The other side of the residency experience: The League of Ordinary Gentlemen and the Strong House Staff Auxiliary

Dr. David Guzick, M.D., Ph.D.

February 21, 2008

Most of what’s written about residency training focuses on professional education. "When I was a resident" stories abound, along with other commentaries on the "good old days." Many articles have been written about the rationale and implications of the 80-hour work rules, and the core competencies of graduate medical education.

There is another side, however, to the residency experience--the side that pertains to life outside the hospital and clinic. This non-professional side of residency education has particular importance for residents who enter their training with a spouse or significant other, especially if children are added to the equation along the way.

Back when house staff were truly "residents"--i.e., living in the hospital--they were provided with meals and uniforms and received little pay. Their entire lives were consumed by medical training--marriage was not a practical consideration. Even a few decades ago, when on-call schedules were typically every-other or every-third night, few residents married during their residencies, and even fewer had children.

Times have changed. Since half of our medical students are now women, it follows that half of our residents are women, recognizing substantial variation across specialties. And male or female, the new work rules have made it possible to "have a life" while a resident. Marriage and family have become realistic options. The "couples match" for married resident applicants is increasingly prevalent. Thus, when choosing a residency, considerations beyond professional training become important, and factors pertaining to the domestic side of the residency experience play an important role in the perceptions of house officers about their overall experience.

I was therefore intrigued when I heard about the "League of Ordinary Gentlemen," a (predominantly male) support group for (predominantly female) ob-gyn residents. Ruth Anne Queenan, MD, MBA, Associate Professor of Ob-Gyn and Program Director of the ob-gyn residency, told me that the League of Ordinary Gentlemen has become a critical part of the overall residency experience in the Department, and suggested that I publicize this in case other Departments would like to mount similar programs for spouses and significant others. As I looked into this, I learned about the Strong House Staff Auxiliary, and I also canvassed our various residency programs about their efforts to support the non-professional side of the residency experience. Here’s what I found.

The League of Ordinary Gentlemen

In the 1980s, residencies in the field of ob-gyn shifted from being virtually all male to about 50:50 male-to-female. By the 1990s, many residency programs in ob-gyn were virtually all female. In June, 2001, my last year as Ob-Gyn Chair to welcome our new class of interns to Rochester and to our residency program, I remember vividly the answers to my question "how did you spend the time between the end of medical school and the start of residency?" Of 8 residents, 7 were female; 4 had spent that time getting married and then traveling to Rochester to buy a home, and two others were already married, also closing on their first home! What ever happened to hiking across Europe? Only two residents were single. A big draw to Rochester turned out to be affordable real estate!

Given this environment, a group of husbands of ob-gyn residents formed the "League of Ordinary Gentlemen" (LoG) several years ago. Despite being named after a Christopher Browne’s movie on pro bowling, the group was hatched over a poker table. Their "official history" (per LoG website) is as follows:

"In 2005, a ragtag group of men hailing from regions across the United States of America were separated from their loved ones by overnight call, night float, and stories about vaginas. Pity for these unfortunate individuals spread across greater Monroe County, and eventually fate would bring them together over a poker table in the dark basement of a house in Chili (pronounced: CHAI-lie). Drowning their sorrows over loose bottles of beer and Diet Dr. Pepper, one-by-one they squandered their savings, folding fifty cents without knowing if they had a straight or a flush. It was on a night such as this that the group found great clarity, when a man leapt out of his chair and shared a grand epiphany with his brethren, ‘It’s Friday night, our women are gone... there is not an orphan among us. We’re bachelors!’ And in that one shining moment, The League of Ordinary Gentlemen was born. Still broke, but not alone, they hatched a plan. They would talk to their wives’ boss and ask for money to play poker, go bowling and run a world-class fantasy football league. She may have rolled her eyes at the proposition, but ever-sympathetic to their plight, she would stand before her superiors and demand funding for this sorry lot. Lo and behold, the League secured a sponsor. Out of gratitude to the program, and in service to their small community of temporary bachelors, the League compiled a document that would derail the sources of their former angst for the benefit of eight new residents with loved ones of their own, once destined to inherit the Gentlemen’s checkered past."

