Understanding where shomer Shabbos residencies come from — and where they are disappearing to — means understanding how residencies are assigned in the first place.Every year, 40,000 medical students apply for residency programs. What is the most efficient way of placing those applicants into 37,000 spots across the country, covering a range of 33 specialties? The answer is the National Residency Matching Program, or NRMP. A fourth-year student typically applies to dozens of residency programs. Landing interviews at ten is considered good, and the interview process is protracted and anxiety-inducing.

After applicants interview at their desired programs, they and the program directors submit ranked lists to the NRMP, indicating their choices. The Match, as it’s known colloquially, uses a computer algorithm to match students to a program as high on their list as possible.

Aside from researching the myriad criteria that all medical students consider, such as desired specialty, location, and academic prestige, shomer Shabbos students also network extensively among themselves to find programs that will work with them. This must of necessity remain a grassroots effort; the programs themselves often don’t advertise this, because of the potential negative publicity.

“No one wants a New York Times headline, ‘Top Program Sets Aside Spots for Jews,’ ” says Dr. Daniel Eisenberg, a radiologist at Albert Einstein Medical Center in Philadelphia and noted lecturer on Jewish medical ethics.

For this reason, Dr. Shlomo Minkowitz, a diagnostic radiologist at Weill Cornell Medicine in Manhattan, runs a website (shomershabbosmedicine.com) that hosts a closed database where students can share their firsthand knowledge with others. Started in 2014 with Dr. Dani Poliakoff, now a pediatrician in Baltimore, MD, the database facilitates communication between fully trained physicians — who have already navigated the residency experience — and medical students applying for residencies.

“Sometimes, the chief resident will tell a frum applicant, ‘No way, the person who told you Shabbos could be accommodated doesn’t understand how the schedule works,’ ” says Dr. Minkowitz. “Our database lets others know who’s making it work practically, how, and where.”

Devorah Segal, MD, PhD, herself a director of a residency program at Weill Cornell until recently, discovered this personally after a period of crushing disappointment. Because her specialty, pediatric neurology, is so complex and uncommon, her residency had three separate required segments. After she had completed one segment — two years of a shomer Shabbos pediatric residency — the program director for her next segment, an adult neurology program, was emphatic that they would not accommodate her Shabbos needs.

“That program director shot me down so fast,” she recalls. “[She said,] ‘We have people of all cultures and religions. When you sign up, you have to understand you may not be comfortable with everything.’ I was devastated. I even considered switching out to emergency medicine.” Although the pediatric neurology residency program wasn’t considered the most prestigious academic program, Dr. Segal had chosen it specifically because of the assurances she’d received that it would allow her to keep Shabbos. Learning that the next segment of the program would be unaccommodating came as a nasty surprise.

However, a quick conversation with the chief resident there revealed that the unsympathetic program director had nothing to do with scheduling, and the chief resident would be happy to accommodate her.

The choices available for frum Jews are not all-or-nothing; rather, they fall on a spectrum. The residents in Dr. Minkowitz’s database share information on the degree to which the institution, even if not formally shomer Shabbos, was sympathetic to their needs. Aside from the official shomer Shabbos spots, many residencies are what might be called “Shabbos-friendly” or “Shabbos-protected,” offering some degree of support, even if not fully guaranteed to be completely shomer Shabbos. Some are even completely shomer Shabbos, though not formally designated as such.

In search of Shabbos-friendly residencies, residents often need to give up on dreams of a particular specialty or location, opting instead for a second choice that complies fully with halachah.

At the turn of the 20th century, no one had heard of a residency that respected Shabbos observance, for the simple reason that quota systems limited the number of Jews accepted into medical schools and residency programs, and of those accepted, relatively few were religiously observant. Jews were systematically discriminated against by both hospitals and medical schools alike.

The proliferation of Jewish hospitals in the early decades of the century was an attempt to combat this systemic anti-Semitism. Hospitals with names like “Mount Sinai” and “National Jewish Hospital” were chartered by Jewish communities and philanthropists around the country, with the express purpose of providing care that would be sensitive to Jewish law, as well as training Jewish doctors, who frequently found other doors barred. In time, well over 100 Jewish hospitals would serve both the Jewish and gentile populations of America’s cities.

