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Join Kelley Butler, a family medicine resident and member of the Committee of Interns and Residents/SEIU, as we delve into the financial struggles faced by health care workers, focusing on the experiences of resident physicians. We discuss the impact of inadequate compensation on patient care, burnout rates, and the overall well-being of health care professionals. Our discussion centers around Senate Bill 525, which aims to address these challenges by advocating for a fair living wage for health care workers. Tune in to discover the importance of equitable compensation and the potential benefits of a more diverse physician workforce.

Kelley Butler is a family medicine resident and member, the Committee of Interns and Residents/SEIU.

She discusses the KevinMD article, “To improve health care, respect doctors’ humanity with a living wage.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast and get CME for this episode by clicking on the CME link in the show notes. Today we welcome Kelley Butler. She’s a family medicine resident and member of the Committee of Interns and Residents/SEIU. Her KevinMD article is titled “To improve health care, respect doctors’ humanity with a living wage.” Kelley, welcome to the show.

Kelley Butler: Hi, Kevin. Thanks for having me.

Kevin Pho: So we’ll get into the article in a little bit. First off, just briefly share your story and journey to where you are.

Kelley Butler: Sure. So I’m a Los Angeles native, born and raised. I come from a background of folks that are mostly in corporate America and education, so there’s a little bit of an inkling as to why labor matters to me. I went on to Howard for undergrad, which formed a lot of my politics, moving through a historically Black university. I come from a long lineage of people that were trained in those systems of education as well. I went straight through to medical school at UC Irvine, and now I’ve landed here at UCSF for residency.

Being in San Francisco has been really interesting and really empowering. I’m lucky enough to say that I really like my program, so that’s beautiful. And what being in San Francisco has also presented is the opportunity to really flex the muscles of being a physician advocate. A lot of that was informed for me in medical school, understanding that so much of the health reality of a patient was dictated outside of the exam, and so much of how we moved through the labor force was dictated by our own social action, as medical students at that time and now as residents.

I don’t think we can really rely on the system to do right by us and for us on its own, because it wasn’t designed to. Residencies were not created in order for residents to be treated well; that’s not where that comes from for us. And so now I’ve taken up the helm of leadership in our union space, and it’s been a beautiful place to flex my interests in policy and advocacy, in making our lives a little bit better, and in how we make sure that we can show up with full cups to pour from for our patients. That’s a lot of what my article explores: how we’re not pouring from full cups, and why that is.

Kevin Pho: Now, before we talk about your article, you’re a member of the Committee of Interns and Residents/SEIU. For those who aren’t familiar with that organization, just tell us a little bit about that.

Kelley Butler: The Committee of Interns and Residents is a local of SEIU. We represent a little over 25,000 residents and fellows across the country, specifically in 11 states. We are the largest union that represents residents like myself, people that are in training, doctors in training, and we represent their interests in everything, from how we show up in the workplace, to what kind of work we do when we get there, to how we’re paid.

My specific role in this union space has been as the president of our bargaining unit here at UCSF. I act as a delegate to the larger national organization on behalf of UCSF, and I’m involved in our committee on political education, which is our political action committee, where non-dues, donations-only work is happening to move legislation and political agendas forward that support both our interests as trainees and those of our patients.

Kevin Pho: Your KevinMD article is titled “To improve health care, respect doctors’ humanity with a living wage.” Now, how did your article come together?

Kelley Butler: Out of desperation. Moving to San Francisco, I thought I had a grip on what it meant to live and work in an expensive city. I outlined that I’m from L.A., which is one, and D.C. I didn’t mention it, but I went to school in Boston too. So I thought I knew what it was like to go to work and live in an expensive city, and was I wrong. I never thought that after being in school for the last 12 years, I would be living paycheck to paycheck, hand to mouth. I did not think that was going to be my reality as a physician.

I’m a doctor. I take care of a lot of people. I’m of the workforce where, if we didn’t show up to work tomorrow as physicians, the system would crumble. The system is deeply reliant on our labor. Silly me thought that meant life would be comfortable, at a minimum that I would have my basic needs met, and maybe a little bit, enough to save or think about starting a family. I didn’t think that was such an incredible ask, but apparently it is.

So my article details the financial reality of encountering a vet bill that’s about a quarter of my salary and the brakes on my car breaking down at the same time, and the fact that my partner and I, who are gainfully employed resident physicians, couldn’t afford to fix or do either, let alone both. Now, when we’re thinking about making decisions about things that are necessary to live, like a car to get to work or your dog’s health, you shouldn’t be struggling in that reality, especially not if you’ve donated and dedicated so much of your life to this field.

I just don’t think that’s an unreasonable ask: to be able to have our basic needs met, to take care of our families, to take care of the emergencies, to not let something like a $1,000 vet bill equal financial ruin, right? I don’t think that’s unattainable, or it shouldn’t be. And so this article comes from a place of being deeply unsatisfied with that reality, and really challenging the idea of how we as residents, and largely health care workers across the entire health care system, are compensated for our contribution.

