“There is a definite hierarchy in residency programs, and the more you suffer, the higher you stand.” A ‘diary’ entry by a graduating medical resident:

Residency is generally considered an unpleasant time of life, but there are varying degrees of unpleasantness, depending on the specialty you’ve chosen and where you do your training. There are “cush” programs where call is once a week, from home, even for surgeons, and there are “malignant” programs, where call is every other night for the interns and you never sleep and you are treated like dirt. In New York City, the programs have had to go a little easier on the residents since the famous Libby Zion case, where a young girl died. It was a complicated case, and whether or not the fatigue of the resident caring for the patient contributed to her death is still controversial. Nevertheless, it did call attention to the long hours residents work. New York passed a law limiting residents’ work hours, and recently an advisory committee to the American Medical Association recommended revising resident work schedules to shifts of no more than 12 hours straight. This would be a radical change. The word “resident” comes from the fact that medical trainees used to actually live in the hospital. For years, the misery of residency was perpetuated, whether because of tradition — ”the old “I suffered, you should suffer, too” philosophy — ”or, as some people say, because it allows for the most amount of training in the least amount of time. Slate

And let’s not forget perhaps the strongest incentive for the ‘training’ system — that it gives the lucky teaching hospitals the most work possible from the cheapest pool of physician labor. It has often been said that medical training does not prepare emerging doctors for the economic realities of modern healthcare. To consider the issue, as this graduating resident does, only from the perspectives of ‘tradition’ or ‘training needs’ is a graphic illustration of the ways in which alienated labor doesn’t even see that it is alienated!