Why “Working Hard” Isn’t Enough in Residency

Residency Reflections #12

Author

Jared Dashevsky, MD
January 21, 2025 • Estimated Reading Time: 6 minutes

RESIDENCY REFLECTIONS

“But They’re a Hard Worker”

The thought hit me as I was falling asleep last night. It wasn’t random—I had run into a colleague earlier in the day. We got to talking about an intern, someone I’d worked with before. My colleague mentioned they were struggling with the intern’s clinical skills, and as we were chatting, their attending stopped by and chimed in.

“They’re a hard worker,” the attending said, almost as if that summed everything up. He went on to explain that giving feedback would be tough because, well, when someone’s already working hard, they tend to think they’re doing well.

That comment stuck with me.

Here’s the thing: it shouldn’t matter if you’re a hard worker. That’s not the point.

When you start something new—like residency—of course, you’ll have to work hard. You’re figuring things out: processes, expectations, the quirks of a new system. It’s like trying to overcome activation energy in chemistry. The effort feels enormous at first because it is.

But it shouldn’t stay that way for long—especially for an intern who’s been working 70+ hour weeks since July 1st. If you’re paying attention and really reflecting on how you’re working, you’ll start tweaking and optimizing. You’ll become more efficient.

Yet efficiency alone isn’t enough. You also have to be effective.

Here’s how I think about it:

  • Efficiency is doing things right.

  • Effectiveness is doing the right things.

  • The sweet spot? Doing the right things right.

You can work hard all day, but if you’re focused on the wrong tasks, your efficiency doesn’t matter. Similarly, being effective isn’t enough if you’re clumsy about execution. You need both.

That’s why I’m not impressed when someone calls themselves a “hard worker.” My expectation is that, with time and practice, you should become so efficient and effective that your work looks easy. Like a duck gliding across a pond—calm and composed on the surface but paddling smoothly and purposefully underneath.

Quack, quack.

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