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Medical residents have overcome many obstacles to get where they are, as detailed in Medscape’s 2022 Resident Salary and Debt Report, which explains their challenges with compensation and school loans, as well as long hours and problematic personal relationships.
While 72% of residents described themselves as “very satisfied” or “satisfied” with their training experience, only 27% felt as highly about how well they were paid. Satisfaction levels rose somewhat after residency, reaching 35% in the fifth year.
Respondents to the Medscape survey described mixed feelings about the residency, with some concluding it was a rite of passage.
Is it easier for residents today?
If so, does this rite of passage get any easier? You will get different answers from residents and doctors.
Medscape asked respondents if their journey to residency has been made easier since the Step 1 exam was converted to pass-fail and interviews went online due to the COVID-19 pandemic.
Many residents acknowledged that their commute had become easier, less stressful and less expensive under the new Step 1 formats. One respondent said that he had been freed up to focus more intensely on higher academic goals such as for example research.
Another respondent called the pass/fail change “a complete game changer” because it allows applicants to apply to all majors while having qualifications other than test scores. A resident who took Step 1 before pass/fail was introduced described the “overwhelming stress of studying for Step 1 to get the highest score possible”.
But not all residents liked the difficulty of being able to differentiate themselves, beyond medical school pedigree, in the absence of Step 1 results.
Meanwhile, some doctors posting comments on the Medscape report strongly disagreed with the idea that residency life is getting harder. They portray residency as a rite of passage under the best of circumstances.
“Whatever problems there are, [today’s residents] they still earn eight times more than me and from what I saw we had a lot more independent responsibilities,” said one doctor who commented.
Other doctors were more sympathetic and worried about the future price to be paid for the difficulties during the stay. “Compensation should not be tied to the willingness to sacrifice the most beautiful years of life,” wrote one commenter.
Online Interviews: Pros and Cons
Many local respondents celebrated the opportunity to interview for online residency programs. Some who traveled for in-person interviews before the pandemic said they racked up as much as $10,000 in travel expenses, adding to debt.
But not everyone was a fan. Other residents noticed that peers could apply for more residencies and “stack” interviews, making the competition much tougher.
And how useful are online interviews for a resident candidate? “Virtual interviews are terrible for getting a real sense of a program or even people,” lamented a first-year family medicine resident. And it’s harder for a candidate to “shine when you’re on Zoom,” says the first-year internal medicine resident.
Whether to report harassment
In its survey, Medscape also asked respondents if they had ever witnessed sexual assault, harassment, or misconduct; and if so, what have they done about it. Among those who did, many chose not to take action, fearing retaliation or retribution. “I’ve seen a resident portrayed as a ‘problem resident’ when he reported it and then ended up being fired,” one respondent recounted.
Other residents said they felt unsure about protocol, who to report to, or even what constituted harassment or misconduct. “I did not understand [an incident] it was harassment until later,” said one resident. Others felt that “minor” or “subtle” incidents did not require action; “they are usually microaggressions and seem to be accepted in the institution’s culture.”
The residents’ confusion increased when the perpetrator was a patient. “I’m not sure what to do about it,” admits a respondent. An emergency medicine specialist added: “Most of the time…it’s the patients who are behaving inappropriately, saying inappropriate things, etc. There’s no way you can file a complaint that way.”
Rewards and challenges for residents
Among the most rewarding parts of residency that respondents described were developing specific skills such as surgical techniques, job security, and “learning a little bit by day,” in the words of a first-year gastroenterology resident.
Others felt gratified by the chances to help patients and families, their teams, and advance social justice and health care equity.
But there are plenty of challenges – mainly struggles for money. A third-year psychiatry major complained that “I was financially strapped in the prime of my life from student loans and low wages.”
Stress and emotional fatigue also often appear as major challenges. “I’m constantly being told to do more, more presentations, more papers, more research, more study,” lamented the fifth-year neurosurgery resident. “I’m expected to be at the top of my game despite the lack of sleep, depression and exhaustion,” muttered the third-year OB/GYN.
But some physician commentators urged residents to look for long-term growth behind the challenges. “Yes, it was difficult, but the experience was phenomenal and I’m glad I did it,” said one doctor.
Batya Swift Yasgur, MA, LSW is a freelance writer with a consulting practice in Teaneck, New Jersey. She is a regular contributor to numerous medical publications, including Medscape and WebMD, and is the author of several consumer-oriented health books, as well as Behind the Burqa: Our Lives in Afghanistan and How We Escaped to Freedom (the memoir of two brave Afghan sisters, who told her their story).
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