Health Matters: Get a Life, Doc

There's an e-mail making the rounds with a job description attached. If you apply, be warned: you will be burdened with "challenging" tasks "in an often chaotic environment" with "variable hours, which will include evenings and weekends and frequent 24-hour shifts on call." You must be "willing to be hated, at least temporarily." Oh, and you'd better love kids, because that's who you'll be working with all day. The job, of course, is "parent"—but it might as well be "pediatrician," which requires a lot of the same skills and then some. That's why lately I've been feeling sorry for pediatrics residents. They're often too busy wiping the noses and taking the temperatures of other people's kids to do likewise for their own.

Training to be a pediatrician—or any other kind of doctor—isn't much fun. The hours are awful. The pay, in some programs, works out per hour to little more than minimum wage. Granted, things could be worse: residents are called "residents" because until the 1950s or so, they lived at the hospital. Their lives now are closer to normal, but a big problem remains: the residency begins around age 26, overlapping exactly with the prime years for bearing and raising children. "We're asking people to do this training right at the time they would normally be starting families," says Ted Sectish, codirector of the combined pediatrics residency at Children's Hospital Boston and Boston Medical Center. "There is an intense commitment to them being well trained—but there also has to be a commitment to them having a life."

Sectish's solution is a part-time pediatrics residency. Children's isn't the only hospital in the country that offers the option—about 25 percent of programs nationwide do—but, with much of medicine still ruled by a masochistic, show-no-weakness mentality, it's one of a precious few where residents choose that track. Take Susan Clinton Martin, who realized during her first year at Children's that her new job left her no time to raise two kids under age 4. "I was leaving before they woke up and coming home after they went to bed, and I was on call every fourth night," she says. "I went into pediatrics because I love children, but I wasn't able to give my own children the time they deserved." Instead of quitting, she went part-time. Now in her final year, she tells the directors she is "their happiest resident."

The part-time track in Boston may well turn out doctors who aren't just happier, but better at providing care. Stories of overworked, sleep-deprived doctors unwittingly making mistakes are legion. Part-time residents certainly get more chances to rest. They may avoid another pitfall: depression, which afflicted 20 percent of pediatrics residents in a recent study coauthored by Sectish—and which can increase the chance of medical errors sixfold.

Given the data—and the fact that 17 percent of pediatricians eventually take on part-time practices—pediatrics residents ought to be clamoring for reduced schedules. Yet the part-time residency remains an extreme rarity. Of the 10,000 "peds" residents in the United States, a mere 10 are part-time, and half of those are at Children's. Why so few? Maybe the other 9,990 are handling their full-time jobs fine; maybe they just want to get their residencies over with quickly. But I suspect they also feel pressure to prove themselves by toughing things out. "What you hear in medical school is, 'Don't ask for anything special'," says Bob Vinci, codirector of the Boston residency program. Too many doctors seem to think there's something noble about working themselves to the bone. When it hurts small people in their care, there's nothing noble about it.