In November, thousands of doctors-in-training launched union drives at four different hospitals across Philadelphia.
Left Voice spoke with an organizer of one of these union drives about their efforts and how residents’ collective power can be used to change a broken healthcare system.
LV: Tell us about the timeline of the union effort. How long ago did it start at your hospital?
I got involved probably six months ago. I think the effort had been going on before that for months, and then it became clear to the greater CIR [Committee for Interns and Residents], which is the organization that we’re unionizing with, that there was actually a capacity for a movement at all of the city hospitals. And so then they were making an attempt to align the timelines so that things could be announced in tandem. Then, with the election and concerns about the NLRB [under Trump], the timeline got moved up fairly rapidly.
LV: What are some of the main issues you are organizing around?
I think pretty universally in medical training, there’s an under-appreciation and under-compensation of medical residents. A lot of it comes down to pay, because that’s so fundamental, but other benefits, like time off and parental leave, are certainly a major concern for people, and moonlighting and overtime and things like that generally are under-compensated as well. At my hospital specifically, there are concerns about access to appropriate equipment and basic medical supplies. So, a lot of this becomes very much like logistical issues.
Let’s say an orthopedics resident needs to splint an arm in the emergency department. There may not be the supplies to do that in the emergency department. They might be on the seventh floor on the other side of the hospital, which means that every time they have to do this, they’re traveling ten minutes to get basic supplies to then do this procedure.
I also think in many departments — particularly surgical ones, although it’s not unique to surgery — there’s an attitude of “You do what you’re told, because you’re a trainee and we can have so much control over your future that we can treat you however we want. And you can’t really do anything about it, because it would put your career at risk.” And that people should not have grievances about the number of hours that they work, or the volume of patients that they’re caring for, because it’s just part of the training process. And so there’s certainly a sort of baked-in culture of suffering. Unionizing gives residents the power to have a say in the conditions of their working lives.
LV: What would winning your demands around pay and working conditions mean for people working in hospitals?
We’re in a very intensive part of medical training, so protections and compensation for residents allows them to be their best selves when they’re taking care of people, right? It’s true for everyone in the world. Higher pay allows people to afford better quality food, for example. It gives more financial buffer for taking care of all the little tasks of life that people who are working 80 hours a week just don’t have time for.
And then you think about things like sleep. Some people work 24 hours straight in the hospital (which actually is, like, 28 hours, because you are always there for a few hours more than you expect to be). And if the “on-call” room is not well-kept, safe, and accessible, you’re not going to sleep as well during the few hours of sleep that you can get in the hospital. And that means you’re not as well-rested, which means you can’t think as clearly. And that, obviously, immediately, becomes about patient care and patient safety!
I also think about mental health from a societal perspective. Suicides among trainee-physicians are pretty high. And it takes so much time and money to train a single physician, and we have such a shortage of physicians in the country. So to lose a single resident to suicide means that the country has less medical capacity. And you can’t just replace that person overnight. You’re looking at four years of medical school and however many years of residency before you have another person in a position to do the work that that person was doing. So supporting mental health means that we maintain the people that we need to take care of the entire nation.
LV: How has the union drive been received by workers? Has there been fear of retaliation?
I mean, there’s been two elements. One is that there’s almost universal verbal support. It’s very rare that we speak to someone who actually is opposed! But on the other side, there actually is very, very active fear of retribution among people. And so there has been reluctance for people to be actively involved. Because there have been attendings [doctors working in the hospital already] who have made it clear that they are opposed to there being a resident union. There’s a spoken or unspoken threat of retribution, if they know that their residents are involved in efforts to unionize.
I think there’s probably a fear among attendings that if residents are unionized, more work will fall to them, because if there are more strict expectations in place around the workload for residents, there’s a concern that attendings will be asked to do more. Actually, I think, generally speaking, people just want to be fairly compensated for the work that they’re doing, they’re not asking to do less. There may be this element of: “You should be grateful for this opportunity. How dare you ask for more?” I think it’s maybe more ideological than material, in a way.
LV: Are there departments where the guidelines on medical education set by the ACGME — the Accreditation Council for Graduate Medical Education — are not respected? Is that part of the issue?
Probably. I think there’s an unspoken understanding, particularly among surgical specialties, that people break duty hours.
Say they work more than 80 hours a week on a regular basis. There’s a lot of vulnerability in reporting it, because if a program is known to break duty hours, it actually puts the program at threat of losing accreditation, and so that puts the careers of the residents in jeopardy as well. And so most people don’t report going over to the hours, even if they do. Or you thought you were going to be working in a clinic, and you’re pulled to go back to work in a hospital for a 12 or 18 hour shift. So we’re talking about compensating for those additional days of work
LV: What role does residents’ labor play in the overall functioning of a hospital? Do you think residents would be ready to engage in some kind of collective action to withdraw that labor — leaving for the day, going on strike?
