The problem is there is no recourse like in a normal job. It’s not like you can just say, working conditions here are bad I’m going somewhere else. Working conditions are miserable everywhere for residents, 80 hour weeks are a norm not an exception, and switching to other programs is near impossible. There’s a specific exception in US anti trust law that helps keep this all going and make it so programs effectively don’t need to compete with each other on things like pay and benefits. If a resident were to leave their program, they’d be saddled with 6 figure student loan debt, be unable to use their degree for the most part, and be very unlikely to be picked up by any other program. And if they did, it’d likely be an even worse situation (why else would the position be open?). Though some programs may be better than others, even the best case scenarios are ridiculous and unsafe to any reasonable person looking at them. It’s this bizarre case of group insanity where people figure it must be reasonable if so many people put up with it, but anyone outside of medicine would be horrified. The entire residency system is broken, has been from the start, and all the external incentives on the residency system are pushing it to get even worse, not better. Need change forced by law from above, the monopoly ended, or resident unions, all three really.

I understand the sentiment but it’s not really helpful. They’re still the ones on call, they need to talk to you, and will be writing your orders and things anyways. Not really like they can just say, oh yeah I am tired I’ll just go home and sleep and abandon all these patients here, why didn’t I think of that?

Helpful things would be writing congressmen and senators about reform to the residency system, supporting unionization efforts. Change will only come if forced from above or if residents get more of a say. Ideal situation in my mind would be a more typical work schedule capped at closer to 50 hours a week, maybe with increased residency training time overall and increased pay during that time to compensate (need to keep up with cripplingly high student loan debt for those who didn’t have wealthy parents who payed for medical school).

Even attending physicians will really need to start unionizing if they don’t want to get totally lost in the shuffle, since they’re mostly employed directly now instead of running their own practices or specialty group, they get very little say in how things are done.

Unfortunately a common experience. While they don’t tell you to lie, the system is set up to make that the only reasonable option. And even if they were holding to 80 hour max (open secret this limit is broken many places) it would still be too much for any job, let alone something high risk like a doctor in training. If you were on a plane with a pilot in training who’d worked almost 80 hrs and been up for 20 hours straight already, you’d rightfully be very concerned.

Don’t forget mandatory resiliency lectures after your 24 hr shift to really rub it in and gaslight you that all of this is somehow your fault.

Residents in the US have 80 hours with maximum of 28 hour shifts, not a ton better. Though average salary is better at 58,000. Still, considering the hours worked and 8 years of schooling up to that point, ugh.

Residency is just a terrible idea through and through, absolutely insane. Where else could you start a job and be told “right so you’re new here, this is life and death decision making, we’d like you to stay up working for 28 hrs straight doing this. Alright, get to work!”

If a resident gets two days off, it’s called a “golden weekend.” What most people refer to as, a weekend. It’s just exploitation. Even more so when you consider Medicare pays for residents (and they even pay the hospitals more than the resident’s actual salary! So the hospital pockets that difference and benefits from all the direct value the residents generate too). There’s even an exception in US anti trust law to make the system legal. Glad more residents are unionizing here as well. Residency is horrible and needs to go.

https://www.acgme.org/globalassets/pfassets/programrequirements/cprresidency_2023.pdf

There’s even this lovely line:

The program, in partnership with its Sponsoring Institution, must ensure adequate sleep facilities and safe transportation options for residents who may be too fatigued to safely return home

So, so tired not even safe to return home (which I mean they’re right, it is not safe to be driving after staying up 24 hours straight) but continue doing patient care while you’re that impaired, it’s fine.

In a prospective study, new medical interns went from 3.9% meeting criteria for major depressive disorder to 25% after starting. And depression was linked with increased medical errors to boot. Of course mean work hours was a major association of depression too.

https://jamanetwork.com/journals/jamapsychiatry/article-abstract/210823

Totally asinine, a whole enormous meat grinding machine that needs to go, but is stuck in place by historical inertia and current profits for large hospitals.

Kind of? They call it that sometimes but it doesn’t look like a true no first use policy in the same vein as China’s and India’s. Putin also threatens nuclear weapons if NATO troops were to get involved in Ukraine, and openly questions the policy.

https://www.cnn.com/2022/12/09/europe/russia-putin-nuclear-weapons-intl/index.html

I’m not sure any nuclear country would stick to these policies if they truly faced an existential threat, whether that threat was nuclear or not. Russia’s policy has a carve out for any existential threat including conventional weapons. US and Russian policies are pretty close, basically okay to use for any existential threat. Doesn’t hurt to try and negotiate more no first use policies and reinforce the norm though.

Looks like the UK, France, and Pakistan also lack no first use policies.

https://en.m.wikipedia.org/wiki/No_first_use

As far as I can tell the article is correct, China and India are the only current nuclear powers with true no first use policies. If that’s incorrect happy to learn more though. Israel not on here cause officially not a nuclear power, but hey we weren’t born yesterday.