Death of Young Doctors: The Strength of Supervision Culture and Toxic Seniority

The medical profession is always framed in narratives of noble dedication and boundless sacrifice. However, behind this dedication lies a dark reality that has increasingly claimed victims in recent times: deaths, severe depression, and extreme burnout among interns and specialist trainees. These tragedies affecting young doctors are not mere coincidences or normal physical fatigue that can be excused or normalised. These incidents are the result of structural failures in our medical education system and hospital governance. When healthcare institutions, which should be centres of healing, instead become spaces of exploitation, we are confronted with an irony of humanity that urgently demands serious critique. Legally and conceptually, we need to reposition the definition and rights of an intern worker in healthcare facilities. Based on the International Labour Organization (ILO) guidelines on Decent Work, interns (apprentices/interns) are individuals in a transitional phase from education to the professional world, where their basic rights must not be ignored. Unfortunately, in our medical ecosystem, young doctors are often treated merely as ‘cheap labour’ to fill shortages in hospital healthcare personnel, without adequate labour law protections. The roots of this exploitation are deeply embedded in a toxic seniority culture that has taken hold. Medical education globally, including in Indonesia, is often overshadowed by what is known in the sociology of medical education as the hidden curriculum, a concept popularised by sociologist Frederic Hafferty (1998). In this unwritten curriculum, practices of hazing, verbal bullying, and the imposition of workloads beyond reasonable limits are passed down across generations under the guise of ‘mental formation’. Such hierarchical structures make psychological violence seem normal, with seniors holding near-absolute power. As a result, medical interns are often forced to endure extreme fatigue—even more than 30 hours of consecutive duty—to ensure their graduation. This oppressive hierarchical culture is further exacerbated by the poor clinical supervision system in the field.