i really think all specialties in medicine need to allow for more flexibility in their hiring practices. residents are employees. why should medicine be so drastically different than other jobs in the world? i think, on the other hand, if medicine would take a look around at how people in other fields work, and make some changes accordingly, we would all stand to gain. for example, ceo's and managers could never act the way some surgeons do in operating rooms (selfish, arrogant, abusive towards others). it's simply not tolerated. yet somehow in medicine, a lot of the time surgeons are expected to be like this. i'm generalizing, but we've all heard of that stereotype, and most of us have met someone, maybe even not a surgeon, who fits it. my question is, how on earth do we allow it to be true so much of the time? it serves no one's best interest to allow such behavior--and yet we do...over and over.
the reason is that medicine lacks innovation in terms of management and human resources. we've pumped all of our efforts at innovation into technology, and have been left WAY behind most other fields in the way we approach management and the idea of professionalism. i was struck as a third year med student by how some residents, when brought together as a group, seemed to act like teenagers. attendings view them often as "kids" and at times refer to them as such. it's absurd. one of the reasons for this, however, is easy to see. when people are brought to the brink of their sanity and their mental health by being expected to work very long hours, you cannot reasonably expect them to exhibit many other professional traits. it's not realistic.
the problem the op faces is just an example of the larger problem of how medicine isn't changing fast enough to accomodate an equally changing workforce. residents don't live on the premises anymore, nor are they expected to spend an ungodly and unhealthy number of hours in the hospital. the 80-hour work-week is just one of the stipulations re. work hours to recently come about. and for goodness sake, it took a lawsuit from a patient's family to spawn it. following that, people had to lobby to defend the idea that--though we should know this to be true as people who have studied science--it isn't healthy to work more than 80 hours/week. hell, 80 hours is a long week. who thinks that's a good idea? moreover, who thinks that's the best idea? there's no excuse for not changing out of fear of managing patient needs if, in fact, you've never attempted innovative change in the first place (which is the excusethat most people used to buck the new 80 hours rules). it isn't easy, but there's truly no excuses in a changing world for staying the same. when are we going to wake up and learn to be more innovative?
really, i think the lack of innovation can be attributed to the fact that in the past especially (this is now changing little by little), people entering medicine were very young and had barely had a job before, let alone worked in any other field prior to their residencies. they had no idea how to manage people, and yet, given the sink or swim nature of residencies, were expected to become managers by second year when they were suddenly "seniors" over someone else. very few people are very good managers. management is a skill that is developed, just like our clinical skills. and i don't necessarily think you find it all that commonly in pd's simply by virtue of their postions. physicians have for a long time over-estimated their own abilities to deal with people well, whether as managers dealong with colleagues or as physicians dealing with patients. we stand to learn a lot in terms of improving our methods of communication when it comes to management.
to do this, people are going to have to let go of how things worked in the past and admit to the fact that as the world changes, markets change, needs change, and physician-training models need to change too. why would we stick to the same model for so long if there is evidence (e.g., more positons being offered and sought outside of the match) that things are changing? isn't that dense?
