A Time for Change—of Residency and Beyond!

Abstract

To the Editor.—I read with more than passing interest the thoughtful article by Sectish et al.1 As a pediatric residency program director for ∼14 years, I have been actively involved in all aspects of resident training. Our program, as have all others, has undergone (and continues to undergo) both mandated and nonmandated, albeit necessary, changes in curriculum, duty hours, and conditions of the workplace(s). My quibble with both this article and others recently published is with the limited arena that has been adopted for change. Although the authors acknowledge the difficulties of attracting graduating students to primary care fields such as family medicine and pediatrics and point out “the advantages [of other areas that offer]…higher income or better lifestyle,” they do not go beyond suggesting change in residency programs. This is fallacious to me. Nine years ago we published a study of stress in pediatric faculty and expressed our concerns regarding the future well-being of medical academia.2 Data published subsequently point to major shortages in pediatric subspecialties (eg, endocrinology, neurology). The regulation of housestaff duty hours and need for observation and detailed documentation of competencies and professionalism impose even more stress on general and subspecialty faculty and further decrease time for academic pursuits and rewards, both tangible and intangible, that follow. This model is not one that our trainees will readily emulate. It is time to look beyond residency and mandate “transformation” of the workplace for all involved, for the good of physicians and their patients alike.