 I mean, I'll stand on this, but I don't really see how that's supposed to help. In the US, after completing undergraduate in medical school, MDs who want to actually do medicine are required to complete a residency, three to seven years of on-the-job training in a specific discipline, with gradually increasing degrees of responsibility and autonomy before they're finally licensed to practice in their state. Residency is infamous for being a hell of a slog. The term originally stems from the fact that aspiring doctors were expected to live in the hospital to become residents there. Conditions vary according to the field, but most residents work more than 70 hours a week. They get a mandated 24 hours off every seven days, and even that is sometimes granted because they're transitioning from daytime shifts to nighttime shifts, or vice versa, just so they can flip their sleep schedule. This time off is usually accompanied by the threat of jeopardy, of being called in to work with 20 minutes notice if the hospital is short staffed for any reason. Also, the 24 hour mandate is an average, not a periodic guarantee. Nothing stops the hospital from requiring residents to work for half a month straight, then granting two days off in a row. It was affectionately termed a golden weekend. Many actually prefer this schedule because if they only have one day off, they really only have time to catch up on sleep before they're back at work, with no time left over to take care of the normal life stuff like taxes and grocery shopping that don't go away simply because you're working hard. On average, residents can expect to work around four shifts a month that exceed 28 hours, a length of time that isn't just absurd to demand someone to remain awake, but has serious adverse effects on health. These long shifts are frequently justified on medical grounds. Transferring a patient from one team to a different team can be risky, so keeping the same people working as long as possible can minimize the number of handoffs and help to reduce the odds that an important fact about the patient gets overlooked by a team that's seen them for the first time. But the average duration of a patient staying in the hospital is four and a half days, meaning that while insanely long shifts might reduce the total number of handoffs, when they do happen, the resident signing out still has to communicate all the important nuance of that medical context, now after having been awake for a day in change. To maintain continuity, nurses usually work in teams with staggered shifts, so even when one person leaves and another arrives, there's always someone on the team who knows the patient's history and treatment plan. And as a result, they usually work reasonable shifts, not so for residents. A recent study suggests that strict limits on resident hours don't affect patient outcomes either way. And as is frequently the case, hospitals took this to mean patient outcomes don't improve with shorter shifts, so there's no reason to change. While active in the hospital, not only are they expected to pay close attention to acquire the final skills that they need to be good doctors, but they're invariably tasked with a substantial amount of scut work, tedious or otherwise undesirable jobs for highly trans-specialists, like calling insurance companies to ask if they'll cover certain medications or filling out routine documentation. Depending on which department they're rotating in, this tedium may be punctuated by occasional gunshot victims, cancer diagnosis, maybe informing new parents that their child won't live another week. Even MDs hoping to go into a less intense field like dermatology have to experience some incredibly traumatic situations while they're doing residency. And all of this was before the additional stress of COVID. The average income for this grueling, physically draining, emotionally harrowing workload is around $60,000 a year, which, if you cap things, is an optimistic 10 hours per day, comes out to about 20 and a half bucks an hour, around the same rate that they'd earn if they were employed as stock workers. A substantial portion of which will be used to pay down years worth of student loans, which on average exceeds $200,000. Now, if you're a sane person, working under those conditions for three to seven years just to be eligible for employment in your state doesn't sound great, but after accumulating an enormous amount of student debt, newly minted MDs don't have a lot of options. They're not in any position to negotiate with the institutions employing them. The nationwide algorithm that once a year matches new med school graduates to resident programs essentially locks those graduates into a contract with their selected organization. They can't legally pursue residency anywhere else. So the only way to eventually be qualified to work in the job they've trained for for the better part of a decade, the only way to earn the money necessary to pay down those astronomically expensive loans is to shut up and deal with whatever conditions they find when they start working for as long as necessary. Medical institutions transparently take full advantage of this fact whenever they hire staff, casually assuming that they'll have a captive workforce of residents who can't quit working tirelessly to get stuff done. Well, I say can't quit, but in some cases after working in these conditions for comparatively low hourly wages with their exceptionally competitive four year graduate degrees, with little time off and unapologetic exploitation as low cost, highly skilled labor in a frequently