Coronavirus: Residents being told to work in DIFFERENT specialty

[Mass Effect]

What gaps?

Thinking an intern can't prescribe, thinking an intern doesn't have a license, thinking an intern doesn't have an NPI, implying psych is like path in terms of intern year, implying OB is like path, implying general surgery is like path. All gaps, every one.

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[Giovanotto]

Thinking an intern can't prescribe, thinking an intern doesn't have a license, thinking an intern doesn't have an NPI, implying psych is like path in terms of intern year, implying OB is like path, implying general surgery is like path. All gaps, every one.

small detail I would have learned in the next 3-4 weeks, big woop. The rest, what? I never said anything about path. I stand corrected in what I said regarding those specialties and lack of prelim years.

If you want to call into question the preparedness of a 4th year medical students (that has been through standardized medical school training) about to start residency on their ability to help I'm going to go ahead and question the ability of a pgy1-2 psych intern (without standardized inpatient medicine training) to do the same.

 

[Crayola227]

Prescisely why they shouldn't be on rotations right now.

For all I said, not sure we should require their participation at this point. Just saying, I see no reason why graduates or med students wouldn't be useful. I leave it to those closer to the fight to determine at what point we do need them.

As for those in residency, worldwide pandemic seems like a teachable moment.

 

[Mad Jack]

For all I said, not sure we should require their participation at this point. Just saying, I see no reason why graduates or med students wouldn't be useful. I leave it to those closer to the fight to determine at what point we do need them.

As for those in residency, worldwide pandemic seems like a teachable moment.

I would prefer they stay home unless they volunteer to stay. If a student wants to stick around for a bunch of death that they're helpless to stop, they can absolutely be my guest.

 

[FlowRate]

small detail I would have learned in the next 3-4 weeks, big woop. The rest, what? I never said anything about path. I stand corrected in what I said regarding those specialties and lack of prelim years.

If you want to call into question the preparedness of a 4th year medical students (that has been through standardized medical school training) about to start residency on their ability to help I'm going to go ahead and question the ability of a pgy1-2 psych intern (without standardized inpatient medicine training) to do the same.

I'd certainly trust the average pgy1-2 psych resident more than a 4th year medical student. Most places you have at least 2 mo inpt medicine + 2 mo that are more variable (from ICU + Inpt Cards to outpt clinic.) Plus we often manage B+B complaints on the psych unit.

But now as a pgy4, I would definitely need to do a lot of refreshing before I'd be competent doing much independently with the average admitted medical patient. I would certainly do an adequate-or-better job functioning as an intern, however.

 

[AngryAsian]

And if a path resident can’t handle a week on the floor with a patient having respiratory ( hopefully stable ) issues then our medical training has failed us. I could bring a grad from Africa and he will deal with it. When I see statements like this, it shows why midlevels are pushing for autonomy. If you are a resident of any specialty and you can’t handle this crisis, it’s a big shame. You are not a doctor.

Medical students are not essential and frankly probably hamper the ability to take care of people if and when the admissions are high.
I don’t think they are going to have path or radiology residents intubate patients or frankly even work in the icu... but come on, surely they are capable and adaptable enough to do an H&P, PE and write orders( heck most emrs have orders sets that makes this even easier)... if they are not capable, then they are a waste of a Doctor. Better the residents/fellows that can be helpful in the icu are utilized there instead of Having to do non covid admissions of floor pts.
Many residents have had at least an intern year with a few months in the ED or IM...it should come back to them.

Though there are institutions that are having residents not see covid pts or potential covid pts.

Well, so much for respecting your colleagues in other specialties and their expertise. It's like a pathologist saying to a non-pathologist, "But you had Histology and/or a Pathology elective in medical school years or decades ago. You can't tell the difference between benign vs malignant just by looking at a slide under the microscope? What a waste."

I personally have no problem having pathology residents or pathologists helping out with patients during this pandemic. We can do the autopsies afterwards too. Continuity of care.... (but really, don't order COVID-19 autopsies).

 

[Mass Effect]

I'd certainly trust the average pgy1-2 psych resident more than a 4th year medical student. Most places you have at least 2 mo inpt medicine + 2 mo that are more variable (from ICU + Inpt Cards to outpt clinic.) Plus we often manage B+B complaints on the psych unit.

But now as a pgy4, I would definitely need to do a lot of refreshing before I'd be competent doing much independently with the average admitted medical patient. I would certainly do an adequate-or-better job functioning as an intern, however.

