Why medical residency should be reformed: It 'can unmoor even the best of us’

July marks a time of change in hospitals across the country. It marks the beginning of the academic year for medical residents and fellows, with new physicians starting their training. As I begin the second year of my medical residency this month, I have been thinking about Libby Zion and Nakita Mortimer.

The former was briefly a household name in the 1980s. Libby Zion was a college student who sought care at New York Hospital (now New York-Presbyterian) with a fever in March 1984, only to pass away after her doctors missed a crucial medication interaction. Her distraught parents believed that overworked resident physicians were to blame and drove efforts to institute work-hour caps for residents.

The latter is tragically less known. Dr. Nakita Mortimer was a resident physician at Montefiore Medical Center, and she died by suicide in May 2023. My colleagues and I became aware of her untimely passing almost immediately, as this news spread rapidly through the medical world. (As with all suicides, it will remain unclear specifically why Dr. Mortimer took her own life.)

My colleagues and I reacted to Dr. Mortimer’s death with shock but not surprise. As one of the senior resident physicians in my program put it, “Residency can unmoor even the best of us.”

All of us in the medical profession know classmates or colleagues who were unable to complete their training, overburdened by the demands of the profession. Studies show that upwards of 50% of physicians report feeling burnout.

Residency is a key contributor to these issues. Usually lasting between three and seven years depending on subspecialty, resident physicians have completed medical school but are still undergoing training and cannot independently practice medicine.

Being a resident means working long hours for little pay (the average first-year resident makes about $60,000 a year). Many residency programs continue to require residents to work 28-hour shifts out of a belief that these long hours enhance continuity of care and resident learning.

But by the end of 28-hour shifts, residents are so sleep-deprived that they have the equivalent of blood alcohol contents of 0.1%, above the threshold for being legally drunk. The resident physicians who were taking care of Libby Zion were in the midst of a 28-hour-plus shift and were also responsible for 40 other patients on the night she died.

Often forgotten in the Libby Zion case is that her death led her parents to push not only for reforms in the medical residency system, but also the consideration of legal charges against the resident physicians and the threat of revocation of their licenses to practice medicine. Therefore, to my co-residents and me, her passing is both a clarion call and a warning, that even if we are tired, we must be perfect or else lose our livelihoods. Of course, with the desire for perfection comes incredible mental stress.

[W]ith the desire for perfection comes incredible mental stress.

We resident physicians recognize that our profession has societal responsibilities. It is our duty to learn and take care of patients, and we do not and should not expect to work regular 9 a.m. to 5 p.m. hours during our training. My goal is to maximize my learning opportunities so that when I complete residency, I can practice medicine independently and competently.

Physicians take an oath to “Do no harm” and try to live up to this credo. But no one can always be perfect.

Some residency programs have been implementing further reforms to protect resident physicians and patients. Over the past year, I have only had to complete one 28-hour shift, compared to my friends in other residency programs who have had to do dozens of such shifts. My residency also has a dedicated wellness curriculum, peer listening programs and access to mental health professionals.

Still, there is more to do. Residents in programs around the country are forming unions and demanding better working conditions and more pay. After 26 years of stagnation, in 2022, Congress finally approved an increase in the number of residency spots, which would decrease the work burden on residents. Our patients should support these efforts and push for further changes because well-rested, better-paid residents are more likely to provide adequate health care.

Few other jobs place physical and mental demands on employees like residency does, and few other jobs come with the awesome responsibility that being a physician has. Continuing reforms will help prevent deaths like those of Libby Zion and Dr. Mortimer. We owe it to all resident physicians and our patients to ensure that such reforms are enacted.

Editor’s note: You can reach the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) and the Samaritans Statewide Hotline (call or text) at 1-877-870-HOPE (4673). Call2Talk can be accessed by calling Massachusetts 211 or 508-532-2255 (or text c2t to 741741).