The Exploitation of Medical Students and Residents is a Metaphor for the Post-New Deal Barbarism

I was happy, secure, and mostly unafraid until med school. I recall in vivid detail the first orientation day. Our anatomy professor stood before an auditorium filled with 125 eager, nervous, idealistic would-be healers and said these words: ‘If you decide to commit suicide, do it right so you do not become a burden to society.’ He then described in anatomical detail how to commit suicide.

— “Why Doctors Kill Themselves”, by Pamela Wible, KevinMD.com, March 23, 2016

The exploitation and bullying of medical students and residents is pervasive, and stories of the most egregious and diabolical hazing are not uncommon. So oppressive are these working conditions, that each year approximately four hundred medical students and doctors take their own lives. Indeed, with the betrayal of the American worker by the liberal class, which is too busy chasing Russian spies to notice that our once proud middle class lies in ruins, the decimation of unionization continues unabated. Compelled to work outrageously long hours by corrupt hospital administrators, while also forced to negotiate a landscape of diminished autonomy due to the takeover of the medical profession by private insurance companies, a young doctor’s ability to help their patients can be steadily degraded over time, and their spirit broken.

This abuse and exploitation of medical students and residents is something that we cannot afford to ignore, for these inhumane working conditions place both the lives of these young doctors as well as the lives of their patients in grave jeopardy.

In “Medical Residents are Abused More Than Chinese Factory Workers”, an anonymous physician writes on KevinMD.com:

I began my internship…and worked up to 160 hours per week, though I only reported 80 hours of my time due to the pressure by hospital administration and fellow residents. That year, a fellow intern, Tony, a compassionate doctor, was killed in a single car accident when he fell asleep at the wheel after working too many consecutive hours without sleep. I too have fallen asleep post-call at the wheel when paused at a stop light, only to be startled awake by blaring horns indicating the light change.

These exploitative working conditions are emblematic of the authoritarian nature of post-New Deal America, where much of the increasingly debt-ridden workforce has been reduced to the status of serfs and indentured servants. This absence of democracy in the workplace is inextricably linked with the fact that there are at present approximately a hundred million unemployed Americans of working age, along with massive numbers of Americans working very low-paying jobs that do not support an independent existence. Consequently, conditions are ripe for corrupt employers to engage in ruthless forms of exploitation, and young people that enter fields where they seek to help others are marked for particularly heinous forms of abuse.

In “The Secret Horrors of Sleep-Deprived Doctors”, written for KevinMD.com, an anonymous physician writes:

During intern year at a program with a nominal 80-hour work week, I worked 100 hours per week for most of a month. I was interviewing a patient when I suddenly realized that I could not remember what I had just asked. I excused myself abruptly and rushed down the hall where I collapsed on the bathroom floor. I leaned against the wall and felt relaxed for the first time in weeks. My face was wet, and I realized I was sobbing. I was so unaware of how exhausted and impaired I had become. I cried because I was tired, and also because the patient I was seeing deserved better attention and care than I was capable of providing. I couldn’t remember any details of his chest pain or risk factors for heart attack. I couldn’t even remember his name or his face. Only that he was friendly and he trusted me. I felt intensely guilty for not being able to stay awake, let alone think like a doctor. I nodded off while crying, propped up against the wall. I woke up and forgave myself. I think I was away from him for less than 10 minutes. I walked back into his exam room and said, ‘Where were we? Let’s start at the beginning to make sure I get this right. Because what you are saying is really important.’ That month during my evaluation, my program director told me that my total number of work hours was a sign of inefficiency.

Medical students and residents that suffer from anxiety, either due to being bullied or as a result of being forced to work outrageously long shifts, sometimes feel the need to see a psychiatrist and yet are fearful of doing so. This is because if a physician is treated for depression or anxiety, the stigma that follows can have a deleterious impact on their ability to maintain and renew their medical license.

Tragically, abused medical students and residents may go on to lose their sense of empathy and compassion, which can result in their becoming callous or even abusive towards their patients.

Some residents are indoctrinated into believing that this exploitation is for their own good, as if this will somehow make them a better doctor. Residents are also indoctrinated into believing that this exploitation is necessary “in the quest for perfection.” In-hospital medical errors are presently the third leading cause of death in the United States. Indeed, this is the “perfection” that hospital administrators and health insurance companies have blessed us with.

There are also significant parallels between the exploitation of young doctors with the exploitation of teachers, for the exploitation of the former is analogous to giving a high school English teacher hundreds of students per semester, which puts them in the impossible position of being unable to make detailed corrections to these essays. The loss of autonomy so acutely felt by doctors, where they are now forced to spend countless hours each week requesting permission from insurance companies so as to be able to prescribe a particular drug or order a particular test, again finds its mirror image in education, where a similar loss of autonomy has resulted in classic works of literature being jettisoned by book burning administrators, and replaced with teaching to standardized tests.

The grade inflation game that many teachers are forced to play can be no less soul-destroying, and undermines high school teachers and professors in many ways. Adjunct professors are easily fired at the drop of a hat should they receive negative evaluations from their students at the end of the semester, as the student is now regarded as a customer, and the professor as a disposable fool that has been hired to dumb down to the lowest possible level. How does one receive negative evaluations? Not giving enough A’s is indeed an excellent method of attaining such a result. This is not unlike a doctor receiving a negative online review for failing to prescribe opioids or antibiotics to a patient that simply doesn’t need it.

The brutality of neoliberalism cannot abide the altruistic. Capital is in the driver’s seat, and those who refuse to swear obedience at the Altar of Profit must be destroyed. Hence, gratuitous savagery and barbarism are unleashed on the kind, the generous, the merciful, and the idealistic. Public school teachers, professors, medical students, idealistic young doctors, nurses, social workers, and public defenders must be relentlessly tormented for their refusal to turn their backs on their fellow human beings. They must be punished without mercy for the crime of altruism.

As we have lost real communities in this country, and many Americans consequently identify with nothing other than their jobs, a career that does not come to fruition as it had when the New Deal was still in effect can be taken as incontrovertible proof that one is a failure, and this can have a devastating impact on one’s mind and spirit.

No amount of yoga, meditation, or Prozac is going to help a suffering resident or medical student. Only with a restoration of the humanities and solidarity will the soulful triumph over the soulless. And it is only then that compassion and empathy will triumph over alienation, hopelessness, and despair.

In “A Tragic Physician Story The Match Doesn’t Want You To Hear About”, published with KevinMD.com, an anonymous physician describes his first days of residency:

It did not take long for my excitement to wane. Within only a few days of starting my residency, I was called ‘retarded’ and referred to with homophobic slurs. Women were commonly referred to with misogynistic labels. I was given no organized instruction on how to perform my duties…. There came a time in which a patient of mine died as a result of a procedure I’d performed. I was told that I needed to lie to the risk managers and make it look like my supervising attending physician was in the room even though he was nowhere to be found, and while I personally didn’t do anything wrong, it would just look bad if I was unsupervised. It became clear that the people I was working for did not live in a world in which accountability existed.

Crushed under the iron heel of the new untrammeled barbarism, the dream of helping others can fade into the night. This inhumane treatment places both young doctors and their patients in extremely grave danger. Caught in the diabolical machinery of merciless plunder, a sleep-deprived resident may even accidentally kill a patient – a mistake they will likely never forgive themselves for.

David Penner has taught English and ESL within the City University of New York and at Fordham. His articles have appeared in Counterpunch, Dissident Voice, The Arizona Free Press, and Global Research. He can be reached at: penadam@hotmail.com. Read other articles by David.