This.

How one could ever compare the knowledge base and ability of an MS 4 in March with an intern - of any specialty - in March is ridiculously laughable.

 

[rokshana]

Well, so much for respecting your colleagues in other specialties and their expertise. It's like a pathologist saying to a non-pathologist, "But you had Histology and/or a Pathology elective in medical school years or decades ago. You can't tell the difference between benign vs malignant just by looking at a slide under the microscope? What a waste."

I personally have no problem having pathology residents or pathologists helping out with patients during this pandemic. We can do the autopsies afterwards too. Continuity of care.... (but really, don't order COVID-19 autopsies).

Seriously? You want me ...and people to think that a pathology resident...an MD or DO is not capable of ...practicing medicine?
I get it that most pathologist are not “people persons”... but are you really trying to say that a 3rd or 4th year MEDICAL STUDENT is a better doctor than you?

Frankly I think I have more respect for your brethren than you do, since I think of called upon , they are capable of stepping up to the plate and can become an adequate clinician.
Wow...just wow.

 

[LucidSplash]

How is this thread still going?

 

[calvnandhobbs68]

How is this thread still going?

Bc some med student who hasn’t gotten slapped upside the head by intern year yet wants to act like he’s hot ****.

I vote we have him do what they just did to the 10K med students in Italy this week. Congratulations you’re an intern now! Rotations start tomorrow.

 

[rokshana]

Bc some med student who hasn’t gotten slapped upside the head by intern year yet wants to act like he’s hot ****.

I vote we have him do what they just did to the 10K med students in Italy this week. Congratulations you’re an intern now! Rotations start tomorrow.

WHAT?!
Where did you read this??

 

[calvnandhobbs68]

WHAT?!
Where did you read this??

Italy rushes new doctors into service as coronavirus deaths rise above 2,500

Italy will rush 10,000 student doctors into service, scrapping their final exams, in an effort to help the struggling health service cope with the coronavirus which claimed another 345 lives.

www.reuters.com

UK is thinking about doing the same thing

UK medical schools urged to fast-track final-year students to help fight coronavirus

Medical Schools Council says release of clinical teaching staff to NHS must not delay qualifications

www.theguardian.com

I say we volunteer our pal here to be first in line since he sounds like he's basically done intern year already. Congrats doc!

 

[Perrotfish]

Seriously? You want me ...and people to think that a pathology resident...an MD or DO is not capable of ...practicing medicine?
I get it that most pathologist are not “people persons”... but are you really trying to say that a 3rd or 4th year MEDICAL STUDENT is a better doctor than you?

I was more capable of doing most kinds of medicine immediately after graduation than now. If you asked me to manage a delivery or run an adult ward as a Pediatric focused MS4 I would have made it work. Don't get me wrong, it would be a cluster, but not a lot worse than the cluster that the average new medicine intern generates. Now my knowledge of adult specific pathology has been rusting for 7 years and I wouldn't have the slightest clue what to do with most non-Pediatric issues. Medical skills have a short shelf life.

 

[Crayola227]

I'm not sure that medical skills have that short a shelf life.

Here we are saying how useless and unknowing med students are, and yet interns get thrown into the deep end in their own specialty every year. If you can go from clueless med student to somewhat with it intern, and on to competent resident, I see no reason why you can't start over. You already know a TON of things the newly minted MS4 to intern just learned/doesn't know.

It really brings up the concern about supervision and how much efficiency you gain or lose having to teach. Residency 2.0 you could call it. To me that's more the rub here than whether or not we can adapt any individual MD to having a role in this, the issue isn't individual but systems. And the system is frakked rn. That means we need people yet at the same time it's a challenge to safely incorporate them.

Images of battlefield medicine comes to mind. You run out of hands just to give people their meds or assistance with changing dressings. If you have to extend manpower for a pandemic beyond what seems rational, who are you going to call in? Ffs I think veterinarians can help. Dentists. EMTs, anyone you can reasonably teach to help toilet people and suction secretions. When you run out of physicians, anyone that understands universal precautions seems like a reasonable first step.

Right now my state is calling on anyone with a license to do telehealth triage if they don't already have another role or are at high risk (over 60 and such). It's not hard to figure out if someone has a respiratory complaint.

