Resident Stress

Sir.—Hoekelman¹ recently identified factors that lead to stress during residency training. He claimed that causes of stress go beyond long work hours and the severely ill population for whom residents care, and stated that the stress to which residents are exposed is accentuated by the uncertainty of their futures once training is completed.

Hoekelman suggested many changes that residency programs can adopt to reduce the stressors that are inherent in the present system. However, significant changes in residency training will not be implemented until members of the medical faculty begin to understand the transformations that have begun to take place in the provision of health care. These have occurred as a result of the corporate restructuring of health care systems. Since the rise of what Relman² terms the medical-industrial complex, hospitals are often managed by business executives rather than the traditional physician administrator who once managed residency training and