It was one of these, Yeshiva University’s Albert Einstein College of Medicine, founded in the Bronx, NY, in 1945, that introduced the concept of a shomer Shabbos residency to accommodate its religious students, and other hospitals soon followed suit.

The latter half of the 20th century was the heyday for shomer Shabbos residencies. At the time, the standard shift was 36 consecutive hours on duty, followed by a rest period of equal length, into which a full 26-hour Shabbos could be shoe-horned.

The eventual decline of the shomer Shabbos residency was rooted in a tragedy that occurred in 1984. A young college student, Libby Zion, died under the care of two residents in a Vermont hospital. Libby’s father, Sidney Zion, a lawyer and former New York Times writer, was convinced that the errors leading to his daughter’s death were caused by exhausted, overworked residents, and he was determined to change the system.

It took time, but due to the awareness raised by the Zion case, in 2003 the Accreditation Council for Graduate Medical Education, the governing body for all residency and internship programs, began to limit the number of consecutive hours a resident could legally work, as well as the total hours in their workweek.

The standard 36-hour shift, followed by an equivalent amount of time off, was cut to a maximum of 24 hours, with a corresponding reduction to the intervening rest periods. For residents who were using their 36-hour window for Shabbos observance, the shorter working hours proved to be a challenge, since the schedule no longer allowed for a break spanning Friday evening through Saturday night.

Due to the scheduling complexities involved with the new guidelines, fewer programs are willing to accommodate Shabbos observance today.

But wait, didn’t we spend years fighting for the right to observe Shabbos in the workplace?

Under Title VII of the landmark 1964 Civil Rights Act, employers are required to accommodate their employees’ religious practices — unless it causes the employer “undue hardship.” That final clause is what gives hospitals their out: In a high-pressure medical setting, subject to strict scheduling guidelines, it can be argued that giving one resident Saturdays off would impose an undue hardship on the employer. “You can’t ask about religious restrictions when interviewing residency candidates, but you are allowed to make clear that they are expected to work the job hours,” says Dr. Segal.

When she interviewed at one residency program alongside an obviously frum colleague, the first thing the director said was that the program does not make allowances for Shabbos observers. Although at the time she was floored, her recent role as a residency-program director has given her a new perspective.

“As a student, I was up in arms about religious freedom,” she says. “To be honest, now that I’m on the other side, I understand.”

And that, it seems, is a growing trend.

The shortage of shomer Shabbos residencies isn’t simply a question of logistics — there’s the human factor as well. No resident, Jewish or non-Jewish, wants weekend shifts, but most personal preferences aren’t accommodated when scheduling duty hours. If the frum Jew is always getting off Shabbos, it can easily breed resentment.

The shift known as a “black weekend,” in particular, can ruin a resident’s weekend plans like nothing else. It entails working overnight Friday through Saturday morning and then again Sunday, and shomer Shabbos residents never have to do it. In any permutations, Saturdays are considered difficult days to be on call, since trauma and ER cases tend to be higher, with fewer staff to share the work. As a program director herself, Dr. Segal says she gained a better understanding of the hardships the other residents face in accommodating a shomer Shabbos. “If you have a small program, or there’s a disparity over how much work there is on certain days, it’s really hard to accommodate everyone and be fair.”

“There’s definitely the potential for animosity,” agrees Dr. Shlomo Minkowitz. “Lots of other residents’ personal preferences aren’t accommodated in a similar way.” Often, the resident’s colleagues don’t see Shabbos observance as the non-negotiable obligation that we understand it to be. They figure they work shifts that are inconvenient for them, including their days of rest, and don’t really get what’s so different about Shabbos.

He cautions aspiring doctors not to play the religious-freedom card; it’s not a question of religious rights, he says. Since the job requires those hours, it’s a question of abiding by whatever terms your agreement contains.