 

[AngryAsian]

AngryAsian said:
Well, so much for respecting your colleagues in other specialties and their expertise. It's like a pathologist saying to a non-pathologist, "But you had Histology and/or a Pathology elective in medical school years or decades ago. You can't tell the difference between benign vs malignant just by looking at a slide under the microscope? What a waste."

I personally have no problem having pathology residents or pathologists helping out with patients during this pandemic. We can do the autopsies afterwards too. Continuity of care.... (but really, don't order COVID-19 autopsies).

Seriously? You want me ...and people to think that a pathology resident...an MD or DO is not capable of ...practicing medicine?
I get it that most pathologist are not “people persons”... but are you really trying to say that a 3rd or 4th year MEDICAL STUDENT is a better doctor than you?

Frankly I think I have more respect for your brethren than you do, since I think of called upon , they are capable of stepping up to the plate and can become an adequate clinician.
Wow...just wow.

Wow...just wow.

Seriously? What part of "I personally have no problem having pathology residents or pathologists helping out with patients during this pandemic" do you have a problem with? Where the hell do you get from my post that pathologists or pathology residents, MD or DO, are not capable of practicing medicine?! Where the hell did I write that medical students are better doctors than pathology residents and pathologists?!

I really hope you read more carefully at work than you do on this forum, for patients' sake.

We are all here to help patients, pathologists and non-pathologists. We all help in our own way.

We all passed the USMLEs and got our medical licenses, even though some of those freaking Steps are not too relevant for the daily practice of Pathology (BOARD HINT: Pathology is NEVER the first step in management.) . How about you go through a Pathology residency and fellowship and pass our boards. Then we'll talk.

Also, if you can't understand or take a joke about COVID-19 autopsies, well I really don't care. Just like I don't care about or need your respect.
I'm just glad I don't practice with you.

PS. This is the Lab calling Dr. rokshana. Your patients tested positive for COVID-19. Go manage it superstar.

 

[rokshana]

Wow...just wow.

Seriously? What part of "I personally have no problem having pathology residents or pathologists helping out with patients during this pandemic" do you have a problem with? Where the hell do you get from my post that pathologists or pathology residents, MD or DO, are not capable of practicing medicine?! Where the hell did I write that medical students are better doctors than pathology residents and pathologists?!

I really hope you read more carefully at work than you do on this forum, for patients' sake.

We are all here to help patients, pathologists and non-pathologists. We all help in our own way.

We all passed the USMLEs and got our medical licenses, even though some of those freaking Steps are not too relevant for the daily practice of Pathology (BOARD HINT: Pathology is NEVER the first step in management.) . How about you go through a Pathology residency and fellowship and pass our boards. Then we'll talk.

Also, if you can't understand or take a joke about COVID-19 autopsies, well I really don't care. Just like I don't care about or need your respect.
I'm just glad I don't practice with you.

PS. This is the Lab calling Dr. rokshana. Your patients tested positive for COVID-19. Go manage it superstar.

Dude...simmer down...

Smh

 

[AngryAsian]

Dude...simmer down...

Smh

I don't apologize for being passionate about patient care.

Good comeback though...

 

[Smurfette]

Keep things respectful please.

It's going to be all hands on deck and everyone will be out of their comfort zones.
Let's help each other instead of snapping at each other.
Remember that some of us will end up being patients needing care from our own colleagues.

 

[Apollyon]

Dude...simmer down...

Smh

When I said something similar, I got a PM stating "F*** off!" and, apparently, you can get away with that.

 

[VA Hopeful Dr]

When I said something similar, I got a PM stating "F*** off!" and, apparently, you can get away with that.

I think there's a report button even on PMs

 

[NITRAS]

As much as I’d like to get in on this discussion, I really think our limiting factor will be beds, vents, RN’s, and RTs rather than mostly mediciney qualified physicians.

I don’t think it would be hard for most physicians to perform a protocol driven medicine, but I’d be really surprised if we had psychiatrists doing this. More likely our surgical colleagues (who actually have to know a lot of medicine though many try to hide it) will be taking on more pure medicine as they will not be doing much elective surgery.

 

[Apollyon]

I think there's a report button even on PMs

I did that, and got bupkus.

 

[Mass Effect]

As much as I’d like to get in on this discussion, I really think our limiting factor will be beds, vents, RN’s, and RTs rather than mostly mediciney qualified physicians.

