Residentured Servitude: A New Definition (Prologue)
An old definition:
Indentured Servant: noun
1. American History: A person under contract to work for another person for a definite period of time, usually without pay but in exchange for free passage to a new country. During the seventeenth century, most of the white laborers in Maryland and Virginia came from England as indentured servants.
2. Contemporary Definition: A person who is bonded or contracted to work for another for a specified time, in exchange for learning a trade or for travel expenses (as to America)
3. See also: debt bondage, bonded labor, debt slavery
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A new definition:
Residentured Servant: noun
- A resident-physician under contract [a,b], reinforced by debt [a,b], to work for a specified period of time in exchange for passage through medical school and residency to an implied (but not assured [c]) land of prosperity, as an attending physician, under the auspice that the endpoint will, in addition to teaching a valuable skill, position the individual for debt repayment [d]
a. the debt and contract are often governed by rules that advantage the lending and employing institutions in manners that other citizens are protected against by law;
b. the person generally cannot exit the contract or debt without severe, detrimental repercussions to career and/or lifestyle (or is at least made to feel as such by either the lender, employer, or overall system);
c. the endpoint of prosperity or basic financial, job, wellness, or psychiatric security are constantly evolving secondary to forces external to the individual or the institutions (e.g. federal healthcare reform, reimbursement changes, maintenance of certification, litigation, specialty encroachment);
d. education in navigating changing aspects of healthcare are often neglected during the contracted job-training
i.e. The individual receives a loan in exchange for being taught to perform a task but not to optimize future payment for the task which hinders his/her ability to repay the loan. This neglect, deliberate or otherwise, prolongs the period of performance of the task to the benefit of the institution, lender, or system, further encumbering the individual.
2. See also: Reservant, The ResiDo, Student, Bambi, House Staff
Continue to Residentured Servitude: Too Many Hours, Too Little Pay, Too Much Debt, Too Few Options (Part I)
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Joshua J. Goldman, MD is a PGY-6 Plastic and Reconstructive Surgery Resident at the University of Nevada, Las Vegas School of Medicine and is Microsurgery Fellowship-bound. His professional interests outside PRS include healthcare advocacy, device innovation, digital marketing, ethics, medical education, and physician wellness. You can follow him on instagram at @GoldStandardPlasticSurgery. Thanks for reading!
The above represent my experience and viewpoints alone. They are not representative of my institution, program, or hospital. I have no conflicts of interest to disclose.
