Attendings often tell stories about residency "back in the day" - more autonomy, more responsibility, more independence. But was training really better, or has the entire system changed?

In this episode of Cut & Tell, plastic surgery resident Dr. Liz Malphrus explores why modern residents often report feeling less prepared for independent practice despite performing similar case volumes to previous generations. From duty-hour debates and supervision requirements to RVU-based compensation and the growing pressure for clinical productivity, she examines the structural forces reshaping surgical education.

This isn't a conversation about whether residency is easier or harder. It's about understanding how the training environment has changed, and what that means for autonomy, burnout, and the future of medical education.

Topics discussed:

• Why case numbers don't tell the whole story
• Resident autonomy and surgical confidence
• The impact of RVU-based compensation on teaching
• Academic medicine's productivity pressures
• Why more residents pursue fellowship training
• The relationship between autonomy and burnout
• How surgical education has evolved over the past two decades
• What attendings and residents can learn from each other

Cut & Tell is a podcast exploring the realities of surgical training, medicine, and life beyond the operating room.

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