I don’t think it would be hard for most physicians to perform a protocol driven medicine, but I’d be really surprised if we had psychiatrists doing this. More likely our surgical colleagues (who actually have to know a lot of medicine though many try to hide it) will be taking on more pure medicine as they will not be doing much elective surgery.

In Italy, it was everyone. That's how bad the shortage of physicians was.

 

[VA Hopeful Dr]

I did that, and got bupkus.

Like you hit it and the report window didn't open?

 

[Apollyon]

Like you hit it and the report window didn't open?

No, I reported it, and I don't see any visible change. So, if ANYTHING was done, it is very mild, at the very most.

 

[VA Hopeful Dr]

No, I reported it, and I don't see any visible change. So, if ANYTHING was done, it is very mild, at the very most.

So you have no idea what was done other than no ban and no probation.

Seems fine to me.

 

[Apollyon]

So you have no idea what was done other than no ban and no probation.

Seems fine to me.

But, that seems like nothing was done, which strongly implies that what's good for the goose is good for the gander.

 

[VA Hopeful Dr]

But, that seems like nothing was done, which strongly implies that what's good for the goose is good for the gander.

Or they could have gotten a warning

 

[SunBakedTrash]

Could someone please extinguish this raging dumpster fire of a thread?

 

[Mass Effect]

But, that seems like nothing was done, which strongly implies that what's good for the goose is good for the gander.

Or they could have gotten a warning

I mean, there's a poster above who's threatening people. Let's triage the warnings.

 

[VA Hopeful Dr]

I mean, there's a poster above who's threatening people. Let's triage the warnings.

Funny thing is, it's the same poster who made an ass of himself defending Kobe Bryant in a thread that brought up that point that he's almost certainly a rapist and another where he argued that taking a long break between end of residency and first job didn't matter.

 

[Mass Effect]

Funny thing is, it's the same poster who made an ass of himself defending Kobe Bryant in a thread that brought up that point that he's almost certainly a rapist and another where he argued that taking a long break between end of residency and first job didn't matter.

Yes and if I recall correctly, in the latter thread, he asked someone to meet him in person and was called out on making a threat there too.

 

[Crayola227]

Back on topic, as I said, in my state they have appealed to every single licensed professional to volunteer.

Even if we run out of beds/vents etc, there is still seemingly endless demand for tele health services in this time.

I predict they'll be able to use everyone, even psychiatrists, in dealing with this virus, one way or the other.

Not to get into anything about Biden, but his website lists as one of his proposed strategies to call on all of the Medical Reserve Corp.

 

[ThoracicGuy]

Back on topic, as I said, in my state they have appealed to every single licensed professional to volunteer.

Even if we run out of beds/vents etc, there is still seemingly endless demand for tele health services in this time.

I predict they'll be able to use everyone, even psychiatrists, in dealing with this virus, one way or the other.

Not to get into anything about Biden, but his website lists as one of his proposed strategies to call on all of the Medical Reserve Corp.

Isn't calling on the medical reserve corps just pulling civilian doctors away from their own patients? It doesn't add to the doctor supply.

 

[LucidSplash]

Isn't calling on the medical reserve corps just pulling civilian doctors away from their own patients? It doesn't add to the doctor supply.

Texas has discussed calling up national guard but with exceptions for healthcare workers/grocery employees/other essentials.

I could see calling up the reserve medical Corp if it meant sending people from currently low levels of hospitalization/ICU needs to high levels. Redistribution of medical resources to hot spots. If necessary.

 

[braineddetermined]

Um...I can speak about the 10k Italian med students because I live here. They won’t work in the ICUs because bluntly put they don’t have the skills; they only know how to measure the pressure and saturation.

 

[Crayola227]

Isn't calling on the medical reserve corps just pulling civilian doctors away from their own patients? It doesn't add to the doctor supply.

The reserves include a vast swath of licensed healthcare workers such as mental health professionals, physicians, nurses, dentists, etc.

Many of these folks may be retired, employed in non-clinical (yet still licensed) or less needed positions, or part time.

Also, the medical reserve corps can include other volunteers and the unlicensed, depending on their experience and the need for them.

Basically it's a way to mobilize people who may not otherwise have a current niche but have some availability.

And we often forget the segment of providers in retirement, who might be appropriate to come out of it.

 

[ThoracicGuy]

The reserves include a vast swath of licensed healthcare workers such as mental health professionals, physicians, nurses, dentists, etc.