To offset the resentment engendered by constantly requesting portions of the weekend off, our sources urge frum doctors to go above and beyond the call of duty to show their commitment to the team. Dr. Yisroel Chaim Cofsky, an internal medicine doctor in Lakewood, for example, reports taking more than double his share of night call in order to swap for Shabbos off.

“You need to bend over backward to show you’re willing to work two or three times as hard as the others,” says Dr. Minkowitz.

“I used up a lot of my social credit with the other residents,” agrees Esther, an emergency room doctor in an East Coast hospital. “You don’t want to be that person that everyone’s avoiding because every time you open your mouth, it’s, ‘Hey, can you swap this shift?’ ” She and other frum residents made sure to take every Xmas, New Year’s, and Easter shift without fail and without complaint.

She also cautions residents to pick only the critical battles. “Chol Hamoed? Move on. Get Yom Tov and Shabbos and move on. If you’re asking for Tishah B’Av, you’re fighting the wrong battle.”

Dr. Eisenberg suggests that abuse of the religious accommodations by individual frum residents may have led to the downtick in the number of programs, a charge echoed by several other doctors we spoke with.

“Some people took advantage,” notes Dr. Eisenberg. “Purim and Chanukah are not days that you are absolutely forbidden to work.”

Entitled overreach in the name of religious accommodation breeds bitterness, and ultimately reduces the opportunities for other frum Jews.

Shabbos in a hospital setting presents halachic challenges from the moment a doctor steps through the door (which might very well be automatic). M’d’Oraisa, halachah allows melachah to be performed to save Jewish lives, and Chazal further allowed the violation of issurim d’Rabbanan to save the lives of non-Jews, since eivah, or animosity, could in turn endanger Jewish communities.

Practically speaking, in today’s hospital wards, lifesaving treatment is generally allowed, but questions and confusing details abound. Is taking a patient history part of lifesaving care? What about routine care, which is not immediately lifesaving but part of the running of a hospital? Does it make a difference if the patient is in the ICU or the maternity ward? May a doctor draw blood, a clear issur d’Oraisa?

Because of the complexity of the halachic issues, many poskim forbid medical students from choosing residencies that will require them to be on call on Shabbos (see sidebar).

Even programs that express a willingness to accommodate Shabbos observance can present challenges. Sometimes, the confusion centers on the very basic understanding of Shabbos, which we often take for granted. Program directors may not be aware that Shabbos is not merely Saturday, but extends from sundown until nightfall, and that a resident also needs time to get home on Friday.

Dr. Eisenberg interviewed at one program where the staff had previously indicated they would be supportive of his Sabbath observance. At the interview, they reiterated the commitment, but added that they were happy to support his religious observances, as long as he’d work on Saturdays. In general, he says, non-Jews sometimes have a hard time wrapping their heads around the very Jewish concept of being “forbidden” to perform work.

“They don’t understand that it’s not just a preference, we can’t just ask a rabbi for a dispensation or indulgence,” he says.

Esther advises medical students to start speaking to their rav well in advance of application season. “If the first time you speak to a rav is after you’ve already interviewed, to find out whether you can take a residency that requires you to come in on Shabbos, then you’re probably not asking the right sh’eilos,” she says.

In her own case, she’d been asking sh’eilos since beginning her medical education. So by the time she came to the rav to discuss the possibility of accepting a residency that was not officially shomer Shabbos, but sympathetic, the rav knew he was dealing with a careful yirei Shamayim, and allowed it.

“He was comfortable giving me that psak because he knew I’d come to him with questions like, ‘Can I wear my lab coat on Shabbos if the pockets are empty, or has it become bosis (a holding vessel or surface)?’ ” says Esther.

She explains that prospective residents need to have their psak boiled down into a two- to three-sentence elevator pitch that they can explain simply to a program director, allowing them to be on the same page from the outset. For example, an applicant might say, “I won’t be able to come in from sunset on Friday until nightfall on Saturday, but I can carry a pager and return emergency calls from home.”

Aside from the cut-and-dry halachah, residents also need to be comfortable with their psak. Even if a rav allows a non-Jew to drive you home, for example, is that what feels right for your family?

