Grave Concerns

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I think that a student's input is appropriate here. If I am wrong, I am
sorry.

In a year, I will enter a residency program. If all goes well, it will be a
surgical residency with a significant trauma component. As many of you can
imagine, the decision last week has been received with some enthusiasm by my
classmates; 'Finally,' the consensus seems to be, 'we can have a life.'

By the end of my residency and possible fellowship, I will have been in
school for twenty-five years. I cannot accept the opinion that medicine is
just a job; I refuse to accept that I will be training for most of my life
to work a set number of hours and leave my occupation at home. Medicine
cannot be part of a doctor's life; instead, it is part of a doctor's
identity.

Everything about me is changing because of my chosen profession: the way I
think, the way I live, even the way that I interact with other people. The
depth of habit and thought required by medicine is such that I believe it is
impossible to *work* as a doctor; rather, one *is* a doctor. To expect the
former is to expect a priest to leave his faith at the pulpit every day.

The changes declared last week are based precisely on this mistaken premise.
Do I look forward to exhaustion during the next five years? Of course not.
My learning and my skill are compromised by being pushed beyond my limits.
But the chain of command and the supervision within are designed precisely
to extend those limits without harming the patient. And while I do not
relish the thought of being worked to ennervation, I eagerly anticipate the
day when I can be called on in difficult circumstances.

With this in mind, then, I am aggrieved to learn of the ACGME's policy
statement. My training will probably suffer for it. I will still be a
physician and a surgeon - but I will have greater doubts as to my
capabilities as such. No hours outside of the hospital can make up for that.

Rishi Kundi
MS-4
Michigan State University.

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