The Huffington Post—October 5, 2011
Helene Pavlov, M.D., FACR, Radiologist-in-Chief at Hospital for Special Surgery
July 1 is a special day in hospitals, medical schools and the medical profession in general. July 1 is like Jan. 1 to most. July 1 starts the academic year in health care. It is the first day of internship, residency and fellowship training. For those leaving their trainee status, it is the first day of the rest of their life as doctors. It is the day they start practicing the medical/surgical subspecialty that they spent approximately 10 years training to become competent and confident in after college graduation. The day also marks the end of waivers for loan payback, e.g., loans taken to pay for medical school, possibly college and even intern, resident and fellowship years if stipends did not suffice. July 1 is also the date when they are required to pay expenses for malpractice, licenses, office space and staff -- expenses that are often much higher than earned income during the first year of transitioning to one's "chosen profession."
So, with all that dedication and delayed gratification, why are so many of these young doctors choosing to work part time?
During the training experience (internship, residency and fellowship), new doctors are trained to expect 10 hours of sleep without work responsibilities. If they are summoned to respond to a patient's needs during the evening hours when they are on call, they are required to calculate when (10 hours later) they can return to work. This 10 hours of downtime is mandated in the name of patient safety and is enforced, even if it means missing an important informative morning conference or patient rounds. If the trainee ignores this mandate, then the training program is subject to substantial financial penalties. As you would suspect, there are oversight agencies with employed people to perform audits and ensure compliance. These policies and procedures reinforce the sense of entitlement and life expectations of our youngest and brightest new physicians.
In the above scenario, while the trainee is not expected at work in the morning after having been interrupted while "on call," the attending physician who supervised the resident/fellow in the middle of the night is expected at work. After July 1, these new "no longer" trainees will discover that the uninterrupted sleep entitlement is over. They will be expected to be at work and to be able to perform. As these young physicians become aware of limited entitlements, many opt to work part-time. They comfortably ask during the interview for a position, "What is the minimum work I will have to perform to keep my job?" I fear that the professional aspect of the profession of medicine is becoming compromised.
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