Resident Wife: 204 Days And Counting

Residency sucks. That's the recurring theme around here. My husband and I expected it to suck; we knew it would involve hard work, low pay and long hours. That's how apprenticeship works. What frosts my ass, though, is that a good portion of those long hours of are spent on tasks that either A.) could be done by someone else, or B.) no longer have much educational value. Yes, it's a good thing to do as many intubations as possible, but with many other procedures, residents are filling staffing needs and not learning anything new. AliasJohn works in a very large, very busy hospital. By the end of his CA-1 year, he had filled the procedure quota set by his specialty board. He's been marking time for the last 18 months, receiving minimal instruction in anything that will help him pass his specialty boards. Alas, "minimal instruction" does not mean working fewer hours. He came home from a meeting dismayed that the program director was more concerned with getting everyone down to 79-hours-and-59-minutes a week than with hiring more staff.

Starry-eyed cynic that I am, I wasn't surprised in the least. According to the Beacon Hill Institute, Boston has the third-highest cost of living among the 50 largest US cities. Couple that with low Medicaid reimbursement rates, and it's no wonder that hospitals here are having trouble recruiting physicians. Yes, it's a problem. Know what, though? It is not the residents' problem. They are there to learn, not to compensate for poor reimbursement rates, an inflated real estate market, and poor resource allocation. (It's hard for me to be sympathetic to a hospital's "plight" when it was paying someone $600,000 a year for a no-show administrative job. Eventually the shit hit the fan and he was fired....) That's more than enough money to recruit a couple of freshly-minted attendings and physicians' assistants, so I'm not buying.

None of the above is anything new, and I've gone over it ad nauseum. So now I'll get to one of the specific reasons I'm so bitter about this whole process. I've never written about it, because I don't want to put out too much specific information about us. But this involves the hospital's blatant disregard for the health and safety of both its residents and patients, and I can't sit on it anymore.

My husband had three rounds of major surgery, spread over four months. The first surgery and its accompanying time for recovery passed without incident. The second surgery had to be postponed because he got so sick that the surgeon wouldn't touch him. Think it had anything to do with being run down from working three weeks straight so he could have a week off to recover? The third and most invasive surgery required two weeks of recovery. Eleven days later (early Sunday morning), the chief resident called, wondering why he wasn't in. I calmly explained that the surgeon had said "two weeks off." The chief resident countered with, "Well, he's on the schedule, and we're really shorthanded." I explained, less calmly, that AliasJohn had two incisions, multiple sutures, and wasn't supposed to lift his arms over his head. Roused by the commotion, my husband dragged himself out of bed, took the phone out of my hand, and listened to the chief resident's spiel. He hung up, and shocked the hell out of me. Out of concern for his patients, nice-guy-guilt (and a dash of the Stockholm Syndrome?), he agreed to go in. I was gobsmacked. He didn't take any painkillers before he left, so at least he wasn't addled by opiates. He was, however, limping along on woefully-inadequate Tylenol, and such a weakened, shambling mess that he may as well have been in a Vicodin haze. They sent him home after a few hours, and didn't bother us for the next three days.

I was (and still am) disgusted by all this. They had months to plan for my husband's absence. But they preferred to risk his well-being (and, frankly, that of any patients he treated) rather than shell out enough money to entice an attending to pick up a Sunday shift. If there were no attendings available, they could have shelled out for a locum. Oh, who am I kidding? Getting a locum or an attending to cover that shift would have cost them almost as much as a resident makes in two weeks.

So let's call a spade a fucking shovel, shall we? This is about the bottom line, not education, and I have no illusions that the system will ever change. I have two small comforts; one is that this will all be over in 204 days. The other is that someday, this hospital will hit us up on one of their fundraising drives; after I laugh myself silly, I will either set fire to the begging letter or send it back after using it to clean up after the dog.

By the way, the surgery was a success.

Comments

Well, it is good to hear that the surgery was successful.
As for the residency, you are absolutely right. Hospitals all too often look upon the interns and residents as cheap labor. Hour for hour, the high school dropout screwing up your order at taco Bell gets paid more than an intern. Yes, you have to figure in overtime to make it work, but it is the truth.
I have another year and a half until my intern year. The only thing I am looking forward to is that I will be getting a paycheck instead of going into debt.

Posted by: doc Russia | December 12, 2004 at 12:34 PM

As an MS4 heading into internship, well, my wife and I cringe daily at the upcoming horror about to fall upon us. This is actually good reading; it helps me solidify me reasons for not moving to Boston for training. Somehow, hospitals in this country have cast an image of a downtrodden, barely-workable system in which they barely make ends meet. In reality, hospitals are some of the most profitable components of the health care "system", and they're mostly deplorable in their means. Have no fear, though, as the bough is about to break. ED's have recently begun offering only screening examinations to nonemergent patients, as required by EMTALA. Soon, they will no longer be taking care of the needy poor, and then we will have a crisis even the press cannot ignore.

Posted by: Chief | December 22, 2004 at 01:12 PM