Many of these folks may be retired, employed in non-clinical (yet still licensed) or less needed positions, or part time.

Also, the medical reserve corps can include other volunteers and the unlicensed, depending on their experience and the need for them.

Basically it's a way to mobilize people who may not otherwise have a current niche but have some availability.

And we often forget the segment of providers in retirement, who might be appropriate to come out of it.

But they would need to be part of this reserve to be called. I suspect most of the people on their lists are active, practicing docs.

 

[Braveheart1985]

It is definitely necessary for all healthcare workers to serve the community as much as they could in this current circumstances.
I just hope that the medical residents in NYC are getting enough rest and some personal time as well so they can function properly. Otherwise, the work atmosphere would be abusive. If NYC hospitals are fully occupied, best next step is to transfer patients to the nearby cities or even states.
In Western New York, the situation in Buffalo, Rochester and Syracuse is not as bad as the NYC area. It would be definitely helpful to use the facilities over there too.

 

[Crayola227]

But they would need to be part of this reserve to be called. I suspect most of the people on their lists are active, practicing docs.

That's fair.

They're not military, when they are activated it's not like those enlisted have to drop what they're doing. They specifically tell people to follow the guidance of their current systems and healthcare officials. It more creates opportunity for those who have availability to be guided to where else they can contribute.

I don't know what proportion of professionals have availability or are retired. The retired physician population isn't exactly tiny though I don't know how it compares to the working population.

My point is more that there may be need for anyone with any healthcare experience (licensed or unlicensed) to contribute. Already anyone licensed in any field or retired have been called in my state. And I doubt Biden is the only one making noises about the MRC, which includes volunteers without specific licensing qualifications (case by case basis).

TLDR
Everyone, no matter their specific experience or qualifications, are being called up already to serve, depending on their location.

 

[chemsmith]

I think this thread has become overly focused on whether specific specialties/levels of training can competently provide care under the current pandemic scenario. The more pertinent question for some of us in residencies that do not manage inpatients regularly (i.e. radiation oncology, my specialty) is: can programs legally force us to suspend work towards our specialty-specific training requirements to staff inpatient floors? I don't want to do inpatient medicine, it's why I went into my field. There is nothing in my contract that specifies this shift in responsibilities so I don't imagine that any such mandate would be enforceable. Thoughts?

 

[calvnandhobbs68]

That's fair.

They're not military, when they are activated it's not like those enlisted have to drop what they're doing. They specifically tell people to follow the guidance of their current systems and healthcare officials. It more creates opportunity for those who have availability to be guided to where else they can contribute.

I don't know what proportion of professionals have availability or are retired. The retired physician population isn't exactly tiny though I don't know how it compares to the working population.

My point is more that there may be need for anyone with any healthcare experience (licensed or unlicensed) to contribute. Already anyone licensed in any field or retired have been called in my state. And I doubt Biden is the only one making noises about the MRC, which includes volunteers without specific licensing qualifications (case by case basis).

TLDR
Everyone, no matter their specific experience or qualifications, are being called up already to serve, depending on their location.

"To serve"

Oh you mean to go staff up private "non-profit" hospitals who I'm sure will be lobbying hard to get reimbursed for all COVID-19 related expenses by the federal government? With all the vent shortage crap being thrown around, I've already seen news articles about hospitals basically refusing to pay for new vents because they want to see if they need them or not first. And then all this junk about hospitals "barely operating at a profit"....idk the sub-VP of patient satisfaction seems to be doing pretty well for himself.

When I see the admins out there on the front lines with facemasks swabbing people or the hospital CEO donating his pay for the year to the cleaning people, I'll be volunteering my services. Otherwise I'll wait till they conscript me.

 

[calvnandhobbs68]

I think this thread has become overly focused on whether specific specialties/levels of training can competently provide care under the current pandemic scenario. The more pertinent question for some of us in residencies that do not manage inpatients regularly (i.e. radiation oncology, my specialty) is: can programs legally force us to suspend work towards our specialty-specific training requirements to staff inpatient floors? I don't want to do inpatient medicine, it's why I went into my field. There is nothing in my contract that specifies this shift in responsibilities so I don't imagine that any such mandate would be enforceable. Thoughts?

Look deep in your residency contract/handbook. There's likely a disaster policy that says that in the event of a "disaster" they can shift employees into different roles as needed. Of course this gives a lot of leeway as to what constitutes a "disaster" by the hospital and exactly how strained they need to be before they start moving residents into other roles. But it's most likely technically legal when it happens.

