: the secretive world of medical boards

      Alan Lindemann, MD | Physician
    • Revolutionize your practice: the value-based care model that reduces physician burnout

      Chandravadan Patel, MD | Physician
    • Breaking the cycle of racism in health care: a call for anti-racist action

      Tomi Mitchell, MD | Policy
  • Recent Posts

    • The unjust reality of racial disparities in pediatric kidney transplants

      Lien Morcate | Conditions
    • The pros and cons of taking a gap year during medical school

      Med School Insiders | Education, Sponsored
    • A family physician’s journey on the OIG list and the struggle to return to practice [PODCAST]

      The Podcast by KevinMD | Podcast
    • Heartwarming stories of cancer patients teaching us about life and the human spirit

      Johnathan Yao, MD, MPH | Physician
    • We need a new Hippocratic Oath that puts patient autonomy first

      Jeffrey A. Singer, MD | Physician
    • The meaning of death in medicine: the role of compassionate care in end-of-life patient care

      Ton La, Jr., MD, JD | Physician

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 11 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

  • Catching the Optimal Amount of Z's May Be Protective Against Long COVID
  • Treating Early Hospitalization Blood Pressure Deemed a No-No for Patient Safety
  • Addressing Burnout in an Invisible Part of the Health Workforce
  • Family-Oriented Sedation Protocol Helps Kids With ASD Manage Routine Healthcare
  • Bariatric Surgery in Kids With Obesity Becoming More Common

Meeting Coverage

  • New Model Aims to Study Intestinal Fibrosis in Crohn's Disease
  • Hypertension Tied to Worse Survival After Surgery for Upper Tract Urothelial Cancers
  • The Role of Amyloid PET in the Management of Alzheimer's Disease
  • New Inflammation Inhibitor Proves Effective and Safe for Dry Eye Disease
  • No Access to Routine Healthcare Biggest Barrier to HPV Vaccination
  • Most Popular

  • Past Week

    • A patient’s perspective on the diminishing relationship between doctors and patients

      Michele Luckenbaugh | Conditions
    • How chronic illness and disability are portrayed in media and the importance of daily choices for improved quality of life

      Juliet Morgan and Meghan Jobson | Physician
    • The hidden factor in physician burnout: How the climate crisis is contributing to the erosion of well-being

      Elizabeth Cerceo, MD | Physician
    • Why affirmative action is crucial for health equity and social justice in medicine

      Katrina Gipson, MD, MPH | Policy
    • The power of coaching for physicians: transforming thoughts, changing lives

      Kim Downey, PT | Conditions
    • Unlocking the secrets of cancer conferences: an end-of-life counselor’s journey among pharmaceutical giants

      Althea Halchuck, EJD | Conditions
  • Past 6 Months

    • “Is your surgeon really skilled? The hidden threat to public safety in medicine.

      Gene Uzawa Dorio, MD | Physician
    • It’s time to replace the 0 to 10 pain intensity scale with a better measure

      Mark Sullivan, MD and Jane Ballantyne, MD | Conditions
    • Breaking point: the 5 reasons American doctors are dreaming of walking away from medicine

      Amol Shrikhande, MD | Physician
    • Unveiling the hidden damage: the secretive world of medical boards

      Alan Lindemann, MD | Physician
    • Revolutionize your practice: the value-based care model that reduces physician burnout

      Chandravadan Patel, MD | Physician
    • Breaking the cycle of racism in health care: a call for anti-racist action

      Tomi Mitchell, MD | Policy
  • Recent Posts

    • The unjust reality of racial disparities in pediatric kidney transplants

      Lien Morcate | Conditions
    • The pros and cons of taking a gap year during medical school

      Med School Insiders | Education, Sponsored
    • A family physician’s journey on the OIG list and the struggle to return to practice [PODCAST]

      The Podcast by KevinMD | Podcast
    • Heartwarming stories of cancer patients teaching us about life and the human spirit

      Johnathan Yao, MD, MPH | Physician
    • We need a new Hippocratic Oath that puts patient autonomy first

      Jeffrey A. Singer, MD | Physician
    • The meaning of death in medicine: the role of compassionate care in end-of-life patient care

      Ton La, Jr., MD, JD | Physician

MedPage Today Professional

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

Stop exploiting medical students and residents
11 comments

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

Loading Comments...