As the escalating Covid-19 pandemic puts increasing pressure on health systems, a shortage of medical personnel has hospitals looking toward unconventional sources to fill the gap. Some are bringing in retired physicians. Others are turning to medical students.
The New York University Grossman School of Medicine recently offered fourth-year medical students the option to graduate early to immediately join the health care workforce on temporary contracts. Other schools have followed suit, including the rest of the New York City schools, all of the Massachusetts programs, and others across the country.
Recruiting fourth-year medical students to work in hospitals hard hit by Covid-19 may be necessary. Nevertheless, it’s troubling that students who don’t yet have the skills or experience to thrive in the hospital environment are being moved to the frontlines at the peak of a pandemic instead of in July, when the first wave will have crested across most, if not all, of the United States. Working in a hospital today invites significant personal risk: Health care workers have been identified as a high-risk group for severe Covid-19 infection.
It is true that there is a degree of risk inherent to the practice of medicine. I am currently being treated for a latent tuberculosis infection I picked up during clinical volunteering. Collective experiences among colleagues and mentors include needlestick injuries, being sprayed with every bodily fluid imaginable, as well as exposures to infections like meningococcal meningitis. These risks are known and understood. We accept them because they are meant to be calculated, and we expect to be given the resources to mitigate them.
But this is not the experience of health care workers on the front lines of this pandemic. The well-documented scarcity of personal protective equipment calls into question if students entering the workforce will be adequately protected. As hospital stockpiles dwindle, there are reports of health care workers having to reuse masks for extended periods of time and making their own protective gear, if garbage bags count as such.
Health care workers are being censured or fired for speaking up about the dearth of protective equipment. Standing at the bottom of a firmly entrenched medical hierarchy, it is difficult to see medical students feeling comfortable about advocating for themselves if they feel unsafe while providing care. In a survey of medical trainees during the Covid-19 pandemic, a student noted that, “It was challenging to ask myself how important it is to protect myself. How important am I in the medical team? Should I let others use resources such as masks and use less for myself?”
If students don’t speak up for themselves, who will?
If the way residents are being treated is any indication, there is serious reason to be concerned about the well-being of new medical school graduates. Some residents report that they are expected to bear increased risk of exposure while their attendings have the option to cover non-Covid services. Residents raising concerns about inadequate personal protective equipment have been silenced. Many are working well over their duty hour limits without overtime or hazard pay, some having been redeployed to services outside of the scope of their training.
If medical students are called to combat Covid-19 in hospitals, protecting them needs to be a priority. This means any such calls to action need to be voluntary, and the graduates should be provided with full employee benefits — including health insurance — and guaranteed access to appropriate personal protective equipment. They should not be made to work in roles they are not trained to do. And trainee work hour limits, which are set at an average of 80 hours per week over four weeks by the Accreditation Council for Graduate Medical Education, need to be protected.
States have called on medical students to volunteer without compensation. Some institutions are also doing this. The Albert Einstein College of Medicine, for instance, offered students the opportunity to volunteer as interns. Students who elected to do that would not graduate early or receive compensation for their work. There is no indication that their tuition will be prorated or refunded. At the Heritage College of Osteopathic Medicine in Ohio, third-year medical students have a mandatory four-week rotation to assist in the Covid-19 public health response, some of whom will be working in health care facilities.
The culture of medicine is built on sacrifice. That attitude begins percolating when the idea of becoming a doctor takes root and continues throughout medical training, to the tune of years of our lives, hundreds of thousands of dollars, and a significant toll on physical or mental health. Putting the needs of others ahead of our own is deeply conditioned. During my first two years of medical school, my concerns during clinical experiences revolved around avoiding being a nuisance and finding ways to be useful. Thoughts of my own comfort and safety fell far down my list of priorities.
This is a common mentality among students. And it can be dangerous, especially during a pandemic. We train to look out for others and frequently forget to look out for ourselves.
Many students feel moved to action by the desperate need of the communities that we swore to serve. Treating trainees as free labor is taking advantage of that eagerness to help. It is not an exaggeration to say that trainees who are volunteering or working in hospitals right now are risking their lives. They need to be given the support commensurate to that risk.
Anna Goshua is a second-year student at Stanford University School of Medicine.