Covid and tired of working 80 hours a week, residential doctors

In the first weeks of the epidemic, Harbor-UCLA Medical Center second-year family medicine resident Dr. Lorenzo Gonzalez worked in the intensive care unit for up to 80 hours a week. He was always afraid of being infected with Kovid-19 and felt guilty for not having enough time to help his ailing father.

In April 2020, her father, a retired gardener, died of heart and lung failure. Gonzalez alone has doubled. Her job as a trainee doctor put her at high risk of contracting the virus and she did not want to infect her family. Economic pressures also gripped him because he had to face the high cost of burial.

Now, while caring for Gonzalez County’s most at-risk patients, Los Angeles County Public Hospital is calling for better pay and benefits for residents who he says earn less than 18 an hour.

“They’re taking advantage of our altruism,” Gonzalez said. He is now head of Family Medicine at Harbor-UCLA and chair of the Interns and Residents (CIR) Committee, a national union representing trainee physicians and part of the Service Employees International Union (SEIU).

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

Residents are newly trained physicians who have completed medical school and must take three to seven years of training at a university hospital before being able to practice independently.

Under the supervision of a medical professor, residents examine, diagnose, and treat patients. Some seek additional training in medical specialties as Fellows.

These doctor-in-trainers are banding together in California and other states to demand higher wages and better benefits and working conditions, following a lot of stress during the epidemic.

As such, they join nurses and nurses, nursing assistants and other health workers who are unionizing and threatening to go on strike, as staff shortages, rising living costs and a lack of uniformity in the supply of personal protective equipment and vaccines against covidia push them. To the limit.

More than 1,300 union residents and other physicians are being trained at three Los Angeles County Public Hospitals, including Harbor-UCLA.

Since March, residents of Stanford Health Care, the University of Southern California Cake School of Medicine, and the University of Vermont Medical Center have been in union.

John August, director of Cornell University’s School of Industrial and Labor Relations, said: “Residents have always worked crazy hours, but the pressure of the epidemic has hit them hard.”

The Association of American Medical Schools, a group representing teaching hospitals and medical schools, did not directly address the residents’ tendency to unite, but the organization’s head of healthcare, Dr. Janice Orlowski, communicated through a spokeswoman that the residence is an apprentice, and that a resident. The job is to provide training.

Orlovsky said residents are paid to be apprentices as apprentices, working to ensure they receive effective training and assistance.

David Simon, a spokesman for the California Hospitals Association, declined to comment. But he pointed to a survey published in the JAMA Network Open in September that showed that surgical residents on syndicated shows did not report lower burnout rates than non-syndicated shows.

According to national union sources, no new union group has reached an agreement so far. However some of the oldest have improved wages, benefits and working conditions. Last year, a union of University of California-Davis residents offered housing grants and parental leave.

With over 20,000 members, CIR / SEIU represents one in seven physicians training in the United States. Its executive director, Susan Naranjo, said a new union group was formed each year before the epidemic, and eight and a half joined last year.

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

The average salary for U.S. residents in 2021 was $ 64,000, according to MedScape, a news website for doctors, and residents can work up to 24 hours in a shift, but not more than 80 hours a week.

Although a survey whose results were published last year found that 43% of residents received adequate compensation, those united said wages were too low, especially due to residents’ work pressure, their debt, student debt and rising living costs.

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

However, with little control over where they train – the algorithm of medical school graduates determining their place of residence – the ability of individual residents to negotiate with the hospital is limited.

To listen to union residents, benefits such as pay rises and housing stipends are often a priority, Naranjo said.

Dr. Shreya Amin, a fellow in endocrinology at the University of Vermont Medical Center, said patients deserve doctors who are not worried about burns and financial stress. Amin was surprised that the agency refused to recognize the residents’ union, considering their personal sacrifices 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 she is proud of her residents for providing exceptional care during the epidemic and respects her decision to join a union. McCain declined to address residents’ concerns about working conditions.

Dr. Candice Chen, a professor of health policy at George Washington University, believes that the Center for Medicare and Medicaid Services (CMS) also bears some responsibility for the working conditions of residents. Since the agency pays hospitals to educate residents, centers should be held accountable for how they treat them, he said.

And the Accreditation Council for Postgraduate Medical Education, which sets employment and educational standards for residential programs, is moving in the right direction with new requirements, such as paid family vacations, but more needs to be done.

It remains to be seen how far these unions will go in achieving their goals.

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 a last resort for its members in Los Angeles County, but blamed the county for continuing delays and canceling bids. Among its demands, the union county complied with the salary increase paid to members of SEIU 721, a union that represents other county employees and called for a $ 10,000 housing subsidy.

A survey of union members found that most Los Angeles County resident physicians said they worked 80 hours a week, according to Naranjo.

Coral Itzakley, a spokeswoman for the Los Angeles County Department of Health Services, thanked her “heroic” frontline staff for providing “the best care in the class” and acknowledged the significant burden the epidemic has placed on their personal and professional lives. He said the Accreditation Council sets hours limits for postgraduate medical education, and most doctors-in-training say they work “significantly less” than 80 hours a week.

Jesus Ruiz, a spokesman for the Los Angeles County Executive Office, which conducts labor negotiations, 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.

This story was produced by KHN, published by the California Healthline, the editorially independent service of the California Health Care Foundation.

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