Locked In: Training Under Pressure in the Dominican Republic’s Public Health System

Medicine in Latin America

By Paria Remolina

Medical training across Latin America often takes place in environments defined by limited resources, high patient volumes, and immense service demands. These challenges do not reflect a lack of knowledge or dedication but rather the difficult realities faced by public health systems stretched to their limits. In this piece, we explore the structure and expectations of surgical residency in the Dominican Republic, where young physicians must navigate not only the complexities of clinical care but also the pressures of a deeply hierarchical and demanding training environment.

A Culture of Respect and Responsibility

In the Dominican Republic, respect for seniority is central to medical culture. Attending physicians and fellows are regarded with deep formality, greeted with titles, and addressed with deference. It is expected to stand in their presence. These gestures reflect a longstanding tradition of respect for experience and authority.

For residents, this cultural framework brings both pride and pressure. They are easily identified by their formal white attire and expected to represent the discipline and commitment the profession demands. However, in the context of overstretched hospital systems, the expectations placed on residents often extend beyond typical working hours and duties and into a realm of physical and emotional endurance, and even distress.

Trancado: When Training Demands Endurance

One of the most striking practices that residents may encounter is colloquially known as trancado, a term that translates to “locked in.” It refers to extended shifts in which residents remain in the hospital well beyond standard duty hours, sometimes indefinitely, often as a response to perceived lapses in performance or communication. While the intent may be to instill accountability, the result can place a heavy toll on trainee well-being.

These extended hours are not guided by formal limits on resident work schedules. Residents in the Dominican Republic are not classified as employees or students in a way that provides clear labor protections. Instead, they occupy a space of intense clinical responsibility with few systemic safeguards to ensure adequate rest or balance.

Training in a System Under Strain

The expectations placed on residents reflect the reality of a health system striving to care for many with limited resources. Hospitals serve as both training grounds and safety nets, and the immense need can create conditions where policies and traditions persist without reevaluation.

As a medical student rotating through public hospitals over the last two years, I have witnessed firsthand how these conditions affect resident morale. I have seen dedicated young doctors managing complex surgical cases while also navigating the weight of traditional disciplinary structures. In one instance, a surgical resident was warned, perhaps seriously, perhaps not, that he would remain in the hospital for a week if students under his supervision failed to complete an assignment. The tone may have been ambiguous, but the silence in the room said enough. These moments underline the immense pressure residents face to meet not just clinical standards but institutional expectations rooted in long-standing norms.

A Call for Reflection

This piece is not a critique but a reflection, an invitation to consider how systems can evolve while respecting cultural values and professional standards. The dedication of Dominican physicians and trainees is undeniable. Their commitment keeps the public health system functioning under immense strain, but even the most committed professionals need structures that support their growth, health, and dignity.

Change does not happen overnight. It begins with honest conversations among trainees, mentors, institutions, and communities. This is one such conversation. A whisper, perhaps. But even whispers, over time, can lead to meaningful change.

About the Author

Paria Remolina (she/her) is a final-year medical student in the Dominican Republic, originally from the USA. With prior experience as a geriatric volunteer in the US healthcare system, and now working within the Dominican Republic’s healthcare system, Paria has gained a unique perspective on the disparities between the two. Her experience has deepened her appreciation for the challenges faced by students, particularly those pursuing surgery, and she is passionate about highlighting these issues in order to drive change.