June 24, 2025. By Dalia Namak.
Imagine you are on your 24th waking hour at work. You’ve worked for 56 hours this week and its only Thursday. You barely sleep through the week because any shut-eye you receive is interrupted by panic and a rushed need to make a life-or-death decision for someone in your care. After only one day off in seven days, life hits the replay button. This is the reality of resident training physicians in our country today. As this demonstrates, we have a system of chronic overwork and inefficient rest for residents. Steps must be taken to allow them to properly recover and show up well to work.
It is understood that lack of sleep is equivalent to drunkenness. CDC reports that “being awake for 24 hours is similar to having a blood alcohol concentration of 0.10% (above the U.S. drunk driving level of 0.08).”[1] This means that our physicians are currently making medical health decisions at times where they would not be legally entrusted to drive a car. But the reality can be starker. Residents are understood to underreport their working hours, drawing towards 120-hour weeks, expected to be fully functional and alert at every moment, swallow any weakness, and do it with a positive attitude because at every moment they are being evaluated and competing with their peers. This is the inherited residency training schedule and culture that permeates our healthcare system today.
How did we get here? The modern North American resident training schedule was widely adopted after its creation by Dr. William Stewart Halsted near the turn of the 20th century.[2] We now understand that its hierarchical structure that demands so much from those in training (such as sacrifice of sleep, and expectations to be near perfect) which thus shifts responsibility away from attending physicians could have served as a lucrative cover up for Dr. Halsted to conceal his addiction to cocaine and morphine.[3] Why would we support a training system when we understand its creation involved unethical origins? Unfortunately, for all residents thereafter, the training schedule caught on.
What happens if we keep the status quo? Dr. Will West’s story paints the unacceptably devastating picture if we remain in our path. Last year Dr. Will West was a third-year ophthalmology surgical resident at George Washington University (GW) known for his tenacity when faced with challenges, and nicknamed “Iron Will.” Despite his character, “Will talked to his brother about how his problems felt too big to solve: He was not getting the training he needed to prepare him to practice medicine. He was not getting enough time to sleep or recharge after long shifts. Happiness, he felt, would elude him always.”[4]
On March 1, 2024, Will took his own life.[5]
His family reflect on the warning signs they didn’t act upon, and the feelings Will had while in training. While at GW his family recalled that his mental health took a “significant downturn,” and remembered Will asking, “Do people think I’m lazy? Will I be able to compete for the jobs I want? Will I be competent if hired? Will I be able to treat patients safely on my own?”
The reality is that students pursuing medicine have everything tracked in their record, and any indication that they may be unwell is a few steps up for their competition. Seeking help for mental health is a fear many students hold and prevents action. What values are we upholding societally if our own physicians are afraid to get the care that they need and deserve?
In his last note, Will says, “To those who will be negatively affected by my actions, I’m so sorry. I have simply run out of gas and have nothing left to give.
To those in a position of authority over residents, a simple reminder that we come to you seeking the possibility of a better life. Some of us with challenges you do not see or backgrounds of which you are not aware. … I hope that an effort can be made to understand, support, and mentor the residents rather than simply to assess and drive them toward their highest potential as doctors.
To be clear, there are other people at real risk here.”
We forget that our healers are human too. Dr. West’s story provides a stark awakening for us to transform our medical training system from one of crippling competition and exhaustion to embracing a methodology that respects the necessary length of seeing a patient through illness for holistic learning, supporting physician training through humane work hours and recovery time, and allowing for our physicians to live fulfilling lives.
Four hundred physician suicides a year is unacceptable.[6] Any suicide statistic is unacceptable. It is time for us to act and recreate our medical training system to support our residents as humans too.
To change this culture, I urge the following call to action:
- The Accreditation Council for Graduate Medical Education (ACGME) lead the medical education effort to evaluate residency training hours and requirements for all specialties within one year
- Revise curricula to adapt training to omit unnecessary responsibilities and adjust/reform core competencies as necessary. Adjust standards to align accordingly
- Adapt hospital operations and policies to match new reform
Hospital Administrators can provide the following benefits to their residents today, while moving to amend working schedules to support physician wellness confirmed by honest reporting:
- Provide residents with comped meals or meal stipends while on duty: While already overstretched at work, providing meals to residents is one less stressor for them, actively supporting their physical and mental wellbeing through nutritious meals. Example residency programs that employ this include
- Memorial Hospital’s Family Medicine program that even go to the extent of providing on-call residents’ families with food from the hospital cafeteria without charge
- University of Pittsburgh’s Internal Medicine program that provides $750 bi-annual meal stipend to cover meal costs during overnight shifts or working through lunchtime conferences
- MayoClinic that provide “meal subsidy for on-call residents”
- Building a dedicated space for physicians: Lounge spaces built intentionally for physicians are simple and cost-effective for driving connection between colleagues and battling burnout.
- Provide access to mental health resources openly
- Change culture by normalizing mental health conversations to combat stigma
- Adjust admission standards to eliminate mental health occurrences as negative for candidate consideration
Dalia Namak, MBA
2024-25 NC Schweitzer Fellow
UNC Kenan-Flagler Business School, Class of 2025
[1] https://archive.cdc.gov/www_cdc_gov/niosh/emres/longhourstraining/impaired.html
[2] https://pmc.ncbi.nlm.nih.gov/articles/PMC7828946/
[3] Ibid.
[4] https://www.washingtonpost.com/dc-md-va/2024/10/03/will-west-doctor-gwu-suicide-note-mental-health/
[5] https://gwhatchet.com/2024/03/25/death-of-gw-hospital-resident-sparks-calls-for-improved-workplace-culture/
[6] https://www.acep.org/life-as-a-physician/wellness/wellness/wellness-week-articles/physician-suicide