 

[rokshana]

I think this thread has become overly focused on whether specific specialties/levels of training can competently provide care under the current pandemic scenario. The more pertinent question for some of us in residencies that do not manage inpatients regularly (i.e. radiation oncology, my specialty) is: can programs legally force us to suspend work towards our specialty-specific training requirements to staff inpatient floors? I don't want to do inpatient medicine, it's why I went into my field. There is nothing in my contract that specifies this shift in responsibilities so I don't imagine that any such mandate would be enforceable. Thoughts?

In a declared state of emergency, they can do whatever is needed .

And remember, they can hurt you more...easily could be labeled unprofessional and your spot could be at stake.

 

[calvinhobbes]

Look deep in your residency contract/handbook. There's likely a disaster policy that says that in the event of a "disaster" they can shift employees into different roles as needed. Of course this gives a lot of leeway as to what constitutes a "disaster" by the hospital and exactly how strained they need to be before they start moving residents into other roles. But it's most likely technically legal when it happens.

Yeah, in NYC hospitals they (hospital leadership) have taken away (canceled) all resident and employee (nurse, tech, etc) vacations and leaves, saying we are all essential employees. So, no one has any vacation time coming up, its been rescinded.

And they (NYC programs / hospitals) are working with ACGME now to allow 4th year med students to start residency earlier, especially with all the travel restrictions and foreign grads may not even be able to start July 1.

"But if the number of cases continues to rise, it is possible that graduating students could start seeing patients — though not necessarily ones with the virus — even before their residencies are scheduled to begin in July.​

“It could be not even a week or two before we have to sweep away some of those restrictions,” Dr. Muller said."​

Coronavirus in N.Y.: ‘Deluge’ of Cases Begins Hitting Hospitals​

​

Also, many states now are suspending restrictions (ie months of paperwork) on obtaining a state license, and are speeding up the process so docs and other allied professions can start working quicker and be licensed (florida, west virginia, etc)

 

[calvinhobbes]

In a declared state of emergency, they can do whatever is needed .

Yup. ACGME pretty much has said "up to the program director" aka, up to the hospital leadership to make decisions on how to mobilize workflow. ACGME duty hours remain in effect, but in reality, no one will be penalized.

 

[chemsmith]

Look deep in your residency contract/handbook. There's likely a disaster policy that says that in the event of a "disaster" they can shift employees into different roles as needed. Of course this gives a lot of leeway as to what constitutes a "disaster" by the hospital and exactly how strained they need to be before they start moving residents into other roles. But it's most likely technically legal when it happens.

I already examined our disaster policy; it covers protocol for training interruptions caused by natural disasters but contains no provisions for a shift in roles. Maybe oversight on their part in crafting the policy as we have not seen something of this magnitude in modern history.

 

[chemsmith]

In a declared state of emergency, they can do whatever is needed .

This is what I am questioning; can they really? Do they actually have that power?

 

[calvinhobbes]

This is what I am questioning; can they really? Do they actually have that power?

Yes, that is also my understanding. You're an "essential employee" and you work for a hospital that has a state license and gets CMS funding, and there'a state and national emergency, so technically, you do what you're told (w/ respect to safety, etc).

 

[Mass Effect]

can programs legally force us to suspend work towards our specialty-specific training requirements to staff inpatient floors? I don't want to do inpatient medicine, it's why I went into my field. There is nothing in my contract that specifies this shift in responsibilities so I don't imagine that any such mandate would be enforceable. Thoughts?

None of us want to do inpatient medicine. I have yet to meet anyone besides IM docs (and sometimes not even them) who want to do inpatient medicine. But in a national emergency, there is no want. Our IM colleagues will be needed in the ED and the ICU and they'll be overworked and flooded with patients. We have to help, the same way we would want help if our specialty suddenly dealt with some emergency. Even if there is no legal way for them to force you to do it, to challenge your program on this will likely result in problems between you and them for the duration of your residency.

That said, if you have some health concern for yourself or your spouse or kids, you may be able to find a way around it if you're so inclined. I know a resident who's a single mom who cares for her elderly mother and her daughter with asthma. She will be among the very last called to help, if at all, unless she can find alternative living arrangements for herself and insure her mother and daughter can get along without her.