Burned out by Covid and 80-hour weeks, resident doctors are unionizing

In the first weeks of the pandemic, Dr. Lorenzo González, then a family medicine resident at Harbor-UCLA Medical Center, faced exhaust fumes as a sophomore and worked up to 80 hours a week in the ICU. He was constantly petrified that he would contract the Covid-19 virus and felt guilty about not having enough time to help his ailing father.

In April 2020, his father, a retired landscape gardener, died of heart and lung failure. González mourned alone. His work as a doctor-in-training put him at high risk of contracting the virus, and he didn’t want to accidentally pass it on to his family. Financial stress also set in as he faced high funeral expenses.

Now, González is calling for better pay and benefits for residents who work grueling hours at Los Angeles County Public Hospitals for less than $18 an hour — while caring for the county’s most vulnerable patients.

“They take advantage of our altruism,” González said of the hospitals. He is now Chief Resident of Family Medicine at Harbor-UCLA and President of the Committee of Interns and Residents, a national union representing junior doctors and part of the Service Employees International Union.

“We need recognition for the sacrifices we’ve made,” he said.

Residents are newly graduated doctors who have completed medical school and must complete three to seven years of training at established teaching hospitals before they can practice independently. Under the supervision of a teaching physician, residents examine, diagnose, and treat patients. Some aspire to additional training in medical fields as “Fellows”.

These trainees are uniting in California and other states to demand higher wages and better benefits and working conditions amid deepening burnout during the pandemic. They join nurses, nursing assistants and other healthcare workers who are unionizing and threatening to strike as staff shortages, the rising cost of living and patchy supplies of personal protective equipment and Covid vaccines have marginalized them.

More than 1,300 unionized residents and other trainees at three LA County public hospitals, including Harbor-UCLA, will vote May 30 to strike for increases in their salaries and housing benefits after months of a stall in negotiations with the county. Since March, residents at Stanford Health Care, the Keck School of Medicine at the University of Southern California and the University of Vermont Medical Center have been unionizing.

“Residents were always working crazy hours, then the stress of the pandemic hit them really hard,” said John August, principal at Cornell University’s School of Industrial and Labor Relations.

The Association of American Medical Colleges, a group representing teaching hospitals and medical schools, didn’t directly address the trend toward unionization among residents, but the organization’s chief health care officer, Dr. Janis Orlowski, through a spokesman, said that a residency is a job of education and that a resident’s primary duty is to be educated.

Residents are paid while they study, train and work as apprentices, Orlowski said, and the association works to ensure they receive effective training and support.

David Simon, a spokesman for the California Hospital Association, declined to comment. But he forwarded a study published in September in the JAMA Network Open that found interns in unionized programs did not report lower burnout rates than those in non-unionized programs.

So far, none of the new chapters have negotiated their first contracts, the national union said. But some of the long-standing ones have achieved improvements in pay, benefits and working conditions. Last year, a residents’ union at the University of California-Davis secured housing benefits and paid parental leave with its first contract.

With more than 20,000 members, CIR represents approximately 1 in 7 prospective physicians in the US. Executive Director Susan Naranjo said that before the pandemic, a new chapter was organized every year and that eight have joined in the past year and a half.

Long before the pandemic, the working conditions of local residents were under scrutiny.

According to Medscape, a news site for doctors, the median salary for residents in the US in 2021 was $64,000, and residents can work up to 24-hour shifts, but no more than 80 hours per week. Although a poll released last year found that 43% of residents felt they were being paid adequately, union organizers say wages are too low, especially given residents’ workloads, their student loan debt and rising rates cost of living.

The wage rate disproportionately affects residents from low-income and communities of color, González said, because they have less financial support from family to subsidize their medical education and pay other costs.

But with little control over where they train – medical school graduates are matched by an algorithm to their place of residence – individual residents have limited bargaining power with hospitals.

For unionized residents looking for a seat at the negotiating table, pay increases and benefits like housing benefits often top the list, Naranjo said.

Patients deserve doctors who aren’t exhausted and preoccupied with financial stress, said Dr. Shreya Amin, Endocrinology Fellow at the University of Vermont Medical Center. She was surprised when the facility refused to recognize the residents’ union, she said, given the personal sacrifices they made to provide care during the pandemic.

If a hospital does not voluntarily recognize a union, CIR may request that the National Labor Relations Board hold an election. The national union did so in April, and with a certified majority, the Vermont chapter can now begin collective bargaining, Naranjo said.

Annie Mackin, a spokeswoman for the medical center, said in an email that it is proud of its residents who have provided exceptional care during the pandemic and respects their decision to join a union. Mackin declined to address local residents’ concerns at the workplace.

dr Candice Chen, associate professor of health policy at George Washington University, believes federal centers for Medicare & Medicaid Services also have some responsibility for residents’ working conditions. Because the agency pays teaching hospitals to train residents, it should hold facilities accountable for how they treat them, she said. And the Accreditation Council for Graduate Medical Education, which sets labor and educational standards for residency programs, is going in the right direction with new requirements like paid family leave, she added, but needs to do more.

How far these unions will go to achieve their goals is an open question.

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

Naranjo said a strike was the last resort for LA Borough members, but accused the borough of constantly delaying and canceling negotiation meetings. Among other things, the union is demanding that the county match wage increases for members of SEIU 721, a union that represents other county employees, and a $10,000 housing benefit.

The union’s membership surveys found that most LA County residents reported working 80 hours a week, Naranjo said.

A spokeswoman for the LA County Department of Health, Coral Itzcalli, thanked his “heroic” frontline workers for providing “the best care” and acknowledged the significant toll the pandemic has taken on their personal and professional lives. She said hour limits were set by the Accreditation Council for medical education and most trainees report working “significantly less” than 80 hours a week.

Jesus Ruiz, a spokesman for the LA County Chief Executive Office, which leads labor negotiations for the county, said via email that the county hopes to strike a “fair and tax accountable contract” with the union.

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

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

This article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health policy research organization not affiliated with Kaiser Permanente.

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