I did not learn in nursing school what and who is a resident physician. It was briefly mentioned that the attending was in charge with residents below them, and that was the beginning and the end of the discussion on residents. But at the end of my first year as a new nurse on a medical floor, I could recite the names of the internal medicine doctors I spent my days and nights mostly working with — residents. By the time I left that job, I knew just a few of the attendings’ full names.
I began to learn what and who is a resident physician in that first job through the friendships I made with residents at 3 a.m. when they would come to get saltines and peanut butter from the unit’s kitchen — “this is the first thing I’ve eaten in 12 hours.” I remember the very first time a resident confided in me that she had just returned after taking a year off for a mental health leave of absence — “I am just grateful to be alive.” I remember vividly the night I learned the resident was the covering physician responsible for 66 patients — “it breaks my heart when a nurse thinks I’m a bad doctor for not immediately recalling all the details of their patient. I wish they knew I have 65 others.” I remember working with another who had come back from six weeks of maternity leave and her first shift back to work was a 27-hour one — “I haven’t slept in weeks.”
And I now have the most intimate front row seat as a wife and witness to a resident.
A minimum of eight years of schooling, often hundreds (yes, hundreds) of thousands of dollars in debt, and an MD/DO after their name all before residency even begins. I will never not cringe when I hear someone ignorantly mistake residents as students and wrongly remark, “they aren’t a doctor yet.”
There is no other job in this country in which people can work 80 hours a week and make near minimum wage, all while being the frontline of America’s health care system — literally saving lives (and grieving for lives). If you are treated in an academic hospital in this country, the majority of your care will be provided by residents (while being overseen by an attending). I was recently lightheartedly reminded of this when speaking to a dermatology attending about a simple procedure I was having when she chuckled, “any resident does probably 50 of these a week, I haven’t done one in years.”
At three different institutions, I have had a resident physician “shadow me” as a nurse, a requirement so they could see what our day is like. The time nurses truly spend right at the bedside, those years and years of experience, and the nursing “gut” is real and valuable for others to see. This is wonderful. Perhaps if I as a nurse was in return required to shadow a resident, I could have been educated earlier on the depth of medical training completed before residency begins. I would have witnessed sooner the mental and emotional toll of working 24-hour shifts, or at best eating a granola bar and a sip of water over the course of a standard 12 hour shift. Maybe I would have seen sooner the absolute magnitude of medical knowledge that residents possess, their ability to return page after page and respond to emergency after emergency without having had a day off in weeks. Maybe I would have seen the grace it takes to remain composed and professional when enduring abuse from patients, nurses, consultants and senior faculty. Maybe I would have sooner seen their capacity to care, to listen, to investigate, to be creative, to fill in the gaps, to not judge, to see what is not said, to give and give and give.
While over the years there have been some efforts to alleviate resident demands, much work remains. A cap of 80 scheduled work hours a week and 24-hour call must not be celebrated as some grandiose and ultimate victory. Arguably, with an aging population, increased complexity of disease and treatment options, and a failing health care system, demands on physicians have never been greater. It is encouraging to see awareness and conversation through social media, individual programs adapting improved working standards, and the increase of resident unionization.
Today is “thank a resident” day. I wish we could thank residents with more protected sleep, protected time to consume nutritious food. Proper compensation for hours worked, proper compensation for responsibilities held. More true days off, not ones spent sleeping after an overnight shift, just to return at 6 a.m. the next day. Public, or at the minimum hospital staff, awareness of who residents are and how they got here. Understanding that “one day they will make a lot of money” is a grand simplification of so many complexities. Easy access to and protected time for therapy.
The health care of this nation would only benefit from these very basic asks.
So on national thank a resident day, resident friends — I see you. I am inspired by you. I am so lucky to bear witness to your brilliance and resilience. I am a better nurse from working with and learning from you and I am a better person too. Thank you for all you do.
Contributing Writer
Alexandra Moschella is a pediatric nurse who loves cooking, reading and spending time with her family. She resides in Ann Arbor, MI where her husband is completing his residency.