Michelle Au, a former anesthesiology resident at Columbia University Medical Center, once breast-pumped in a vacant women’s locker room shower stall while eating a raw “hot pocket” (or, appropriately re-named, “cold pocket”). Afraid to seem “weak” as female resident with an infant at home, she refused to ask for an additional five minutes to her allotted 30 minute lunch break, in order to compensate for the line at the lounge’s sole microwave and to accommodate the need to empty her bladder. After all, doing so, she feared, could incur resentment for her “playing the baby card.” This story comes from her 2011 autobiography, This Won’t Hurt a Bit (And Other White Lies), a vivid memoir of her development from medical student to pediatric intern to anesthesia resident to anesthesiologist.
Regrettably, it’s believable, even today. Particularly during professional transitions, she is sometimes figuratively “thrown to the wolves,” but she lands on her feet thanks to the right combination of professional mentorship, familial support and personal resilience.
Personal sacrifice is necessary in order for physicians to put their patients first, and that’s a good thing. No medical student, resident or junior group member expects his or her life as a doctor to be a cakewalk. Let’s face it: being an anesthesiologist is no joke—it’s serious work that is intellectually, emotionally and physically challenging. But cruelty to the young members of our profession need not be an inevitable part of the process. It’s a dirty little secret in health care—in anesthesiology too—that doctors sometimes “eat their young.” This practice strikes at the core of our profession’s ideals. I for one am proud of our profession’s history of ethical and selfless patient care, but maybe it’s time to treat our “own” with the same compassion. Students are entering the profession during a time of unprecedented change in health care delivery, and they need support during this crossroads in our specialty. Their success is our future, and we can—and should—aim to improve the experience junior anesthesiologists have during their formative years of training and practice.
The time medical students spend in the operating room is a critical opportunity for us to serve as diplomats of our field. We can choose to represent anesthesiology by shuffling a student around the operating rooms in search of an I.V. or intubation, or we can carry him or her under our wing, representing our role as the keepers of the “surgical home.” Ensuring a supportive work environment sends the message that students are welcome in our profession and that there will be a place for them to thrive intellectually and professionally.
When we deliver caring, comprehensive peri-operative care and expose them to the breadth of our practice, we set an example that could permanently positively impact their view of the profession. And when we prioritize mentorship, we will subsequently recruit the strongest students into our field, an outcome which benefits us all.
And for our residents, the true ambassadors to the specialty, success depends also on their personal engagement in the field. Educating them to be the strongest clinicians and researchers is a small part of the task at hand. Residents need a chance to fully participate in professional societies, the opportunity to get to know a diverse set of mentors, the time to achieve personal goals and the chance to learn how to navigate inevitable pitfalls in their careers. Some will struggle academically or personally to meet the demands of their new job; they deserve our extra attention. If we treat a vulnerable resident with compassion—by giving one an extra few minutes to breast-feed, for example—we will have invested in that resident’s future. I believe kindness, support and meaningful mentorship, pay dividends to our field over time.
But the task doesn’t fall solely on the shoulders of academic physicians. Few transitions are as formative in the life of a young physician as the transition from residency into practice, or even the transition between practices themselves. Most practices behave ethically and even kindly towards the “young,” encouraging applicants' interest in their groups, respecting employment law during interviews and recruitment, displaying reasonable transparency in contracts, minimizing bullying and offering careful mentorship towards success. This behavior is admirable and reflects positively on our profession.
Each anesthesiologist has the opportunity to make a difference in the future of our profession by nurturing, not “eating,” the young. The newest and most vulnerable members of our profession are also our most precious resources, for the future of our specialty lies in these physicians’ hands. Mentoring a young anesthesiologist to professional actualization means putting money in a “401(K)” to our field’s future.
It may not only be morally laudable behavior, but will probably be economically fruitful in the long run. I am certain our profession’s compassion knows few bounds. Extend it to our medical students, residents, and junior colleagues—and we all win.