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Some projections place the peak of Covid-19 infections in the U.S. between May and June. If it is still going strong at the end of June, it will collide with the start of a new year in teaching hospitals across the country: July 1 is traditionally the day that new doctors who had been medical students just a month or two earlier start work as doctors.

As of now, nearly 38,000 newly minted doctors will begin their first-year positions as residents at the beginning of July. Around the same time, doctors advancing to their second year of training will be switching hospitals, even states, as they advance in their chosen specialties. And in specialties like ours, internal medicine, those who have competed the third year of their residencies will be moving on to pursue careers or fellowship training at other hospitals.

The yearly influx of new doctors is called the July Effect because of the perception that there are more medical errors and surgical complications because of the presence of new doctors. While that has been both supported and disputed by studies, what is true is that there is an increased need for orientation and supervision of new trainees and hypervigilance by senior attending physicians to educate and prevent medical errors. July is traditionally a less busy time for hospitals, so interns and residents can be given the attention and training they deserve.

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Bringing new doctors into hospitals at the peak of Covid-19 is a bad idea. If a hospital is inundated with infected patients, who will have time to supervise and train doctors who are just starting out? And under shelter-in-place and social distancing orders, how will doctors who have finished their training leave and move to other posts across the country?

Serious thought must be given to hitting pause and pushing back the U.S. medical education timetable before it’s too late.

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In these unprecedented times, we urge the credentialing body of medicine, the Accreditation Council for Graduate Medical Education, to push the start of the medical academic year past the tail end of the epidemic’s peak. And if that decision is going to be made, it must be made now, before graduating medical students get caught in the mire of leases and moves across the country.

From a public health perspective, relocating thousands of new medical residents during a national state of emergency would be ill-advised as long social distancing and shelter in place are still important ways to contain Covid-19.

If medical students face delays in starting their residencies, they don’t have to sit out the crisis on the sidelines. Even now, medical students across the country are trying to help by providing child care and groceries to exhausted medical personnel. Students at Harvard Medical School are compiling a Covid-19 curriculum and infographics on the most up-to-date information. There are innumerable ways for graduating medical students to help besides through training.

The Covid-19 epidemic is forcing everyone to make hard choices. The delay in educating the new doctors of the future is not an easy decision ethically nor logistically. It would also be challenging to tell current residents to stay in place rather than progress in their careers. At this point, both possibilities have to be raised and seriously considered. Before it’s too late.

Martin Kaminski, M.D., is an internal medicine resident at Cambridge Health Alliance, a Harvard Medical School teaching hospital. Frances Ue, M.D., is the chief medical resident at Cambridge Health Alliance.

  • “If medical students face delays in starting their residencies…”
    It won’t be medical students, it will be new physicians. I agree that training everyone during the peak would be bad timing, but I like the idea of starting early for those who volunteer. That could help stagger the training load and fill the workforce need.
    Nicely written article, good luck out there!

  • I would suggest that the ACGME encourage residency complement increases in advanced programs (radiology, anesthesia, dermatology, etc.), as there are a lot of prelims that have not secured PGY-2 advanced residency positions, that can easily be retained by opening up a slot for them. Similarly, IMGs with experience should be absorbed as PGY-1s to assist with this emergency.

  • This is interesting since currently the LCME and AAMC is looking to graduate these students early to help. This is already being implemented in NYC with other schools to follow I’m sure

  • I see your point but what do Medical graduates do then? You want graduating physicians to grocery shop along with MS-1’s? Also, how do these graduates manage this logistically? We no longer will have loans to support us yet we also won’t have a salary we were expecting

  • You made a great point however, most hospitals are short of staff and bringing in new residents to help out would not be a bad idea. Desperate situation calls for desperate measure. Moreover there are many well trained doctors out there trying to get into the residency program. Bringing them on board would not be a bad idea at all. We need all the help we can at this time.

  • The development of drugs is more important to preserve the life. Because desease is several and make vitmes by died.

  • ThAnk You, where is the ACGME in addressing this issue for residents, and the LCME and COCA for medical students?

    • Dear Shawn,
      I don’t know where the ACGME is in addressing this issue for residents. I have not seen any guidance.
      Cheers,
      Frances

    • Dear Shawn,
      I don’t know where the ACGME is in addressing this issue. I have not seen any guidance.
      Cheers,
      Frances

  • And those who are finishing residency would then be expected to prolong their indentured servitude of 80 hour weeks and terrible pay? I don’t imagine anyone will be excited about that, so you’d just end up short workers if you didn’t bring in new people. Or should all the third (or final) year residents be promoted to attending salaries in their current institutions?

    • Dear Sara,
      You bring up excellent points. I don’t know the answers to these questions. How do we balance the need for an all hands on deck approach in this crisis with the equity and rights of all workers?
      Cheers,
      Frances

  • There are reports from Italy of medical students and others being trained being rushed into the action to cope with the situation. If the need for manpower is grave enough you may find yourself doing the opposite of delaying residencies.

    • Dear Eric,
      Totally agree. We have this window either to start medical students early and train them now, or delay. It is simply not reasonable to have their start time coincide with the peak of this crisis.
      Cheers,
      Frances

  • And how do we survive without that expected residency paycheck? Am I supposed to volunteer? How do I pay my student loans, because GOP is opposed to canceling student debt. How do I pay my rent, pay for groceries? No. That doesn’t make any sense. I’m a valuable member of the team and need to be trained.

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