traumatic environment run by an organization with no incentive to do anything but bleed them dry. Some residents make a practically irreversible decision to leave those programs and the path to being doctors to pursue opportunities in fields that don't require a medical license. Biotech corporations, research companies, there are all sorts of employers who are looking for people with an MDs training and work ethic, even if they're not full on doctors. Employers who only ask that they work 40 hours a week offer a decent amount of pay time off and rarely ask their employees to console families while loved ones are dying. That's got to sound attractive to even the most diehard gunners after a few weeks of frantic 14 hour shifts where there's no time to sit down, let alone eat or go to the bathroom. People who work in medicine call this, I think it's safe to say, wholly justified departure from the meat grinder of residency, burnout, which is a brilliant PR move echoed in all sorts of articles and think pieces that raise the alarm about burnout and ask what can be done to prevent it. Specifically, what can be done to keep residents from making that decision without changing the working conditions that are very clearly driving them to do so. If you do a quick Google search on burnout, you'll find an impressive number of self-help guides many published by medical institutions on how to keep yourself from burning out, building resilience, how to push through. Some teaching hospitals hire therapists to be visited outside of work hours obviously and encourage residents to really make the most of their days off to restore their mental and emotional wellbeing so they can come back and work. To combat the routine lack of sleep, which any doctor will tell you is bad for memory, cognition, mood regulation, immune response, all sorts of important stuff, the Accreditation Council for Graduate Medical Education recommends strategic napping, especially after 16 hours of continuous work. All of this exceedingly helpful advice carries the unstated implication that if the structure of the medical system makes things hard for residents, it's their problem for them to work at, you know, some time when they're not working. This move reframes the wholly rational decision to leave an abusive work environment and do something that sucks less, maybe something that pays more as a flaw of a character, a failure of metal. We don't ask what specific conditions made residents reconsider their career path after years of cutthroat competition and dedicated study. Why they might make such drastic and substantial life changes all to stop working at their chosen vocation. By shifting the whole conversation to be about how to enable these individuals to soldier on when they feel like quitting, we slightly imply that quitting isn't a valid, reasonable response to the situation. A situation where their wellbeing and happiness isn't even part of the conversation, only the extents of what they can be made to endure. These conditions are familiar to everyone who's worked in a hospital and have been for more than a century. Many older doctors can recount war stories of residencies that make the nightmare that I'm describing sound relatively tame. We've known about this abuse for all that time and the conversation about what adverse effects these working conditions might have on the people who work in healthcare to keep us alive and healthy was only kicked off in the past 20 years or so. When some folks started worrying that maybe that unending torrent of sleep deprivation and stress might be hampering their ability to work effectively for us. Again, the conversation isn't about them or their desires. It's about their productivity and performance in maximizing our benefit. There are a lot of things wrong with the American medical system. Costs are insane compared to costs in almost any other country. Health outcomes are not great. There's also a doctor shortage in the U.S. right now which partially explains why hospitals rely so heavily on the incredible work ethic and dedication of these individuals to keep people healthy as best they can. In this situation, every person who makes it through medical school is an incredibly valuable resource for saving lives and every such person who makes the decision to leave residency, either because they realize it's not worth it or they have nothing left to give is a tremendous societal loss. A job that puts no upper bound on what it will demand of you besides your own breaking point isn't worth any salary. And if that's the way things keep running, we shouldn't be surprised if we find fewer and fewer people zealous or stupid enough to take that deal, which will only make the situation worse for those who stay. I'm angry about this because there's someone I care about. One of the most stoic, tireless, patient, compassionate and hardworking people I've ever met who's struggling desperately under the abuse of a system that is coldly and strategically strip binding them for everything that it can. I can't ask you to care about them, but even if you don't feel anything for the brutal lives of aspiring doctors, maybe take a moment to reflect on how that engine of abuse, what they call burnout, is thinning the ranks of people trying to keep you alive. Do you know anybody who works in medicine? What do you think of the phenomenon of burnout and the residency paradigm that's causing it? Please leave a message below and let me know what you think. Thank you very much for watching. Don't forget to blah, blah, subscribe, blah, share and don't stop thunking.