Generations of first-year residents at Johns Hopkins Hospital have worn a short white coat as they made rounds and treated patients.
The coat was different than the the longer style the other residents wore. It was meant to symbolize a year of learning — that residents were not true physicians until they spent some time on the job caring for patients.
But starting with the newest class of residents in Hopkins’ Osler Medical Training Program, the short white coat will be retired. A younger generation of residents increasingly found the short coat offensive and said it unnecessarily distinguished them from the other residents.
As complaints about the coat length crescendoed each year, the head of the oldest resident program in the country thought it best to give up the tradition.
Dr. Sanjay Desai, director of the residency program, sent an email to residents earlier this month announcing the change. He expressed nostalgia for the short white coat, but said younger residents didn’t interpret it in the same way.
“Today, it does not promote the values which it was intended to promote,” Desai wrote. “Instead, it represents a physical symbol of the past, and of an excessive rigidity and hierarchy. This is unfortunate, but it is real. All institutions have to adapt to stay relevant and to ensure their traditions continue to uphold their core values. It would be a mistake for us not to.”
Beginning in July, the short white coat will follow the fate of other medical traditions that have disappeared over the years with modernization and societal advancements.
First-year residents at Johns Hopkins once wore white pants and white shirts under their coats. All residents once lived at the hospital, they couldn’t get married and they had to be men, said Dr. Mark Anderson, director of the department of medicine at the Johns Hopkins University School of Medicine and physician-in-chief at Johns Hopkins Hospital.
“That was what society expected at the time,” Anderson said. “It was considered this complete personal commitment.”
Anderson said that residents were surveyed and overwhelmingly didn’t like the short coat. They viewed it as a pejorative and worried patients would think they weren’t quite ready to give them proper medical care.
“You want to be careful when you change a historical tradition,” Anderson said. “The signal of discontent rose above the noise and became clear over the last several years, so we made this decision.”
The white coats have been around since the 1900s and were first worn at hospitals and then spread to medical schools, said Wolfgang Gilliar, dean of the NYIT College of Osteopathic Medicine.
Doctors wear white coats to symbolize cleanliness and science, said Dr. Ken Ludmerer, a medical historian at Washington University in St. Louis.
At some hospitals bedside physicians would wear the shorter coats because they were doing more physical work and didn’t want the coat touching or dragging on the ground, said Dr. Richard Heitmiller, chief of surgery at Medstar’s Union Memorial and Franklin Square hospitals who is also director of the resident surgery program.
“You had the long coat on because you were directing traffic rather than doing the work," Heitmiller said.
Short white coats are common in medical schools, where students are presented the garments in white coat ceremonies at the start of their studies. The coat lengths vary at hospitals, Gilliar said. Some specialties, such as pediatrics and psychiatry, have moved away from the white coat altogether because it is uninviting, he said.
“In the end the white coat has become more a symbol of tradition than reason,” Gilliar said.
Residents in other Johns Hopkins programs, such as surgery, wear longer coats. Johns Hopkins Bayview residents have worn long white coats for decades. Residents at the University of Maryland Medical Center, Greater Baltimore Medical Center and MedStar Health hospitals also have worn the longer coats for as long as residency staff at the hospitals can remember.
At the end of the day, the length of a coat doesn’t contribute all that much to treatment of patients and isn’t a core value at Hopkins, Anderson and others said.
“It’s a little bit sad in a way,” said Dr. Sandra Zaeh, one of four chief residents at Johns Hopkins. “But the program is about so much more than the length of the coat. And enough people were not supportive of the tradition that it wasn’t worth it. It’s an article of clothing at the end of the day.”
Dr. Paul Foster, program director of the internal medicine residency program at Greater Baltimore Medical Center, said he doesn’t even remember the length of the coat he wore as a resident at the University of Washington. He thinks it was a long coat.
“There is a whole mythology around the white coat,” Foster said. “Now we have the millennials shaking up the system a bit.”
At the University of Maryland Medical Center, name tags distinguish the rank of the physician, said Dr. Mary J. Njoku, associate professor and vice chair for education in the department of anesthesiology at the University of Maryland School of Medicine.
All four chief residents at Hopkins liked the idea of the short coat and the tradition behind it. They described it as a rite of passage, but also supported the decision to eliminate it.
“I wasn’t bothered by it all,” said Dr. Alex Ambinder, one of the chief residents. “I was glad to be at Hopkins. I was proud to be starting my career as a doctor and that came with the territory.”
But many of the younger residents saw it as a symbol of hierarchy, the chief residents said. And, they acknowledged, resistance to the coat wasn’t going away.
“There has been grumbling for several years now and they have been getting a little bit louder and louder,” said Dr. Michael Kelly, also a chief resident.
Part of the disgruntlement about the coat came because some ancillary staff also wore long coats.
“Many others wear long coats, so then the hierarchy isn’t clear and doesn’t really make sense,” said Dr. Mickey Brener, another chief resident.
Brener said medical students considering Hopkins don’t always understand the full meaning of the tradition. The change could help with recruiting, he said.
“We don’t want to turn people off since the value of the program is much more than the length of the coat,” Brener added.