Covid and burned by the 80-hour work week, the resident physicians union do

In the first weeks of the epidemic, Harbor-UCLA Medical Center family medicine second-year resident Dr. Lorenzo Gonzalez, who worked about 80 hours a week in the ICU, ran in the smoke. She constantly feared that she would catch the Kovid-19 virus and felt guilty for not having enough time to help her ailing father.

In April 2020, her father, a retired landscaper, died of heart and lung failure. Gonzalez mourned alone. Her job as a doctor-in-training put her at high risk of contracting the virus and she inadvertently did not want to spread it to her family. Financial pressure was also created because he had to face the cost of a steep burial.

Now, Gonzalez is calling for better pay and benefits for residents working on Los Angeles County Public Hospital’s painful schedule, which he said amounts to less than $ 18 per hour – while caring for the county’s most at-risk patients.

“They are being victimized by our altruism,” Gonzalez said of the hospital. He is now the chief resident of Family Medicine at Harbor-UCLA and chairman of the Interns and Residents Committee, a national union representing physician trainees and part of the Service Employees International Union.

“We need recognition of the sacrifices we have made,” he said.

Residents are newly trained physicians who have completed medical school and must spend three to seven years training at an established teaching hospital before practicing independently. Under the supervision of a teacher physician, residents examine, diagnose, and treat patients. Some want additional training in medical specialties as a “partner”.

These trainees are banding together in California and other states to demand higher wages and better benefits and working conditions amid intense burnouts during the epidemic. They join nurses, nursing assistants and other healthcare workers who have been pushed to their doorsteps by staff shortages, rising living costs and an inconsistent supply of personal protective equipment and covid vaccines.

More than 1,300 union residents and other trainees from three LA county public hospitals, including Harbor-UCLA, will vote May 30 to cut their salaries and housing stipends after months of stalemate with the county. Since March, residents of Stanford Health Care, the University of Southern California’s Cake School of Medicine, and the University of Vermont Medical Center have gathered.

John August, a director of Cornell University’s School of Industrial and Labor Relations, said:

The Association of American Medical Colleges, a group that represents teaching hospitals and medical schools, did not directly address the trend of unification among residents, but the organization’s chief health care officer, Dr. Janice Orlovsky, said through a spokeswoman that a resident is a job. The primary role of the apprentice and a resident is to be trained.

Orloski said residents are paid as trainees when they study, train and work and the association works to ensure they receive effective training and assistance.

David Simon, a spokesman for the California Hospitals Association, declined to comment. But he forwarded a survey published in the JAMA Network Open in September that showed that residents of surgery in the unified program did not report lower burnout rates than those in the unified program.

So far, none of the new chapters have discussed their first deal, the National Union said. But in the long run some people have improved salaries, benefits and working conditions. Last year, a residential union at the University of California-Davis offered housing subsidies and parental leave through its first contract.

With more than 20,000 members, CIR represents 1 in 7 physician trainees. US Executive Director Susan Naranjo said that a new chapter was organized every year before the epidemic and that eight joined in the last year and a half.

The working conditions of the residents came under scrutiny long before the epidemic.

According to Medscape, a physician news site, the average resident in the United States had a salary of $ 64,000 in 2021, and residents could work up to 24 hours in a shift, but not more than 80 hours per week. Although a survey whose results were published last year found that 43% of residents feel they have been adequately compensated, those who are doing union say wages are too low, especially because of residents’ work pressures, their student loan debt and rising living costs.

Wage rates disproportionately affect residents of low-income communities and communities of color, Gonzalez said, because they receive less financial support from families to subsidize their medical education and other expenses.

But with little control over where they train – medical school graduates are matched to their residency by an algorithm – individual residents have limited ability to negotiate with the hospital.

To unionize residents seeking seats at the table, benefits such as wage increases and housing stipends are often at the top of their list, Naranjo said.

Dr. Shreya Amin, an endocrinology fellow at the University of Vermont Medical Center, said patients deserve doctors who are tired and not busy due to financial stress. He was surprised when the organization refused to recognize the residents’ union, he said, considering the personal sacrifices they had made to provide care during the epidemic.

If a hospital does not voluntarily recognize a union, the CIR may request that the National Labor Relations Board conduct an election. The National Union did so in April, and with a convincing majority vote, the Vermont chapter could now begin bargaining together, Naranjo said.

Medical Center spokeswoman Annie McCain said in an email that it was proud of its residents for providing exceptional care throughout the epidemic and respected the decision to join a union. McCain has refused to address residents’ workplace concerns.

An associate professor of health policy at George Washington University. Candice Chen believes that the Federal Center for Medicare and Medicaid services also have some responsibility for the working conditions of residents. Since the agency pays teachers’ hospitals to train residents, the facilities should be held accountable for how they treat them, he said. And the Accreditation Council for Graduate Medical Education, which sets work and educational standards for residency programs, is moving in the right direction with new requirements, such as paid family vacations, he added, but more needs to be done.

How far these unions will go in achieving their goals is an open question.

Strikes among doctors are rare. The last CIR strike was in 1975, by residents of 11 New York hospitals.

Naranjo said a strike would be his last resort for LA county members but blamed the county for the persistent delay and cancellation of the bargain. Among its demands, the union has matched the county’s wage increase for members of SEIU 721, a union that represents other county employees and is calling for a $ 10,000 housing allowance.

The union member survey found that most LA County residents reported working 80 hours a week, Naranjo said.

Coral Itzcaly, a spokeswoman for the LA County Health Services Department, thanked her “heroic” front-line staff for providing “the best care in the class” and acknowledged the significant damage the epidemic has done to their personal and professional lives. He said hours were set by the Accreditation Council for undergraduate medical education and that most trainees reported working “significantly less” than 80 hours a week.

Jesus Ruiz, a spokesman for the LA County Chief Executive’s Office, which conducts labor negotiations for the county, said in an email that the county hopes to reach a “fair and financially responsible agreement” with the union.

The results of the May 31 strike vote are expected to be announced, the union said.

The story was produced by KHN, which publishes the California Healthline, an editorially independent service of the California Health Care Foundation.

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