One of the first things the group did was construct a web site that provided information for incoming residents. Music to a residency program director’s ears, the first statement on the LoG home page is "Congrats on your match! Quite simply, this program is awesome." They go on to recognize that "your first priority was probably to check a U.S. map to see ‘exactly just where am I going to be living for four years?!’" And in the welcoming spirit that has made the group so important for the overall experience of ob-gyn residents and their spouses, they go on to tell the new interns: "Perhaps the most important thing you’ll find here is a list of several residents, many of whom have offered to house you while you’re in town searching for a place of your own. Don’t get a hotel; there are plenty of good, free bed and breakfasts at the homes of friends you don’t even know yet."

The leader of this group from its inception (up until last year) is Jeremy Willmott, a post-doc in the laboratory of Bob Bambara, PhD, Chair of Biochemistry. (Jeremy’s wife, Lyndsay, graduated from the ob-gyn residency last year and is spending this year as a faculty member running the resident clinic. Next year she and Jeremy will move to "the O.C.," where Lyndsay will be a Fellow in gynecologic oncology at U.C.-Irvine.)

Jeremy points out that "You’re coming across the country and might be a bit apprehensive, but here’s a bunch of guys who went through the same thing. While your wife is on call, at least 7 others are also on call. You check the schedule on our web site, and can give another guy a ring--dinner, watch a football game, etc. Everyone is encouraged to host and post events--LoG gets everyone involved." In addition to the spur of the moment movies, last year the LoG ran several events for residents and their families: a BBQ during orientation, a poker tournament, fantasy football, and a buffalo wing-a-thon. According to Jeremy, one or two husbands per year say that this was a big part of their decision to come to Rochester.

Mike Anderson the husband of Meghan McKeever (currently a Chief Resident in Ob-Gyn) was also nice enough to give some insight into the LoG: "We were first exposed to the early makings of the group at the applicant dinner prior to Meghan's interview back in December of 2003. At that time we had heard good things about the program from previous University of Washington transplants, but didn't know anyone here. We only knew that Rochester was far away from Seattle in more ways than one. At the dinner I met Ken Droz and Jeremy Willmott, two resident husbands and…we left that night feeling like we could be happy here with the family atmosphere that we experienced. It became a big factor when it came time to rank programs. Once we arrived it was nice to get help settling in, with referrals for a realtor and offers for a place to stay while house-hunting. Since then, Jeremy, Ken and others formalized the group with the rather clever name, website/forum and spiffy welcome packet for incoming residents and their partners. We continued with the fantasy football league and I am proud to say that the (in)famous Roman Soldier trophy for the league champion is now proudly displayed in our living room (much to the chagrin of my wife)! At subsequent applicant dinners several of us have made an effort to connect with prospective residents' partners and fill them in on life in the program, and it's fun to hear them say that they have actually heard of us before even coming to the dinner!

The Strong House Staff Auxiliary and Department-based activities

Ken and Julie Morse were already married when Ken was looking at residency programs in orthopaedics six years ago. Ken is now a 5th-year resident in Orthopaedics. He matched to the UR residency in Orthopaedics from Tufts University School of Medicine and received a brochure on the Strong House Staff Auxiliary during orientation. He thought it was something that Julie might be interested in and showed her the brochure.

Julie found herself in much the same situation as Jeremy Willmot--they had both recently arrived in a new community with no friends, family or other support systems, and with a spouse who was away from home quite a bit, often overnight. And there was one additional issue--Ken and Julie were starting a family during his residency. Julie decided to attend some of the Auxiliary’s events and found them to be very helpful in providing her with a sense of community in a strange new place.

