Much attention has been given to nurses and other healthcare workers and the strain that COVID has placed them, but there's another segment of the frontline response team that tends to be ignored as a result. It is crucial that we remember one of our most undervalued healthcare workforce: physician residents.
Physician residents suffer in silence without a public voice. They are forgotten for the societal and economical value afforded through their care. Despite the increased workload, they lack the protections to individually or collectively negotiate terms of employment and compensation.
Meanwhile, national headlines feature stories such as about Kaiser Permanente, a large healthcare company, which recently avoided a potentially crippling strike between union workers over two-tiered wages for its nursing staff within its 366 multistate facilities. Even high-profile Senator Bernie Sanders publicly urged Kaiser Permanente's CEO to support its company's nurses and other healthcare workers, calling them "heroes and heroines" for fighting on the front lines. Yet, physician residents who are a large labor workforce within the walls of many hospitals are missing in the conversation.
It is well known that training as a physician resident involves grueling physical and mentally challenging conditions. On average, physician residents spend a minimum of 60-80 hours caring for patients on top of an average of 50 additional nonclinical work hours. Their weekly schedule consists of 24-hour call shifts, and they are not afforded the state-mandated breaks given to typical employees. This is in contrast to physician assistant students and advanced practice nursing students, who work 40 clinical hours.
It is not uncommon for physician residents to eat their lunch for less than 10 minutes while charting, or taking an opportunity for dinner at what should be sleeping hours. Even the simple acts of drinking water and using the restroom are withheld until a convenient time allows after patient care. Overall, physician residents' lack of sleep and rest has contributed to mental health issues and burnout. In addition, their clinical duties have increased in response to the COVID pandemic.
Despite this noble work, it is clear that the mental and physical demands of caring for patients take a toll. Prior to COVID-19, physician residents had already been experiencing high rates of depression and suicide. This year, physician residents continued to describe the trauma of being in healthcare and their lack of autonomy.
In Medscape's 2021 Residents Lifestyle & Happiness Report, 35% of residents surveyed said they rarely or never have time to lead a satisfying social life, an increase from 27% in the previous year's report. While the idea of self-sacrifice is historically perpetuated in the culture of training as a physician, this new reality of physical and emotional turmoil was not part of their expectation.
Although it is well known that physician residents work grueling hours, it is less known that they are not well compensated. In the United States, there are nearly 140,000 physician residents who work across US health systems, according to the Association of American Medical Colleges.
The average wage of physician residents in the United States is less than for nurses. Residents who work beyond the 40-hour week do not receive overtime pay for weekend, overnight shifts, or holidays. In contrast, US wages for the average American worker are higher and adjusted for "overtime" considerations. When accounting for inflation, wages for physician residents have remained stagnant.
Critics may view this conversation to be detrimental to valuing non-physician healthcare members. It is important that we value the contributions of all unsung heroes and heroines, including physician residents.
Meaningful programs that address the current challenges of medical residents are critical. This includes modernizing resident compensation to be consistent with their value, and providing accessible mental health programs and organizational support to balance residents' workload demands with the rest of their lives.
Echoing the voices of our healthcare colleagues, pizza parties, parades, and letters of appreciation are not the final solution to addressing the mental trauma that the COVID pandemic has created in our early physicians.
As we take the time to remember and honor our heroes in healthcare, we must shine a bright light on the forgotten workforce of physician residents.
Lisa Solomon, DO, is an assistant professor in the department of anesthesiology at Rush Medical College in Chicago. She completed her own residency and fellowship at Loyola University Medical Center. She is passionate about preparing and empowering residents and is a Public Voices Fellow of The OpEd Project.
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Image 1: Lisa Solomon, DO, FASA
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Cite this: The Undervalued and Forgotten Healthcare Workforce: Physician Residents - Medscape - Jan 07, 2022.