Residency: Becoming a death sentence for American doctors
I had a very traumatic residency experience and ended up resigning during my second year. It has taken a lot of time and energy to heal and recover from the bone crushing fractures from falling off the mountain that is residency. Upon reflecting on my experiences there are several aspects contributing to the death sentence delivered to residents from program directors, attendings, AMA, ERAS, ECFMG and other organizations which enable this to occur to young talented physicians.
Programs are being paid taxpayer money to train physicians; they are not being paid to abuse their power and torture or end a residents budding career. Often a program director or attending takes their subjective dislike of a resident (“they don’t fit in” or there was a minor conflict) and objectifies it by anonymously filling out an evaluation form giving low marks on certain “metrics” and negative comments with the purpose of abusing the resident and starting a paper-trail to get them terminated. It only takes one reason or conflict that the resident has no control over to get the abuse rolling.
Instead of teaching a resident about being a doctor and treating patients appropriately suddenly they expect the resident to know everything already. It is very easy to run afoul of the higher-ups in medicine. Unfortunately, when the program’s abuse of a resident begins the resident becomes so fearful and terrified that this creates more problems at work and they are more prone to little mistakes from lack of sleep and exhaustion caused by constant overwhelming stress.
Once a powerful person in the program gives the signal for the dogs to attack, the resident will be in for the abuse of a lifetime with no relief. There is nobody there who’ll try to stop the slaughter from the program. It’s a totalitarian dictatorship and many program directors are also the head of the department that no one dares cross. Each program director then uses their templated approach to destroying a resident called “disciplinary actions” to appear as though they attempted to help remediate or rehabilitate a resident to success while officially signing their death certificate and establishing a perfect paper-trail Of documents to cover their backs legally so they can guilt-free dismiss an alleged “problem resident.” If the program director was supportive they’d be utilizing their energy by helping the resident or finding alternative programs to set them up for success.
No one deserves a undignified death sentence for displeasing an attending along the way nor should they be railroaded out of their job and even career for failing one course, rotation, or having a few minor bumps in the road which everyone experiences in life.
Everyone, both residents and attendings, makes mistakes. Feedback should be intended to educate the resident or attending to help them learn. When feedback is used as a stress-inducing torture and dismissal aid device there can be no real instruction or learning in this type of hostile workplace environment. Most issues would take a phone call to discuss and create change and then everyone would go about their business. Residencies are becoming the training grounds of producing vicious clones for hospitals or insurance companies to maximize profits.
The dismissed resident is traumatized but tries reapplying year after year to The Match through ERAS spending even more of their hard earned money while being in debt close to half a million dollars. Many programs take the money and don’t even consider the application. Often they will exclude someone who is a “used resident” looking for a new beginning. It is completely unethical and should be illegal to cripple someone’s ability to gain employment in their chosen field. On top of struggling to find a new residency, the American physician then has to compete with everyone in the world because other medical organizations (AMA, ERAS, ECFMG, etc) complicate the situation by lobbying for and encouraging the use of foreign visa dependent doctors who already are experienced and trained physicians in order to make massive amounts of profit from their added applications.
Now what if I told you the program was heavily foreign residents with foreign attendings and a foreign program director. It was clear from the start that they preferred imported foreign visa doctors. They made it publicly know that they perceived me as not measuring up to the other trainees skills by targeting me with insults ( “stupid” ) and threatened firing for any mistake or even needing a vacation. The program didn’t want to train me instead they wanted to use me like I was a labor horse. They believed I should have come to the program already knowing how to do every aspect of my job. A toxic workplace environment caused by the uncontrolled and unopposed flood of foreign trained visa doctors assimilating into our medical culture. During hiring of new residents the committee comprised of foreign doctors showed favoritism to foreign trained applicants over American doctors. This is illegal and therefore we must make legislation to hire Americans before we open positions to foreign trained visa workers.
After destroying enough promising American resident’s futures, program directors prioritize experienced foreign doctors from other countries who do not need any training. They essentially hire someone who already knows the subject then they don’t have to do as much work and life becomes much easier. This causes almost 7,000 American citizen doctors to be unable to find gainful employment in residency each year. This number of unmatched American doctors grows by the thousands every year in line with the unprecedented increases of importing and replacement with foreign visa doctors into residency programs. We are allowing total destruction of American citizen doctors to occur and no one is speaking out about the abuse or illegality. Medical organizations like the ECFMG claim that foreign doctors are better qualified but in reality they want to maximize their profits and know that this means they won’t have to train an American doctor – even though that’s what our taxpayer dollars are paying residency programs to accomplish.
Additionally, increasing foreign visa doctors contributes to more abusive and aversive workplace environments because now when a program wants to go after someone they can compare them to an already experienced resident trainee. These foreign visa physicians mainly come from India or Pakistan to earn a significant amount of money in comparison to their own country. The foreign doctors don’t care what the expense is to the American educational system because they will profit.
Our leaders in government and medical communities must drastically reduce the amount of visas for foreign medical doctor applicants and remove this already trained foreign medical supply in order to fix our educational system. The Match in ERAS is making a lot of money off applicants and giving them false hope of jobs. The Match must legally give our American citizens jobs before opening up the applicants to foreign visa workers. This will reduce the growing death sentence imposed on 7,000 U.S. citizen doctors being blocked by foreign visa doctors from gaining employment yearly and thus begin to reduce the abuse of residents from residency programs.
Without swift action the growing unemployment and malicious program behavioral problems will get progressively worse as it has every year for the last two decades. The decision must come from the top-down approach or we are purposely sentencing doctors to a premature death sentence. As long as program directors have a continuous supply of highly experienced doctors from other countries they will continue to sacrifice our own flesh and blood with little care or concern. American residents will continue to be unable to speak up in fear of being fired and replaced by profit making imported foreign visa doctors. The defunct medical residency organizations need total restructuring that prioritizes American citizens to allow the healing of educational systems and reduction in unemployed American physicians.