In 2019, residents organized coast-to-coast to protest low pay, unsafe working conditions, and insufficient benefits. Residents at the University of Washington and UCLA walked out of the hospital in reaction to stalled contract negotiations. Residents at Yale interrupted a meeting to introduce a “Resident and Fellow Bill of Rights,” outlining basic rights such as a living wage and safe working conditions that all residents should have access to.

In addition to work hours, “housing insecurity, food insecurity, issues with access to childcare are all factors that negatively affect an individual’s ability to provide the highest level of care,” says Dr. Kellie Satterfield, the president of the University of Washington Housestaff Association and ophthalmology resident.

It is odd to hear doctors worrying about food and housing. Dr. Zoe Sansted explains, “In residency, you are caught in two worlds where you are a professional and also are exploited labor.” Dr. Zoe Sansted is the vice president of the University of Washington Housestaff Association and a family medicine resident. But with stagnant wages, many residents struggle to keep up with the cost of living. “For call purposes, people still have to live in the most expensive neighborhoods with rising rent,” says Dr. Satterfield.

Why does this matter to patients?

Because residents are workers, and their work will affect patients. Toxic work conditions and fatigue contribute to medical errors. “We are human, and we don’t need to be proving our toughness by working more than 80 hours, especially because there are concrete implications for patients,” says Dr. Eden Almasude, a psychiatry resident at Yale.

This is a settled issue, codified in Libby’s Law, which imposed work hour restrictions for residents after under-supervised and overworked residents failed to recognize a medication error that killed a young woman in New York.

“There is a general crisis of physician wellness and burnout,” says Dr. Sansted, “and that interacts with residents.” “It takes two graduating medical school classes just to replace the number of doctors who commit suicide” every year, says Dr. Almasude.

Drs. Almasude, Sansted, and Satterfield unanimously agree that the poor working conditions and inadequate benefits that residents receive are both patient safety and workers’ rights issues.

To become a resident, you must complete four years for an undergraduate degree, then four years of medical school. Then, medical students apply for “The Match.”

“The Match” is an algorithm designed to optimize student and program preferences to “produce the best possible outcome for filling training positions available at U.S. teaching hospitals,” according to “The Match” website. Students across the country receive their marching orders in the spring and move to their new training hospitals in June.

Several outlets have reported on the average debt that medical students collect. The pressure to make enough to pay off these loans can make residents feel trapped. “If I don’t finish residency, I don’t know how I will pay back hundreds of thousands of dollars in loans,” says Dr. Walker Keenan, a psychiatry resident at Yale University.

The health care system has felt financial pressures that trickle down to patients and residents. Hahnemann University Hospital (HUH), an urban, safety-net hospital in Philadelphia, declared bankruptcy in mid-2019.

In a very public debacle, 571 residents and other trainees had to scramble to find other training programs.

Without completing their training, these residents cannot become accredited, start working, or efficiently pay off their student debt. HUH is just one hospital affected by a wave of hospital closures sweeping the country. According to the Sheps Center for Health Services Research at the University of North Carolina, 124 rural hospitals closed in the last decade, including four in the first six weeks of 2020.

Perhaps due to these financial pressures and a lack of will, “resident pay, adjusted for inflation, has never gone up since the 1960s,” says Dr. Sansted. According to a national survey by the Association of American Medical Colleges, the average first-year resident salary was $57,863 in 2019. However, residents often work 80+ hours per week.

So on average, residents earn about $15/hour. In addition, residents often have limited access to health care and pitiful child care assistance. “Residents don’t ask for much. They don’t know their rights, and they get taken advantage of,” says Dr. Sansted.

“The [Resident and Fellow] Bill of Rights is about basic fundamental human rights that we should have access to,” Dr. Almasude says. The document “creates a common understanding for residents and administrators to talk in,” says Dr. Keenan. He continues, “Quite frankly, there is not a good understanding of what residents need,” but adds, “not knowing what residents need is awfully generous. It’s awfully convenient that [administrators] think what [residents] need is so much cheaper than what [residents] really need.”

One of the motivations for the creation of the Resident and Fellow Bill of Rights was “to take away the weapon of ignorance that administrators use when things go wrong,” explains Dr. Keenan.

One key right outlined in the document is the right to a living wage. “Lots of people make straw man arguments, such as ‘what if someone wants a living wage of $200,000 per year? How will we ever fund that?’ Those arguments are made in bad faith,” explains Dr. Keenan. Dr. Sansted adds what a living wage may mean for residents in Seattle, “what I think we deserve is increases in pay that account for the increase in the cost of living in Seattle. I think we deserve yearly raises of 4% that keep up with that.”

That is nowhere close to $200,000.

The institution of residency requires a structural change to be just for patients and workers say Drs. Almasude, Keenan, and Sansted. One key step in the right direction is preserving current gains and increasing wages and benefits for residents.

Dr. Almasude concludes, “I hope that more folks in positions of power would trust their residents, who are running the hospital, that we want something better for our patients.”

Sejal Parekh is a pediatric resident and can be reached on Twitter @sejalparekhmd.

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