The Myth of Resident Replaceability

How residents have more power than they think and why using it can feel so scary.

As a medical resident, I often feel like I’m just another faceless cog in a massive machine, yet I’m constantly reminded that I’m an “essential worker.” The healthcare system and medical establishment work hard to balance these conflicting messages because both are necessary for the system to function as it exists today. But I can’t feel too important, or that would be dangerous, because I might start to realize just how valuable my labor actually is and start to think that I deserve better. At the same time, I must also feel replaceable, and like my work is needed, but someone else could step in just as easily. So if I want better pay, shorter hours, or more control over my schedule, too bad! Because someone else will always be there, eager to fill my place without complaint.

The threat of replacement, combined with the responsibility of being “essential,” creates the perfect cage. It convinces residents that we have no leverage, power, or choice. If we leave, we’re told someone else will fill our spot. If we complain, we’re ungrateful. And if we organize, we risk harming patients. 

But are residents even as replaceable as we’re told?

Attendings, PAs, NPs, and other clinicians could theoretically fill these roles, but how feasible is that? It would likely be far more expensive, since residents are notoriously underpaid, and logistically chaotic. Even if hospitals wanted to replace residents, their ability to do so is limited. They might draw from the pool of unmatched medical graduates, but outside the Match cycle, hiring new residents is slow and difficult. Residency is essentially the only job with a single hiring day each year. As restrictive and monopolistic as the Match system is, it also creates a unique form of collective leverage. It’s just a matter of actually using it. 

Residents spend years working toward a single goal, accumulating dizzying debt, sacrificing time with family and friends, and enduring a highly competitive training process to secure a residency position. Once we arrive, everything we’ve worked for feels precariously balanced on our ability to keep our heads down and survive. Speaking up can feel dangerous. We worry about retaliation, poor evaluations, damaged relationships with supervisors, lost fellowship opportunities, or being labeled as difficult. Even when those fears are never explicitly voiced, they linger in the background of every decision and action.

The irony is that medicine trains us to be fierce advocates for our patients while discouraging us from advocating for ourselves. Collective action asks residents to do something deeply uncomfortable, to stop surviving quietly and start challenging the conditions we’ve been taught to accept. It requires us to question institutions that hold tremendous influence over our careers and futures. To risk being seen as disruptive in a profession that rewards blind obedience. Most importantly, it requires us to confront the possibility that being a “good resident” and demanding better treatment are not mutually exclusive.

Guilt, duty, and fear continue to keep us in place. Every resident who has imagined calling out, organizing, or striking has probably had the same first thought, “What about the patients?” The moral weight of this question feels crushing, because despite the gruelling working conditions, most residents still genuinely care about the people they serve. That concern is often weaponized against us so that we’re made to feel personally responsible for every consequence of an understaffed and overburdened system, while the institutions that created the conditions get off free.

The responsibility for safe patient care ultimately lies with hospitals, accrediting bodies, and the systems that design residency training, not with individual residents already stretched to their limits. These institutions are responsible for creating conditions in which both patients and physicians can thrive. But they face little pressure to change because residents have no real option but to stay, and have historically lacked the collective power or willingness to challenge the status quo. And so the narrative persists: residency is temporary, so just endure it.

Each generation pushes through, assuming the next will fix it. Then residency ends, the first attending paycheck arrives, and the urgency fades. We stop looking back at the system that broke us because we’re finally free from it. Medicine glorifies suffering and calls it resilience. We’ve accepted the idea that temporary must mean brutal, and that success requires unnecessary suffering.

We’ve been taught to keep our ambitions small, to see the road to doctorhood as one straight and narrow path with no room for resistance. Our greatest limitation may not just be the structure of the system itself, but our own inability to imagine alternatives.

The reality is that residents hold more power than we’re led to believe. Being the backbone of the healthcare system creates exhausting working conditions, but it also creates leverage. The challenge is not whether residents have power. The challenge is whether we are willing to recognize it and overcome all of the fears we’ve been conditioned to have in order to finally utilize it. 

So what can we actually do? 

Perhaps the most important first step is cultivating greater solidarity among residents. Residents across the country, in unionized and non-unionized programs alike, will benefit from larger conversations about what residency could and should look like. We need networks that extend beyond individual programs, hospitals, and specialties. We need spaces where residents can share experiences, coordinate goals, exchange organizing strategies, and recognize that the frustrations they experience are not personal failures but structural problems. Isolation keeps residents compliant, while community creates the possibility of action.

National conversations alone, however, are unlikely to be enough. 

If residents truly want institutions to listen, they will likely need to exercise collective power in a way that cannot be ignored. Historically, labor movements have achieved meaningful change not just through discussion, but through largescale coordinated action. For residents, that may ultimately mean a national strike.

The idea feels almost unthinkable. The type of thought that gives you nervous jitters the moment it pops into your head. Many residents would experience intense guilt at the thought of stepping away from patient care, even temporarily. Others would fear retaliation or damage to their careers. Those fears are valid and worth considering, but it’s also worth asking, what are the consequences of doing nothing?

How many physicians will burn out, leave medicine, become depressed, delay starting families, or sacrifice their own health, all because we were too afraid to challenge a broken system? How many patients are already being cared for by exhausted trainees working under conditions that everyone knows are unsustainable?

Just imagine if every resident in New York State simply didn’t show up for work for a day, or even a week. More than 18,000 residency positions would suddenly require coverage, likely at dramatically higher cost. Hospitals would scramble to find replacements, and many simply couldn’t. The system would be forced to confront the truth that resident labor is indispensable. Would residents get fired? Maybe. But would that solve the underlying problem? Hospitals would still face thousands of vacancies with no practical mechanism to replace them. They cannot simply hire a new class of residents outside the Match, nor are there enough unmatched graduates waiting to step in. Now imagine this at a national scale. Hospitals and residents would find themselves in a stalemate—and for maybe the first time, residents would possess genuine bargaining power. But we also need to be a unified front, and know exactly what it is that we’re bargaining for, which is where the solidarity building and organizing come in. To maximize our effectiveness, we need to strategize and develop a plan, so that once the world is listening, we know exactly what we want to say. 

Sometimes the greatest moral injury is not challenging a dysfunctional system, but continuing to participate in one because we’ve been convinced that we have no alternative.

The suffering that medicine glorifies is not required for us to do our jobs well. Wanting humane hours, fair compensation, meaningful autonomy, and sustainable lives is not a weakness or a moral failing. It is reasonable. Caring for ourselves is not separate from caring for patients; it is part of it. Improving conditions for residents strengthens the entire healthcare system, and there is nothing selfish about that.

The question is no longer whether change is necessary. The question is whether residents are willing to act together to achieve it. We can continue accepting the story that we are powerless, replaceable, and lucky just to be here, or we can recognize what the healthcare system already knows: it depends on us.

And if it depends on us, then we have far more power than we’ve ever been taught to believe.