The Strong HouseStaff Auxiliary (SHA) began in 1995 as a support group for the wives of male residents. It evolved into an organization for resident spouses and significant others of both genders, but has remained predominantly female. They have "adults night out" without children, organize shopping excursions and get-togethers in which they bring children to someone’s home, a museum or a park, and are otherwise available to one another informally, much like LoG. They also support an annual fund-raising drive as part of the "Adopt-a-Family" program at Strong.

One residency and three boys later (ages 5, 3 and 1½), Julie found the Strong House Staff Auxiliary to be an important support system--so much so that she now leads the group as its President. She has improved the brochure for incoming residents, established a newsletter link from the GME website, and searched for ways to publicize the availability of the Auxiliary to spouses and significant others in all departments. Julie feels that others could benefit from SHA if they only knew more about its existence. Next year, Julie and Ken move to The University of Pittsburgh Medical Center for a fellowship in Sports Medicine, after which they plan to return home to Maine, where they believe that the combination of family ties and professional opportunities would be best for them.

I am grateful to the Program Directors and/or Department Chairs who answered my query about spousal/significant other support groups during residency, and the non-professional side of the residency experience in general. This is clearly viewed as an important issue, as I received prompt responses from each and every department, and most were of some length.

The residency program survey turned up some recurring themes. Virtually all of them make special efforts to create opportunities for informal resident-applicant interactions during interviews. Many Program Directors commented that the best strategy for recruitment is to create a program that produces happy residents, who then become the program’s most influential advocates and recruiters. Residency Program Directors and/or Department Chairs typically give presentations about Rochester as a family-friendly city with affordable housing, great schools, professional sports on a small accessible scale for children, Strong Museum, etc. There is usually a welcoming party, a summer picnic or other event, and a winter holiday party to which families and significant others are invited. Sometimes spouses/SOs are invited to a resident research day and the awards dinner that follows. Sometimes faculty season tickets to professional sports teams or theater or the RPO are made available to residents on a first-come-first-serve basis. In one department, it was stated that "we don’t have a ‘support’ group per se because we just all hang out together."

Concluding thoughts: At the end of medical school, one has an M.D. degree, and has acquired the basic principles underlying the art and science of clinical medicine. It is during residency training, however, that medical school graduates are turned into competent physicians who understand all aspects of medical practice in their chosen field--this includes medical knowledge and patient care, but also the interpersonal, humanistic, ethical, and "medical system" aspects. This level of professional training over several intense years is at once exhilarating and demanding. And yet, as more and more residents are getting married and starting families, our residents must increasingly balance the intensity of their time in the hospital and clinic with their responsibilities for their spouse and children. And the spouses themselves can feel like they’re in a glass bubble of sorts--while their husbands or wives are experiencing the steep learning curve of patient care, requiring intense focus for 80 hours per week, they find themselves in a strange town with no family or acquaintances, either alone or with small children.

It is not surprising, therefore, that groups of resident spouses have organized in a grass-roots manner. The League of Ordinary Gentlemen arose out of a bonding of male spouses married to residents in a department with predominantly female house staff. The Strong HouseStaff Auxiliary arose as a support group for wives of male residents, which now has representation across several departments. It is striking that in 2007, a generation or two after the women’s movement of the 60s and 70s, we have this dichotomy of support groups by gender. Is this, as articulated in a recurring column of Ms Magazine, a "click" moment? Or should we accept this as reflecting the present reality of the needs of residents and their spouses?

I will leave the answer to that question to you. For my part, as a Dean who wants to support our residents, their spouses, and our residency programs, I will work with our GME office to encourage Program Directors and Chairs to assess the receptivity and enthusiasm of their residents and spouses to the idea of a department-based support group, and to provide the modest support required if this is thought desirable. In addition, we will work with the Strong HouseStaff Auxiliary to publicize their group and to improve access to SHA and the breadth of their activities, so that spouses of both genders, with or without children, can take advantage of a supportive community during residency.

Meliora,

David S. Guzick, MD, PhD
Dean, School of Medicine and Dentistry
University of Rochester

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