Mistreatment of Medical Interns and Residents

by Jessica Craig

Most pre-medicine and undergraduate students have heard stories of interns and new residents being harassed, publicly embarrassed or mistreated by older doctors and even their peers. Some stories are more extreme, but all can make aspiring doctors a little more anxious about medical school, internships and residency. How much truth lies in these accounts and what is it like to be a real intern or resident?

In 1991, the American Medical Association conducted a national survey of the treatment of first-year residents across the country. The survey was mailed to 10 percent of the nation’s second-year residents, asking them to report about their experiences as a first-year resident. Of the 72 percent that responded to the survey, an astonishing 93 percent reported at least one incidence of mistreatment or harassment; 63 percent of female residents reported an incidence of sexual harassment; and over 70 percent of residents reported incidences of working under impaired conditions, namely sleep deprivation.

The Association of American Medical Colleges now conducts yearly surveys to monitor the treatment of medical students, interns and residents. Many well-known teaching hospitals and medical schools such as Johns Hopkins and the University of California at San Diego have taken great legal strides to prevent mistreatment of new doctors. Despite these efforts, more than half of second year residents still report incidents of mistreatment. These include physical violence, public embarrassment, bullying, harassment and forcing interns to perform non-medically related tasks for their older resident.

Why do older residents and doctors resort to such extreme measures to teach the incoming class? The longevity of the mistreatment might signify that, in some way, it helps teach young doctors how to work under extreme pressure or how to handle the social interactions that being a doctor demands. Doctors justify the harsh conditions by telling trainees that every new doctor goes through this. In this way, the mistreatment parallels hazing that might be seen in fraternities or the military. It is also a common belief that these conditions expose new doctors to such extreme emotional and psychological stress that it helps to remove emotions from their work, reinforcing impartial judgment. Some doctors even believe that the mistreatment ensures that doctors are truly dedicated and passionate about their jobs; the harsh conditions “weed out” weak doctors.

Is the tradition of mistreating interns and residents really the most effective way of teaching and training new doctors, or is it causing undergraduates and medical students to rethink their occupation choice? One aspiring doctor in the University of Virginia’s (UVA) medical program found that his original ambition was not worth the abuse. After graduating from the University of Maryland with a bachelor’s degree in chemical engineering, Dr. James Clark attended medical school at the University of West Virginia, in hopes of someday becoming a general surgeon.

After medical school, Clark found himself in the General Surgery Residency Program at UVA. Describing his experience as a surgical resident, Clark stated that every day of his internship, he felt “that he was a completely unworthy human being, … an incompetent doctor.” He understood that, as a resident, he truly had very little knowledge about medical practice and surgery, but the harsh, constant reminder of this made him feel unmotivated and hopeless. “The doctors and surgeons I worked under made me feel as though I didn’t deserve to be a doctor,” he said. “During my entire first year as a resident, I learned more about how unworthy and stupid I was than I did about medicine and surgery.” After his first year of residency, Clark left medicine and pursued a career in chemical engineering. But his work there was unfulfilling. Now, three years later, Clark has reapplied to residency programs and plans to try again in June 2014.

When mistreatment of residents surfaced as a major problem in the medical field (notably after the 1991 survey), psychologists, medical schools and hospitals across the country began conducting their own surveys and interviews to explore the psychological effect of abuse on young doctors.

One survey conducted at Rush Medical College in Chicago, Illinois, showed astonishing data. Psychologists and other researchers found that over 40 percent of interns and residents experienced recurring bouts of depression and extreme anxiety. In almost all of these cases, interns changed areas of specialty, changed hospitals or residency program or took time off before returning to complete their residency or fellowship. About 20 percent of these interns and residents left the medical field completely and pursued other jobs. In about 1.2 percent of these cases, interns and residents either committed or attempted suicide.

While he is now entering a specialty typically considered less competitive than surgery, Clark admits he is nervous about returning to medicine and facing the conditions he remembered. But he hopes that, in light of the recently published surveys and studies, conditions will have since improved. Research suggests that the problem has been identified; but in this area, the field of medicine has yet to undergo the major reform it needs.