COVID-19 Crisis Exposes Resident Abuse

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APRIL 28, 2020 — Janelle (not her real name) had just wheeled a patient into the recovery room at her Brooklyn, New York, hospital when an alarm sounded over the public address system. Another patient with COVID-19 was coding. The surgical resident rushed to the ICU to see if she could help, but all she had on was a mask, the same N95 respirator she had been using for days. She needed a gown, but the hospital had run out. Staff had resorted to wearing trash bags with holes cut out for their arms and heads. It was better than nothing. She spotted a roll, peeled one off, and began to yank it over her scrubs.

“Don’t wear that!” said a clerk, who was watching her fumble with the bag. “I have to,” she snapped. “We’re out of gowns.” But then she realized what he meant. Janelle was about to put on a body bag.

Even as residents are being lauded as heroes for their frontline work fighting COVID-19, they are also trainees who say they are being taken advantage of by hospitals in crisis mode.

In New York and New Jersey, where there have been more deaths than the rest of the United States combined, some residents are caring for COVID-19 patients with little to no supervision and minimal training.

“I had never touched a ventilator before this,” says one first-year resident in New Jersey. “I have no clue how to change the tubing if something goes wrong, and I have no idea where the attending is most of the time,” the resident says. “As an intern, I don’t have access to all the medicines, so I can be in situations where a patient’s blood pressure drops and I don’t have any means to treat them.” He has found himself looking after up to nine COVID-19 patients at once, more or less on his own. It’s terrifying and exhausting, he says, and he is not only worried about himself, but also about the compromised care for his patients. “I’m doing my best, but half the time I don’t know what I’m doing.”


His hospital is also running out of N95s, so he’s been reusing an ill-fitting N95 that makes his glasses fog up. The program coordinator that he would normally communicate concerns to isn’t working because the position is considered non-essential.

Medscape spoke with nearly 20 residents working on the front lines of the COVID-19 crisis and found that, while some academic hospitals are going above and beyond to protect their trainees, others have fallen short. Residents face massive workloads in normal circumstances. Now, particularly in COVID-19 hotspots, they’re overwhelmed and working longer hours for the same pay, often with inadequate personal protective equipment (PPE). They’re doing jobs outside their scope of work and facing burnout and emotional and physical fatigue. And they’re doing it all, in some cases, for little more than minimum wage.

“There is a very dark side to medical training,” says Rachel Hughes, MD, an emergency medicine physician in Madison, Wisconsin. “Medical trainees are vulnerable and, in most situations, they cannot say no.”

Trainees in Crisis

The current crisis has amplified all of the problems that residents faced previously, says Amy Plasencia, MD, chief medical resident at Brookdale University Hospital Medical Center in Brooklyn and executive vice president of the Committee of Interns and Residents, a union that represents more than 17,000 interns, residents, and fellows across the United States. Even during normal times, residents face grueling working conditions. But in the middle of the COVID-19 pandemic, the abuses have been egregious and, in some cases, life-threatening. Residents have been asked to take greater risks than their attending physicians. Some have been told to enter COVID-19 patient’s rooms with inadequate PPE.

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