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After the Match

After the Match: Where Do Residents Park in China?

Cook, Thomas MD

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doi: 10.1097/01.EEM.0000432262.26287.4c
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    ACT 1: I am in the curious position of writing this in an airplane over the North Pole. I am five hours into a 13-hour flight from Detroit to Beijing with my final destination being Chengdu, China. It's a place you have never heard of with 12 million people living in a huge metropolis with five beltways. (You think you've seen traffic? This city makes Atlanta look easy.)

    This is my third trip to work with the emergency department at West China Hospital in Chengdu. My hosts are some of the most gracious people I have ever met, and although it is one hell of a long way to China, and am blown away by what I see and experience. No place on earth has turned my head around the way this place does.

    The hospital is the largest in the world — 4,500 beds. It's basically a medical city that has risen out of nowhere. We were walking through the hospital park (yes, they have a park) on the last trip, and our guide pointed to one of the buildings, and proudly declared, “This is our first building!” It was typical of all the massive buildings surrounding us, with lots of glass and contemporary architecture. “When was it built?” we asked. “2006,” he said.

    It took 15 years to get the HVAC system at my ED fixed, but they built the world's biggest hospital in a fraction of that time. This hospital also has all the fancy machines and amenities that we see in any world-class medical facility.

    Medical education, however, is similar to the United States in the 1970s. Residents are housed in dormitories around the hospital complex where four men might share 800 square feet with no air conditioning. (Think “House of God” with really slow Internet service.)

    But there's good news! Resident parking is very easy. This is because none of the residents owns a car. In fact, they have never driven one. That's right. These highly educated folks in their late 20s and early 30s in the world's second largest economy cannot drive. Instead the residents park in a huge lot with thousands of — you guessed it — bicycles. Where in North America could you find this outside of Portland?

    Of course, the concept of “duty hours” is totally different there, as in, “It is your duty to work really long and hard when you are on duty, which is all the time.” The chief resident for the emergency medicine residency lives in the ED. She has a little room with a thin mattress (and no cable TV). She gets to go home one night each week to be with her husband. When she graduates from residency, she will make 20-30 percent of what we do.

    ACT 2: Let's play “Man on the Street.” It's like “Late Night with David Letterman” when someone on his staff approaches you in Central Park with a map of Europe, and asks you to pick out France or tell how many stripes are on the U.S. flag. Only now the question is: “If I offer you a job right now that will pay $50,000 per year for three years, and after this will pay you $250,000 annually, would you take it? There are very strict rules that do not allow you to be overworked, and you will make about $8 million after 30 years. And you can get a job in any city in the United States.”

    The obvious answer for most folks: “Where do I sign up?”

    ACT 3: It's that time of year again. Senior residents with dollar signs in their head try to not let on about how much moonlighting they're doing, and soon-to-be interns are trying to make a good impression on the staff while looking for a place to live in their new town. Meanwhile, the media cranks out stories about baby boomer tidal waves, the Affordable Care Act, overwhelmed emergency departments, health care worker burnout, and rampant prescription drug abuse with its nefarious drug seekers.

    What's a new intern to think? You are cast from “student” to “doctor” with the wave of a diploma from your medical school and a program director willing to put the local community at risk by signing the paperwork for your temporary state license. You feel as if all eyes are upon you (because they are), and you do your best not to show how nervous you are while struggling with learning EMRs that would confound all the boys at NASA during the Apollo missions. How to dictate a chart to finding the scrubs are all new things to learn that everyone else takes for granted.

    But these are just the first few steps of the incredible journey we call residency. You come into training as a pleasant, overachieving youngster, move on to being a sullen PGY2 resident reminiscent of the oppositional defiant teenager in the mental health pod, and then become the seemingly solid citizen ready to go forth and heal in your last year of training.

    But at some point in residency it's not about getting the test questions right but getting through the shift, the rotation, the year. Nearly all residents reach a point where they get tired and frustrated with the negative aspects of our profession. These brilliant young people eventually end up griping about how much work they are doing and how the job saps the energy that drove them into this profession in the first place. It becomes easy to get negative when the professional culture around you seems to thrive on it.


    Keep perspective during those tough times. You live in the most powerful country in the world during an incredible time of exploding interconnectivity. You are surrounded by talented and caring peers who want to thrive in life (not just in their bank account). You have faculty who will nurture you, care for you, and help you find the path to your definition of success. You not only drive but own a car, and you get to go home every day and sleep in your bed. The food is OK. The AC is really cold. You are forced into taking days off. You are in a really great place.

    Keep calm, carry on, and remember China.

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    About After the Match

    I present, with some anxiety, the first of what I hope will be entertaining and thought-provoking columns. I give my thanks to EMN for allowing me to share my thoughts on graduate medical education. There are a lot fantastic program directors out there with lots of great things to say, and I hope to collaborate with some of them in the future.

    In the meantime, I am sure my partners are rolling their collective eyes, hoping that I keep my proverbial foot out of my mouth and not get us all fired.

    Please share your thoughts with me about emergency medicine residency by writing to

    Thanks, Tom Cook

    © 2013 by Lippincott Williams & Wilkins