Because again, if we didn’t show up to work, things would go really, really wrong. People would suffer. People might even lose their lives. That’s how vital our contribution is. And what this article, and largely this legislation that we’re pushing for, asks is that our contribution match our compensation.

Kevin Pho: So give us a sense: In general, how are residents compensated these days? Because it’s been decades since I was in residency. Just give the lay of the land of the financial landscape. Is this specific to high-cost-of-living areas like San Francisco? Is this happening across the country? Just give us a sense of how pervasive this issue is among resident physicians today.

Kelley Butler: This is not an issue that’s unique to residents in extremely expensive cities. The reality for residents is we’re making, on average, something in the $60,000-per-year range, boasting $200,000 debts that we’re going to have to repay in a couple of months, working 80 hours a week. And when you do the math, we get paid less than minimum wage for the work that we do. That’s not unique to San Francisco; it’s pervasive.

And so when we are thinking about legislation, Senate Bill 525, which would establish a basic minimum wage for all health care workers, not just residents, of $25, it’s in order to lift up the entire system, and also to set a precedent that this is possible: that you actually can pay people to equate to their worth, that it’s not some fantasy that residents don’t have to live in poverty, because that’s the reality.

Recent studies were published, especially up here in the Bay Area, out of Berkeley, and they indicated that about 48 percent of the health care workforce in this state is dependent on social services like Medi-Cal or food stamps. So again, it’s not something that’s unique to residents either. It’s not unique to California. It’s not unique to San Francisco. It’s a health care workforce issue. And that’s why this bill is so important. That’s why the organizing effort around this is so important, because it spans the entire sector.

It’s not just residents saying we need to be paid more. It’s the entire system saying, “Workforce shortages are impossible. I can’t afford to put food on my table as a janitor, environmental service worker, cafeteria worker, nurse, etc.” And that’s unacceptable. Our people, who are so gainfully employed, who have dedicated so much time to education and training, who do something as pivotal and vital and important as taking care of the lives of human beings, are relying on public assistance. That’s unacceptable. It just is. And so by lifting the minimum hourly wage for all workers to at least $25 an hour, it’s going to lift so many health care workforce sectors, or parts, above that level of poverty, so they can better take care of themselves. That’s what it’s really about.

Kevin Pho: You alluded to this a little bit earlier. Tell us about some of these financial stresses and pressures. How do they affect you as a resident physician taking care of patients?

Kelley Butler: I think the workforce shortage piece is the most important to think about when it comes to our worth not being matched with our compensation. If people don’t feel like they can be reasonably compensated in the job, they’re just not going to take it. What that means is, my patient shows up to the emergency room and says, “Hi, I had this complaint.” Someone triages them, someone sees them and dictates that they need to be admitted to the hospital, for example. That person is waiting to get into a room because there aren’t enough janitorial staff to clean it. That person is waiting an extra three hours to start their Lasix for their heart failure exacerbation, for example, because there aren’t enough nurses to get the med to that person. That person might be waiting in the emergency room waiting room for four extra hours because they had to close an entire unit of the emergency room, because there’s not enough staff.

And here I am as a doctor who really just wants to do well by this person and practice the medicine, and I can’t, because of systems issues, because of workforce issues, because of shortage issues. That affects patient care. And what that person is going to do, even though they’re huffing and puffing, can’t breathe, are in an exacerbation, and really need some support from us, is leave. They leave because they don’t want to wait, because the room couldn’t be turned over, there wasn’t enough nursing staff, there wasn’t someone to cart them upstairs to the room on the inpatient floor. That’s unacceptable, that someone could then suffer because we couldn’t figure out how to compensate our workforce enough. That’s what it feels like.

Beyond that, it also means that the moral injury that we experience as physicians is not even thought to be addressed, as residents especially, when we are dedicating so much time to this profession, and willingly so. We sign up to do this for a reason. I have my reasons for being a physician, and that hasn’t left me, but it doesn’t mean that I should be expected to suffer.

So I want to address the moral injury too, which can be somewhat quelled or ameliorated with adequate compensation. It’s that at least, if I’ve gone through the wringer, I’ve gone through a hard day, I’ve taken care of patients who have had COVID and died in front of me, etc., etc., all the trauma that we know well, right, at least I’m not then going home to an empty fridge. At least, right? That’s what I mean about the moral injury. At least I can go home to some comfort. At least I can put away for savings. At least I can afford child care while I’m at work for 14 hours a day. At least, right? And that’s what this bill has made possible, with the mobilization of a lot of people like residents.

Kevin Pho: So tell us about the role of the union. What is the Committee of Interns and Residents, what are you guys doing about it?

Kelley Butler: So the Committee of Interns and Residents has really taken up the helm in identifying some legislative partners and introducing Senate Bill 525 into the legislature. In this effort, we’ve had to have really good conversation and dialogue with our partners in the legislature in order to make sure that this is something that could actually get through. And so we’ve made some concessions. For example, the legislation has changed; this is a really dynamic process. The bill still provides for $25 an hour for health care workers in California, but now, in the updated bill, it’s just 1.5 times the rate that we would be paid. So that means a minimum resident salary of about $78,000 a year.