I think that’s a complicated question in a hospital, since a lot of people are very wary of striking in a patient care setting. It’s true, the hospital fully relies on us for labor and for patient care. The reality is that the day to day tasks of providing care for those patients are performed by the residents. In the absence of those workers, you worry about appropriate patient care being provided. So I don’t think anyone would ever take on a strike lightly. And I think there would have to be conversations around how, what, what type of strike would it look like?
But there’s other ways to strike that are not about patient care, actually. So one thing that people have done is a documentation strike. Residents are the ones who write all the notes for all the patients every day, right? And it’s how the hospital bills. So you can still see the patient, but you just don’t write the note.
So then, the attendings have to write the notes. Or the hospital loses money because these things are not getting documented. So I think that’s something that has come up as a possibility. You’d want to be creative, right?
LV: There’s been all this talk about health insurance after the murder of Brian Thompson — and how much hatred there is for health insurance. Can you say something about you and your coworkers’ relationship to the insurance system?
My perspective on that is that the whole system is broken. What health insurance is supposed to be is an insurance that people can receive the health care that they require, right? That’s what conceptually it should be. But everyone in the country has experienced times when they or a loved one needed life-saving medical care, and their insurance company refused to pay for that care. So on top of the amount of money that they are paying monthly for healthcare premiums, they are not receiving the benefit of having an insurance policy. They are still in debt for tens of thousands, hundreds of thousands of dollars.
We spend years of our life in medical training. We have the expertise to say, “You have this medical condition; this is going to be the best medicine for you, based on everything that I know.” And the insurance company says, “No, you can’t use that. I’m not going to pay for that.”
So then you’re in a position of either saying, “Okay, do I use something that I think is going to be less effective or less safe for this person? Or do I try to jump through all these hoops of arguing with the insurance company about covering this medicine? Or do I have to say to the patient, “Well, it’s your choice, either you pay out of pocket for this thing, or we do something else that isn’t going to work as well.” There’s a lot of distrust for insurance companies, and resentment.
And [among physicians] nobody wants to do paperwork all day. That’s not what we went into medical training for. I’ve spent almost a decade in medical training and I am often the person who is responsible for sitting down and filling out a form that mostly includes my patient’s mailing address, and figuring out how to get it faxed somewhere, and then waiting for the response, and getting on the phone and potentially having to argue with somebody, and so on. That’s 30 to 45 minutes of my day that I’m not seeing a patient, I’m not reviewing their labs, I’m not talking to somebody else about their care.
LV: You have to go through residency and give your sweat and blood in a few years of very intense training, so you can acquire the knowledge and the skills to do your job later. I always thought it was completely unnatural, and it takes a toll on your health. Do you think there’s a smoother way?
I totally agree that to be a well-trained physician, it takes time. You have to see a certain number of patients, you have to see a certain number of clinical scenarios. There’s no replacing that time. But what happens in residency is that they consolidate it as as much as possible into however many years of training you have. And so in order to get X number of hours of or to do X number of procedures to be proficient, you’re working 80 plus hours a week.
In today’s world, a lot of it actually comes down to educational debt. Because if you go to medical school and you accrue $200,000, $300,000, or $400,000 in educational debt, you need to get through training as quickly as possible so that you can start making a salary. Because you do not make enough as a resident to pay back your educational debt.
If we had access to less expensive medical education, or if, as residents, we were paid better salaries, then the pressure to leave training as soon as possible would be lower, and you could conceivably draw out the training period longer so that it wouldn’t be as intensive.
LV: You’re describing this system of healthcare where all of these people are becoming so rich: the institutions that loan money to students; the heads of insurance companies; the upper administration of hospitals. How do you see this as in contradiction with the responsibility of caring for human beings and their health?
The healthcare system is a particularly stark example of many things that are wrong with society. There’s so much of a focus on profit and profiting from healthcare and profit being such a huge motivator in every sector of our world. And as a priority over people having housing, people having healthcare, people having access to food. So healthcare is not unique, but it’s one of the most vulnerable parts of our society; that’s when people are the most vulnerable, when they are ill. But it’s not that the healthcare system is independent of the rest of our systems, because we treat every part of our lives like this. Now, you know, people pay more for groceries because the grocery companies would like to increase their profits. People can’t afford to buy houses because private equity is out here buying up houses to rent back to people at exorbitant prices, right? It’s everything.
LV: How do you see unions, and your new union, fitting into a world that’s not just about voracious profit-making, but instead protects people and aims to change society?
I hope that, in building collective power, you enable people to take back power from these large corporations that dictate so much of people’s lives.