“We trained his father”: When lineage gives a few residents a special introduction

I know, I know. There was an entire storyline in Grey’s Anatomy about how the title character, Meredith Grey, was the daughter of a very prominent general surgeon (her mother!) in the program where she was starting as an intern. The chief of surgery would formally greet the other interns, then lean down and whisper in Meredith’s ear, “You are the splitting image of your mother.” Her co-resident, Christina Yang, was incensed about not having this same advantage: “My mother is not Alice Grey.”

It’s not some isolated incident relegated to the world of TV residencies, where everybody wears beautifully-fitted scrub pants that don’t fall off when you’re wearing too many pagers*. It’s real. There is privilege that comes from having the right “lineage,” when you have a parent who trained in the same program, or is well-respected leader in the field.

And let’s unpack that a little more– who was doing residencies back in the 60’s and 70’s? Generally men, overwhelmingly white men. It is even a plot point that Meredith’s mom was one of very few female surgical residents during the time of her training. And what does a physician parent confer to their children, other than sleepless nights with a pager and many missed childhood milestones (I’m guessing)? They are able to pass down keen insight into the medical school and residency admissions process that most other applicants do not have in their homes.

And so then, the privilege gets passed down to the next generation. I’m not saying that the children of these physicians are worse than their family reputation would suggest; they are often excellent.

What irks me is that we can’t even pretend that it’s an even playing field for the rest of us.

Let me give you an example from my residency. I trained in an institution in the northeast with a very famous reputation. It’s the kind of place where you walk down the halls and there’s portraits on the walls of people who have diseases named after them. The senior faculty are internationally well-known in the field; having a good word put in with them can be a serious leg up in the career game (i.e. opportunities to conduct research with them, introductions from them to other prominent department heads when looking for jobs, etc).

In our program, every year, after we find out which 4th year medical students have matched with us, our program director sends out an email to the entire department, including the senior faculty, with the names of each incoming resident. For each person, it includes their name and medical school.

But every now and then, one of these bright students will get a shout-out aside from the usual information; it will be intentionally noted if one of the incoming residents has a parent who graduated from our program. For example, “John Smith is the son of Abe Smith, MD, who graduated from our program in 1985 and is currently department chair at [insert esteemed institution].”

This is the only information that most of the faculty will receive about the incoming class. There is no counterbalancing information given about the other incoming residents, such as a mention of exceptional research or clinical work. There’s nothing which could give everyone else a memorable quality with which to create a positive first impression.

Having been through residency, it’s pretty clear that first impressions matter. I’ve seen first-hand what can happen when a resident makes a minor mistake that anyone else could’ve made, but has a poor reputation (whether warranted or not); this resident receives more criticism and the reputation then worsens. It’s not fair, but it’s the way it is. (To be fair, I think I benefited from the reputation game in a different way, having been a little older and more confident than my intern classmates, which then made me appear to have my stuff together more than I really did. I’ve seen both sides of this.)

Giving a wink and a nudge to the faculty about incoming residents with prominent family members only widens the divide.

Defiant Bitch, MD
*Re: the scrub pants: tell me I’m not the only one!!