Now, for full transparency’s sake, some of us are making more than that, and some of us are making less. And so I’m really excited to be able to uplift the residents that are making less, and that’s what our union is able to do. Our union, with contributions to our political action committee outside of our dues, is able to push legislation like this forward that not only uplifts us as residents, but the entire health care workforce. We’re able to show up in Sacramento and shake the hands of legislators and say, “This is why this matters to me, and this is why I’m bringing this to your attention.” With the support of my union, I’m then able to take that legislative effort and power back to my bargaining unit at UCSF and say, “Hey, look what we’re doing at the state level. Can you match that or do better?”

It’s the ability to work in a collective space, because the voice of one resident, while powerful and meaningful, is simply not as strong as the collective voice of our union. And that’s what it means to be a unionized resident, to me. It means that your voice and your needs are heard, because there are so many more voices saying the same thing than just you. It also means that the concern that’s probably shared among you and your co-residents is not lost in the void. It means that it’s uplifted, enforced through contract language, and addressed in the legislative vehicles as well.

Kevin Pho: So give us examples of some wins from your resident union, or resident unions across the country. What are some measurable wins that you have gained?

Kelley Butler: I’m really proud of what we were able to do at UCSF, actually. Our bargaining cycle was a long one and a grueling one, but a rewarding one. We came out as now the highest-paid residents in the country, even though we are still considered low income in San Francisco. We managed to win a fertility benefit, because a lot of our reproductive years are spent working, so we don’t have the time to build families, and I already spoke to how we don’t have the financial resources to do that either. So now we can do things like freeze our eggs or go for an infertility evaluation, which is an unfortunate reality for us as residents.

We managed to double our parental leave, from two weeks before us being unionized to now eight weeks. Again, woefully insufficient, but still a win. We managed to protect some of how we are able to access personal protective equipment. And if we don’t have things like masks walking into the room of someone with tuberculosis, or proper lead to cover us as we walk into a room where we’re going to be exposed to radiation, we can actually then escalate that. There are a number of different things that we are really proud to have won here at UCSF, and things that I hope our partners at other shops who are still in bargaining can win as well. Looking at you, Stanford. Looking at you, Massachusetts General. Looking at you in Boston. Looking at you in Pennsylvania.

Kevin Pho: Take us into that negotiating room. I’ve always wondered, what’s it like negotiating with people that could be your colleagues? So what’s it like when you’re negotiating for these?

Kelley Butler: I personally think that it’s a little bit of an opportunity to take the power back. So much of our lives as residents is dictated by someone else: our schedule, when we show up and go home, who we see, what we do, how we’re trained, who trains us. None of that’s dictated by us. Not even really where we go to train is dictated by us. We just put in an application into the computer abyss and hope that it spits out a place that we would like to be. So much of our reality in the workplace is not dictated by us.

Contrary to popular belief, we don’t negotiate a salary when we are hired, like most people in the workforce do. We don’t get to say, “Here’s the time that I’ll take off.” I can’t just request paid time off anytime that I want to. So much is out of my power, and the bargaining process for us is the opportunity to take some of that power.

What it also means is that I have the opportunity to connect with people across programs. You can often feel really siloed as a resident, just in your program or your field of study, so that you don’t have the opportunity to connect with the other members of your resident workforce. And that’s what bargaining also afforded: this chance to hear about the concerns about lead and radiation, because that’s not my reality as a family doc. I don’t understand that struggle. I don’t know what it means to go to work and not have lead. I don’t know what it means to lose a child that was in my womb because I was exposed to radiation. I don’t know that as a struggle, but my co-residents and co-fellows did.

And so when we were able to come together in that bargaining room, it was about making sure that, again, that complaint, that need, is not lost in the void. And that’s what bargaining affords: that you can have that interplay and dialogue between people. It also affords this political mobility that I think is pretty incredible. It also means being across, figuratively, since we were mostly operating on Zoom, from people that are trying to protect the interests of the institution, which are often quite contradictory with the interests and needs of residents, or the people that are uplifting and supporting them.

Kevin Pho: We’re talking to Kelley Butler. She’s a family medicine resident and a member of the Committee of Interns and Residents. Her KevinMD article is titled “To improve health care, respect doctors’ humanity with a living wage.” Kelley, tell us some of the take-home messages that you want to leave with the KevinMD audience.

Kelley Butler: That physicians have power. I want to make sure that everyone who’s listening to this knows that you have power. If you’re the physician, the medical student, the resident, the fellow, it doesn’t matter your stage of training, you have power to effectuate progressive change for your patients and yourself. There’s no need for you to suffer at the helm of this system if you don’t have to.

I also believe strongly that unionization matters, and I’m so excited that we’ve had such a new swell in waves of people coming into our union space. If you can, seek it out. If you want to ask questions of us, head over to our website, set up a meeting with one of our organizers, and learn more about what it means to be unionized at your program and your work site. We can do this if we do it together.

Kevin Pho: Kelley, thank you so much for sharing your story, time, and insight, and thanks again for being on the show.