Dr. Danielle Rivera cherishes the “moments of joy” in her work — seeing her patients’ symptoms improve.
Born and raised in Albuquerque, she is now in her fourth year of training as a psychiatry resident, specializing in child and adolescent psychiatry at University of New Mexico Hospital.
Rivera’s workdays average nine to 10 hours — something she said “most other doctors are very, very jealous of,” as they work even longer shifts. She usually gets one day off each week.
Medical residents like Rivera are doctors who provide care to patients under the supervision of an attending physician. They’re getting hands-on training near the end of their medical education, though many also choose to pursue a fellowship to hone their expertise in a particular specialty.
A residency, which can last from three to seven years, is a tough job. It involves managing the typical responsibilities of adulthood between long shifts, few days off and relatively low pay — often while burdened with hundreds of thousands of dollars in student loan debt.
To Rivera, it feels like starting her career at a disadvantage.
“You’re dedicating yourself to this career path, but also starting off … way, way behind the starting line, just trying to keep up,” she said.
Push for higher wages
For many medical residents, low pay is a consistent source of frustration, said Dr. Rupali Gautam, another medical resident in the state.
Gautam is in her third year of a pediatrics residency at UNM Hospital, which trains the vast majority of the state’s medical residents. She’s also the regional vice president of the UNM branch of the Committee of Interns and Residents, an affiliate of the Service Employees International Union.
After four years of undergraduate education and four years of medical school, most physicians graduate with $200,000 or more in student loan debt, according to the American Medical Association.
A first-year resident’s salary starts at $65,550 at the University of New Mexico, under a collective bargaining agreement for fiscal year 2025 between UNM regents and the union representing medical interns and residents. Residents get a pay bump after each year of their graduate education.
“Residents don’t get paid like attending doctors do; that might be a misconception,” Gautam said. “So if you were to break down our pay over the number of hours we work, we work [for] around minimum wage.”
The residents’ union is currently pushing for more competitive wages. Former Interior Secretary Deb Haaland, who is running for governor, joined union members in October in calling for raises amid contract negotiations.
“We really are just asking for fair pay, pay that’s comparable with other institutions across the region,” Gautam said. “We’re asking for benefits that support residents during these really pivotal years.”
‘Often missing milestones’
The years Dr. Spencer Cook spends in residency will be pivotal — for him and for his family.
After graduating from the Burrell College of Osteopathic Medicine in Las Cruces, Cook is now in the first year of a neurology residency at UNM.
Though residents’ schedules change depending on specialty and rotation, they can be grueling. Gautam said residents average between 60 and 80 hours of work per week, with 11- to 13-hour shifts each day.
That’s a big sacrifice: “We’re often missing milestones — family members’ birthdays or weddings or friends’ engagements and other life events that most people are able to attend,” she said.
She added, “It feels like we have kind of spent so much of our youth — our 20s — in our education and training.”
So far, Cook said he’s been able to balance his responsibilities as a resident with his responsibilities as a husband and father to two young children. Most nights, he said, he gets home early enough to spend some time with the kids before bedtime. He and his wife also lean on a support system of neighbors and fellow congregants at their church.
Cook described his residency at UNM as “very humane.” The program rotates scheduling and assignments to ensure residents can take sick days and split work fairly.
But spending quality time with his family remains a priority.
“When it’s time to be with the kids, I need to be present,” Cook said. “I need to make the time worth it because, by the time I’m done, I’m going to have an 8-year-old and a 5-year-old, and they’re going to remember this time.”
He added, “I can’t really lose these years.”
Stress weighs on residents
Like all medical professionals, resident physicians are subject to the stresses of working in New Mexico’s modern medical system, where long wait times for care can frustrate patients and worsen outcomes.
“The wait times to get into certain specialties is so long that it limits my ability to care for patients,” said Rivera, who also serves as a delegate and political action committee chair in the residents’ union.
She gave the example of sleep apnea, a sleep disorder in which breathing stops and starts. While poor sleep might not seem directly related to patients’ mental health, “sleep is one of the most fundamental things that we need in order to function,” she said.
Currently, she said, the wait time for a sleep apnea evaluation hovers around 18 months — meaning she doesn’t always have the time to improve patients’ symptoms during her yearlong rotations.
“If I see a patient for a year before they transition to the next provider, and I haven’t even been able to do the evaluation or get the consults that can help me improve their mental health, it’s hard, and it’s hard on the patient,” Rivera said.
While patients have grown accustomed to the long waits, they create an additional challenge for providers, Rivera said: a high rate of no-shows. Particularly for patients with serious mental illness, it’s hard to keep track of a doctor’s appointment in six, 12 or 18 months.
Waiting for care is disappointing for her patients, too.
“It’s frustrating. It’s really hard,” Rivera said.
But, she added, “If we aren’t there, it’s going to get worse.”