I probably would have the same perception as the OP, if my fiance wasn't a resident at a teaching hospital. At least in this particular hospital, the night resident is responsible for 80-100 patients that night on the floor by him or herself. He tells me that it's really about keeping someone stable until the day team comes in. For any emergent cases then something will be done, but with so many patients to look after and so many pages from nurses he has to prioritize. He says he gets about 100-130 pages from nurses on his shift.
I have so much empathy for residents now because of my fiance. They are truly overworked and underpaid. I make double than he does and I only work 36 hours a week while he works 70-80. I did not know how underpaid they were until he started residency! Like in nursing, you'll have great residents and bad ones.