Dr. Daniel Krich received a fairly lenient psak from his rav, since so much of his work as a pediatric pulmonologist deals with life-or-death situations. He made sure to wear his Shabbos suit even while on call, so as to keep the atmosphere of Shabbos front and center.

“Never get so used to it that going in the car on Shabbos doesn’t bother you,” he says. “Stay in the mindset. It should always be a little bit of an odd feeling.”

Once matched into a residency program, the resident has little leverage if there is no official, in-writing guarantee of Shabbos observance. Chief residents are the ones who actually create the schedule, so even a sympathetic program director does not guarantee Shabbos accommodations.

“My first-year scheduler had no idea what was flying, and I spent a ridiculous amount of time swapping shifts,” remembers Esther.

While her prodigious efforts ensured she never ended up on call on Shabbos, she did have a half-dozen times when she needed to pay a non-Jewish driver to get home. One memorable Friday evening, she waited in vain for her driver to pull up outside the hospital, not realizing that he was a mere 50 feet away — inside the hospital. Being unable to call him, she needed to find a cab company that could help her, trying awkwardly to explain that she had no money, but that it was waiting in her purse in the trunk of her car, which she would give them access to once they reached her home.

Other residents have had to find creative solutions to a variety of halachic problems they faced. A physician Dr. Neuberger knew who did his residency when no shomer Shabbos options were available was told he could bandage patients, but not cut the bandages, so he was constantly leaving rolls of tape hanging off patients.

One suggestion that often comes up is hiring a non-Jew to perform melachah.

“I thought, ‘Who’s actually going to hire a scribe?’ ” says Dr. Eisenberg. “But then a resident I knew in Boston Children’s Hospital, who had previously attended my weekly Jewish medical ethics shiur, brought it to the hospital’s legal committee, and they allowed him to hire a non-Jewish med student to take notes for him.”

The chances of landing a shomer Shabbos residency vary widely by specialty and location. Some specialties, like surgery, contend with particularly complex scheduling involving multiple teams, and are simply too complicated to also factor in Shabbos observance. Others, like dermatology, are so incredibly competitive that they have no reason to try to accommodate anyone’s preferences.

“If they accept one out of every 1,000 applicants, they don’t need to accommodate you,” says Dr. Minkowitz. Instead, he advises medical students, “If you train at a prestigious medical school or otherwise have an outstanding application, you can leverage to try to get into a slightly lower-tier residency program, because that will trade off the hassle for the prestige you bring.”

Hospitals that offer less academic prestige, such as inner-city community hospitals, often offer shomer Shabbos spots as a way of attracting talent they might not otherwise have access to.

Dr. Cofsky interviewed at one program that told him frankly that they offered four shomer Shabbos spots, because they got much better candidates that way. “When people within the program get upset at what they perceived as the frum residents’ preferential treatment, the director tells them that these doctors wouldn’t come to our program otherwise.”

Hospitals with larger programs can also more easily accommodate a particular restriction, since there are more people available to pick up the slack. The University Hospitals program in Cleveland, OH, where Dr. Cofsky served his completely shomer Shabbos residency, had about 50 residents.

“It’s always been a goal to attract a diverse group,” says Dr. Keith Armitage, who heads Dr. Cofsky’s residency program. “We’ve been doing this for 30 years, started by my immediate predecessor, and we’ve attracted some really talented students, some of whom have stayed for fellowships and joined our faculty. We’ve been really blessed with talented residents.”

“One person I know who was in a small program had colleagues who became very resentful of his special treatment; they felt they were always covering for him, Dr. Cofsky says. “In a large program, you don’t work with the same people all the time.”

If you personally don’t aspire toward a medical career, is the endangered shomer Shabbos residency a concern for you? Dr. Krich believes that it should be.

Decades ago, his wife’s grandfather broke his leg, and the paramedics refused to take him to the local hospital: “He’s a Swej,” they said, using a pejorative term for Jew.

While today we enjoy federal protection for our civil rights, and such blatant anti-Semitism would never be tolerated, Dr. Krich points out that we need advocates who are sensitive to halachah at critical times, such as when deciding how to prioritize care for a mother in labor whose baby is endangering her life.

