Who Does What … and Where? Perceptions of Resident Physicians in Periphery Hospitals about the Contents of Their Residency Program and Their Implications

Residency, the period of graduate medical training, is a professional formation stage during which the young physician performs supervised work in a clinical setting. This period may extend to several years, exposing the trainee to a profession-stipulated curricula while performing a specified type and number of procedures. Upon its successful completion, the physician is identified as a specialist in a clinical area, and is licensed to perform autonomously. At the formal level, specialisation acquired during residency is not necessarily validated internationally, rising questions regarding the universalism of medical training, and affecting the occupational trajectories of physicians. Can this universalism be questioned also at the national level? Based on a qualitative study including face-to-face, in-depth interviews with 54 residents in non-central hospitals in Israel, the perceptions of what accounts for a residency program and its implications were analysed. Residency was interpreted as a "hard-working phase", a period in which young physicians described themselves as "merely a pair of hands" in understaffed departments. Constantly comparing themselves to their colleagues in central, advantaged catchment-areas hospitals, physicians in periphery hospitals yearned professional-learning opportunities (such as protected "library time" and "interesting cases") as well as (greater) availability of diagnostic and treatment technologies. Concurrently, study participants stated that seemingly professional disadvantages such as lack of equipment and staff, as well as complex patients' case-mix, offer them the opportunity to "practice hands-on, real medicine" much earlier than their colleagues in advantaged settings. In conclusion, differentials in residency programs question the universalism of medical training at the national level, especially due to system and organization constrains that shape the contents and structure of the residencies. Differences among these programs might track physicians to specific practices, thus functioning as a stratifying mechanism of physicians also in a specific country.