The Resident and Fellow Bill of Rights

Last June, I became a freshly-minted young doctor, bright-eyed, and enthusiastic about heading off to my dream residency program. By August, I found myself crossing the street on my way home, wondering if I had made a horrible mistake that could have harmed a patient. The most painful thing was, I hardly had the energy to care.

This is not why I chose to dedicate myself to medicine.

Like many medical trainees, I believed I could compassionately serve my community and advocate for my patients in this profession, and this belief pulled me through the grueling years of medical school under the weight of $200,000 of student loans.

Early in intern year, however, I felt smothered by the cumulative effects of chronic sleep deprivation, sexual harassment and xenophobia, inadequate supervision, toxic workplace culture, hazing from other health care staff, and the extraordinary new responsibility that comes with being a brand-new doctor.

Recognizing the impact of these structural forces on our personal and professional lives is not a sign of weakness. It requires self-awareness, vulnerability, and an overwhelming commitment to safe and empathic patient care.

Doctors are not superhuman. We have limitations that we must recognize and respect. When basic human needs are not met, we are seeing the consequences. These include increased rates of medical errors, difficulty learning new information, and extraordinarily high rates of depression and completed suicide. Indeed, physician burnout is killing us. Each day, we lose a physician to suicide, at a rate of 28 to 40 per 100,000 or more than double that of the general population.

Meanwhile, “wellness” programs are giving us free ice cream and bringing in therapy dogs. Sure, I love ice cream – but it doesn’t fix the systemic issues underlying physician burnout and suicide. It doesn’t fix sleeping for four hours a night for weeks at a time. It doesn’t fix unsafe conditions for patient care.

What can make a real difference? One of the most crucial rights that residents should have is health coverage, including mental health. Fortunately, psychiatry residents at Yale do have excellent mental health coverage — but this should be available to all physicians.

Many of our colleagues in other specialties struggle to access mental health care themselves, due to a combination of grueling work hours that severely limit our ability to schedule appointments and completely different coverage packages. How is it that, as physicians, we don’t even have access to this fundamental aspect of health care?

As new and inexperienced doctors, residents — especially interns — need supervision. I often found myself feeling overwhelmed and alone. I was desperately scrambling to safely care for ten patients, double the number I had been trained to care for as a medical student. Moreover, I was learning a new hospital system, and for the first time, I was putting in orders that didn’t need to be co-signed. It was the first time I was pushing my body to endure 28-hour shifts. There were so many nights when I came home feeling nauseous, wondering if I should eat or sleep or shower, before the cycle began again. The learning curve was steep.

This isn’t the fault of any individual — it’s a structural problem. It has to do with shift scheduling, the make-up of medical teams, and understaffing which leads to an over-reliance on resident labor.

These are just a few examples of basic rights that need to be ensured for all residents and fellows. It’s important for our own health, for our patients’ wellbeing, and for our communities. Drawing inspiration from the Patient Bill of Rights, a coalition of residents across specialties at Yale-New Haven Hospital began organizing to reach three major goals: to ensure a training process that is fair and humane, to demand a workplace and health care system that is diverse, inclusive, and just, and to uphold our collective power and protect our existing rights.

Sign the Bill of Rights here.

The Resident and Fellow Bill of Rights

1. Right to work conditions that ensure patient safety. We have the right to duty hours, team structures, and on-call responsibilities that allow us to safely care for our patients.

2. Decisional accountability to the community. As residents, we are also members of this community and have the right to hold our institution accountable. We have the right to ensure decisions that facilitate equitable distribution of our labor and institutional resources.

3. Right to a diverse, inclusive training environment. Our institution must reflect the diversity in our society, and purposefully include trainees and faculty from groups underrepresented in medicine.

4. Right to respect and equity. Our institution must establish policies to combat workplace discrimination based upon physical, mental, or social differences in order to promote a culture of respect, wellbeing, and opportunity.

5. Right to supervision and mentorship. We have the right to sufficient supervision to protect patient safety. As the next generation of physicians, we have the right to invested and compassionate mentorship.

6. Right to fair and balanced evaluation. We have the right to appeal disciplinary actions and educational evaluations through an objective, transparent, and democratic process.

7. Justice in health care. Our training must equip residents to contend with health inequities in order to reduce disparities rather than perpetuate them. We deserve to fully care for all of our patients, regardless of ability to pay.

8. Right to health. Our institution must promote our health, defined by the WHO as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” We have the right to comprehensive health insurance, including mental health coverage.

9. Right to a living wage. We have the right to compensation and benefits that are sufficient for ourselves and our loved ones to thrive.

10. Right to democratic representation. We have the right to represent our interests in the administration of residency programs. We have the right to know how our hospital system makes decisions and allocates resources.

Eden Almasude is a psychiatry resident.

Image credit: Shutterstock.com

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