“We would never want to return to the old style, before they let Jews become doctors,” he says. “We need frum doctors.”

Dr. Neuberger counts off the ways a frum doctor is an indispensable asset to the community. When she once had a sh’eilah about fasting on Yom Kippur, her rav called a community member who was an endocrinologist. In another case, a cancer patient she knew needed to travel many miles to do routine lab work and follow-up at the distant hospital that was treating her, so a local frum doctor gladly agreed to see her at her own practice, no questions asked or red tape to cut through. Shidduch concerns? Ask the psychiatrist, oncologist, or geneticist neighbor. Fertility and family halachah? The local frum ob-gyn.

“Having people who understand where you’re coming from as a frum person, who are willing to answer the phone at 10 p.m. — these things are invaluable,” she emphasizes. “You’re not getting that from every doctor.”

When she was considering her career options, Dr. Neuberger remembers a rav who taught in her school telling her, “As a medical student, you’ll be treif only until you graduate — then you’ll be a hero.”

In hindsight, she can appreciate the wisdom in that brutally honest counsel. Medical education places students on the horns of unsavory dilemmas, to the point that many rabbanim advise their students to avoid the profession. At the same time, the frum doctor is a prized community asset. Can we afford to do without them? Will our most committed young people feel forced to choose different careers?

A shortage of shomer Shabbos residencies is a loss to individuals who are compelled to forgo their calling, to students whose desperation leads them to compromise their precious Shabbos observance, and to a community that needs physicians who understand its value system. While many a joke hinges on the Jewish mother kvelling about “my son, the doctor,” for the frum community, he may be part of a vanishing breed. —

We need frum doctors.

—Dr. Daniel Krich

We’ve been really blessed with talented residents.

—Dr. Keith Armitage,

University Hospitals, Cleveland

He was comfortable giving me that psak because he knew I’d come to him with questions like, ‘Can I wear my lab coat on Shabbos, or is it a bosis for muktzeh?’

—Esther, emergency medicine

Make Me

a Match

Dr. Daniel Eisenberg, a noted medical ethicist, has proposed leveraging the Match’s efficient system to solve the shomer Shabbos quandary.

A highly sophisticated program, the Match can manage more than just a simple one-to-one pairing. Already, he says, couples who wish to stay together can participate in a couples’ match, where the match prioritizes a shared location over other preferences. In other words, by choosing a couples’ match, an applicant is sacrificing a more desirable program for a preferred location.

Similarly, Dr. Eisenberg suggests a shomer Shabbos match condition. In his vision, each residency program would decide how many shomer Shabbos residents it would realistically be able to accommodate. Applicants who indicate a shomer Shabbos preference agree that if they cannot secure a shomer Shabbos spot at their higher-ranked choices, they will resort to lower choices that did have shomer Shabbos spots, thus securing their shemiras Shabbos while not receiving preferential treatment at the expense of any other applicants.

“Let’s say Penn can accommodate two shomer Shabbos residents,” Dr. Eisenberg says. “Penn can mark two spots with an S. The computer will fill Penn’s first five spots with whomever. Then, if it gets to my name, and there is still an available S spot at Penn, I get it. Otherwise, I drop down to the next S spot.”

The beauty of this plan, explains Dr. Eisenberg, is that non-participants cannot be harmed by others’ participation. Candidates who choose to rank shomer Shabbos spots on their list are only discriminating against themselves.

While Dr. David Longnecker, then head of the national match, was amenable in theory, practical considerations tabled the plan. Many Orthodox residents didn’t want to be restricted to the formally shomer Shabbos spots. They felt confident that they could manage in typical residencies, by making swaps or relying on various heterim. And without full participation, it’s very hard to tabulate accurate numbers, or to explain why one yarmulke-wearing resident is getting special terms while the other is permitted to work on the supposedly nonnegotiable day of rest.

For now, at least, those interested in pursuing shomer Shabbos residencies will continue to need help from their network of peers, lots of prayer, and a hefty dose of siyata d’Shmaya.

(Originally featured in Mishpacha, Issue 841)