RAMS SPECIAL FEATURE
SAEM PULSE | SEPTEMBER-OCTOBER 2022
Learners and Laborers: The Dual Nature of Resident Physicians and Their Impact on Our Workplace Rights
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By Ryan D. Pappal, MD, MSCI; Daniel Artiga, MD; Hamza Ijaz, MD; Daniel Jourdan, MD; Michael DeFilippo, DO; and Taylor Brown, MD, on behalf of the SAEM RAMS Resident Labor Task Force The structure of the United States medical residency system is somewhat of a marvel. Our residency matching process successfully distributes thousands of resident physicians into training programs across the entire spectrum of medical and surgical specialties each year. In emergency medicine (EM), where we match plays a definitive role in our trajectories as physicians — where we show up for our first shift, the patient populations we treat, the pathology we see, and who our coworkers (and eventual best
friends) are. Undoubtedly, our residency system plays a key role in ensuring our physician workforce is well-trained to tackle the substantial challenges that come with caring for upwards of 330 million Americans. Unfortunately, few systems implemented on such a massive scale turn out perfect. Resident physicians are beset by numerous challenges that cause stress during the most critical learning phase of our careers. Burnout is prevalent among EM resident physicians and
is associated with factors largely outside of our control, including lack of administrative and clinical autonomy1. Another challenge is debt. With a median burden of $212,000 per EM resident, our lingering education debt imposes persistent background stress and unduly influences life, career, and future employment decisions2. Prior to the COVID-19 pandemic, the emergency department was already considered a potentially dangerous work environment. A 2018 ACEP survey found that 47% of EM physicians