Does Residency Actually Work?

At some point, all M.Ds have to go through residency before they are able to work independently in a hospital. Residency acts as training for medical school graduates, where they are able to practice under the supervision of senior medical clinicians. The main goal of the training is to prepare doctors for their specialization. Depending on the field of interest, a resident may actively train for 3 - 7 years before they are able to practice without direct supervision. However, recently many questions regarding residency have manifested, with one being, does it actually work? 

According to a recent editorial from Emergency Medicine News, emergency residency programs are doing a poor job of preparing their residents for the real world. The authors note that a typical, large urban academic emergency department comprises less than 5 percent of the U.S. ERs, and that “residency programs train physicians in some of the most inefficient EDs, [emergency departments], in the land. Relative value units of emergency medicine work per hour in the teaching hospital setting is typically half that seen in private practice.” The editorial also brings up another point: residents train in a culture where chaos exists. According to data from the Emergency Department Benchmarking Alliance and Press Ganey, “the large urban tertiary care and teaching hospital EDs have the slowest throughput times, the highest left-without-being-seen percentages, low patient satisfaction scores, and high complaint ratios.”

This brings up an important question: if residents have never seen an organized and professional environment, how will they know how to practice in such an environment? Or, how will they create this type of environment in the future? On top of this, an emergency physician, for example, entering practice post-residency is immediately confronted with the expectation that they deliver “highly efficient, patient-satisfying care.” Many, however, were not trained to do such things, as their environment was much messier than the average ED looks. Such practices may be the reason that nearly “50 percent of new graduates do not survive their initial practice choice for even five years.” 

It is also important to note that depending on where one does their residency, or where they get matched, more accurately, changes the environment and workplace they will experience. Brownlee and Colucchi write “Whether they are on the path to becoming pediatricians or pediatric brain surgeons, residents absorb the habits and assumptions of the senior doctors around them. [...] Practice style varies from hospital to hospital, and gets transmitted to young residents through what's often called the "hidden curriculum." It's one of the most important differences between residency programs.”A report from the Dartmouth Institute for Health Policy and Clinical Practice also makes clear that there is a dramatic difference in the complexity and efficiency with which sick patients are treated, even among the top hospitals in the country. 

Across the country, residents are placed in environments that are not similar to workplaces they may face in the actual industry, a situation that causes many of them to change specializations. Regardless of the fact that some residency programs do accurately prepare a doctor for the professional field, unless they all do, the question will continue to be asked.

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Welch, Shari J., et al. “Weʼre Failing Our Residents: Training ED Docs for the Real World.” Emergency Medicine News, vol. 32, no. 2, Feb. 2010, p. 5, journals.lww.com/em-news/Fulltext/2010/02000/We_re_Failing_Our_Residents__Training_ED_Docs_for.5.aspx, 10.1097/01.eem.0000368072.75863.28. Accessed 26 June 2022.

‌Brownlee, Shannon, and Joe Colucci. “Do Prestigious Residencies Mean Better Doctors?” The Atlantic, theatlantic, 12 Nov. 2012, www.theatlantic.com/health/archive/2012/11/do-prestigious-residencies-mean-better-doctors/265038/. Accessed 26 June 2022.

‌https://data.dartmouthatlas.org/downloads/reports/Residency_report_103012.pdf

“What Is Medical Residency Really like (a Resident’s Perspective) - TheMDJourney.” TheMDJourney, 14 Apr. 2021, themdjourney.com/what-is-medical-residency-really-like-a-residents-perspective/. Accessed 26 June 2022.