The Resident: Hollywood’s Latest Take on Graduate Medical Education

Last night, Fox’ new series, The Resident, debuted after the NFC Championship Game. The storyline is set in Atlanta’s Chastain Park Memorial Hospital and centers on third-year resident Conrad Hawkins’ interactions with his first-year protégés, surgery chief Randolph Bell and a support cast of nurses and hospital staff.

Per the show’s producers, “the plot centers on an idealistic young doctor who begins his first day under the supervision of a tough, brilliant senior resident who pulls the curtain back on all of the good and evil in modern day medicine. Lives may be saved or lost, but expectations will always be shattered.” In the opening scene of Episode One, Bell mistakenly severs an artery of a patient on the operating table, then orchestrates a cover up story with the surgical team the surgical team who agree the patient died of a heart attack. Like others in its genre, The Resident paints an unflattering view of life in medicine and chaos that’s normal in hospitals. Reviews have been mixed:

  • USA Today reported “Dr. Conrad Hawkins, The Resident of Fox's new medical drama, doesn't play by the rules. He's foul-mouthed, obnoxious, has no respect for authority but he gets results. We've seen him before…. Self-important, predictable and inconsistent…”
  • The San Francisco Chronicle described the series as a “melodrama at every opportunity, it explores interesting ethical issues arising from its fundamental premise that a medical institution’s concern for the bottom line sometimes takes priority over saving lives”.”
  • Forbes surmise was this: “It (the series) puts a new spin on the genre by painting veteran doctors as sleazy, power hungry people obsessed with the bottom line - a role usually reserved for hospital administration in this kind of show….While the pilot paints a picture of hospital life that would leave one truly frightened to seek medical care, the following episode does quick work to pull things back some so as not to throw a wrench into the idea of going in for treatment.”
  • Hollywood Reporter offered: “Fox's new medical drama goes from annoying to average, leaving stars like Matt Czuchry, Emily VanCamp and Bruce Greenwood deserving better..”
  • TV Line’s take was “With a strong cast and gripping storylines, The Resident brings a welcome hint of darkness to the hospital-show genre..”

Along with police drama, depictions of the healthcare system have been staple in prime-time TV fare for 70 years. Baby boomers grew up with Marcus Welby, Ben Casey, Medical Center, MASH and Dr. Kildare. Gen X watched St. Elsewhere, China Beach, Doogie Howser and Dr. Quinn. Gen Y got Chicago Hope, LA Crossing, Scrubs, House and others. A total of 58 primetime series have been offered the public dating to 1951’s City Hospital. Along with The Resident and last year’s The Good Doctor are the newest offerings.

Through the years, these series have reinforced themes widely held by the public: the fallibility of our caregivers, tension between administrators and clinicians, the complexity of high tech hospital care, patient dependence on their physicians and, in some cases, their victimization by the system. More recent series have tackled stickier issues, like access to insurance coverage, physician burnout, hospital closures, mental health, hospital consolidation and others.

What makes The Resident unique is its central focus on medical residency. Scriptwriters will, no doubt, dramatize the 80-hour work week requirement, low pay for residents, medical debt and clinical depression that’s impacts one in four. They’ll explore their social lives and adaptability as as 31,757 matriculants navigate the transition from med school to front-line medical care. But public policy about medical education and its paltry $10 billion in annual funding isn’t likely a storyline: that’s not pop culture fare.

The key takeaway from The Resident is this: the public’s view of how our system operates is largely the result of their personal experiences. The Resident is Hollywood’s take on graduate medical education: its powerful stereotypes are largely unflattering but people are watching.

Pop culture and social media play a large and growing role in how our system of care is perceived. The Resident is the latest effort to dramatize how we operate and where we fall short.

Paul

P.S. In the flurry of media coverage about the government shutdown, last Thursday’s headlines about the deal involving four not-for-profit health systems did not get the attention it deserved:

  • "Fed Up with Drug Companies, Hospitals Start their Own” New York Times Reed Abelson, Katie Thomas
  • “Hospitals Plan to Produce Generic Drugs in Bid to Fix Troubled Market” Wall Street Journal Melanie Evans

The significance of this venture to manufacture generic drugs goes beyond this project. These systems—Intermountain Healthcare, Ascension, SSM Health and Trinity Health—are betting their effort will create more competition in the generic market. I think this is only a start.

The Tax Cuts and Jobs Act’s corporate tax reduction is a boost to investor-owned hospitals profitability. It is disadvantageous to not for profit hospitals already facing increased uncompensated care as the ranks of the uninsured climbs. And on their competitive horizon are large-cap companies like Optum, Amazon, CVS and others not so inclined toward mission-driven purposes.

This venture is well-timed. Generic drug price escalation needed attention, but the potential that not-for-profit systems can harness their buying power and influence to redefine the future of the health system merits attention. These opportunities go well-beyond group purchasing and outsourcing: these are yesterday’s solutions. The future is about health and well-being, not just bricks and clicks. It’s no longer local; it’s regional, national and global. It’s not just about delivery; it’s about financing. It’s not just about services intermediated by third party payments; it’s retail, wellbeing and services that prevent and sustain healthiness.

Leadership by visionary not-for-profits like these can re-define how our system of health evolves.

Quote of the week:

“The health service’s problems—too many patients and not enough staff—aren’t seasonal. Britain’s population is growing older, and as medicine advances, treatments become more sophisticated and expensive….social care for the elderly and other groups hasn’t kept pace with what’s required, placing an added burden on more costly medical professionals. Fixing that kind of misallocation would improve the system’s value for money spent. The public’s devotion to the NHS’s underlying principle is undiminished: the British see healthcare as a right. Increasingly, though, they’re also demanding higher standards of care, and those come at a price. Taxpayers must dig deeper to maintain the current service—deeper still to improve it—or accept that the NHS will continue to disappoint.” Britain’s Unavoidable Health-Care Choice: Low Taxes or free, high quality medical services: The country has to pick one” The Economist January 15, 2018.