Since COVID-19 hit the nation, essential workers, including those in health care, have been applauded as “heroes” as they put their own lives at risk for the greater good. Articles about the mistreatment of health care workers, including oft-ignored resident doctors, have made headlines, focusing on the need for loan forgiveness, hazard pay and personal protective equipment, parallel to wartime protections for soldiers.
Resident doctors, who constitute a bulk of frontline providers, are newly minted doctors, fresh out of medical school and continuing their training in specialties from psychiatry to surgery. Mistreatment of residents, glamorized in TV shows as an initiation ritual of sorts and a way to prove mental fortitude, is not new, and has been rampant for decades. Titled “residents,” they once lived in the hospital, and even now they endure 80+ hour weeks and 28-hour shifts, often at minimum wage. In 2017, The Atlantic pointed out that “neither truck drivers nor bankers would put up with a system like the one that influences medical residents’ schedules.”
We can and must enact specific policies that can increase overall funding for and change the broken system that existed for all residents far before this war began.
The coronavirus pandemic did not create, but rather highlighted existing systemic racial and socioeconomic inequalities. The same can be said for systemic issues in medical training. While loan forgiveness and hazard pay would help resident doctors, these mere Band-Aids for those working amid the coronavirus pandemic do little to heal the deep, chronic wounds suffered by doctors during medical training. It should not take a pandemic to treat residents like humans. We can and must enact specific policies that can increase overall funding for and change the broken system that existed for all residents far before this war began.
I am a child psychiatry fellow in New York City redeployed to medical teams to lead end-of-life discussions. I’m proud to help alleviate the suffering of hospitalized COVID-19 patients, and I’m lucky I have the option to work virtually. Resident doctors like myself and prematurely graduated medical students all over the country have been redeployed to jobs for which we did not sign up, at the sacrifice of valuable training in our desired specialties. PPE is scarce, days have become a flurry of deaths, intubations, goodbyes and “Do you want to be on life support?” discussions. Compassionate residents obediently serve new roles, with no option but to repress fear of contracting the virus, or of the trauma that would ensue. But this scenario is a new low to an already inhumane problem.
Resident doctors, myself included, and prematurely graduated medical students all over the country, frequently without choice, have been redeployed to jobs for which we did not sign up, at the sacrifice of valuable training in our desired specialties.
At baseline, residents already spend day and night in the hospital, often coerced to lie on timesheets so programs don’t lose accreditation for surpassing 80-hour workweeks. We accept scarce benefits (for many, this includes only four weeks of paid maternity leave, inclusive of vacation and sick days) and lack of typical employment protections. It is not uncommon for residents to experience lapses in paychecks and health care coverage; this can result in the inability to pay rent and medical expenses ― something I experienced firsthand. We are often expected to begin a fellowship, specialty training that happens after residency, before residency ends (think overlapping shifts in Los Angeles and Boston on July 1).
Many of us signed up as young 20-somethings and face an average of $250,000 of student debt, as well as spending thousands on board certification tests and credentialing and moving cross-country on our own dime. We are trapped in a hierarchy that essentially owns us. If we quit, we are left with no way to repay our debt. We love our jobs. We just want basic rights.
Tax dollars fund resident training primarily through Medicare, and hospitals can allocate extra funding to increase the number of residents or pay. In 2014, funding for Mount Sinai Hospital in New York City provided roughly $173,000 per resident, while on average it paid residents $60,000. This statistic is made more shocking given studies that show hospitals, despite incurring costs for educating residents, still profit an extra $160,000 to $218,999 per resident doctor annually. Hahnemann University Hospital in Philadelphia, which in 2019 filed for bankruptcy, auctioned 550 residency slots for a total of $55 million.
If we quit, we are left with no way to repay our debt. We love our jobs. We just want basic rights.
Because residents are “trainees,” protections in other jobs do not apply to us or our union, which recently drafted a resident Bill of Rights requesting basic rights. Our exploitation for monetary gain, disguised as “education,” results in increased depression rates, suicides (many hidden), poor quality of life and the pressure to choose jobs based on salary rather than where need exists, leading to health care inequalities that itself kills.
With hundreds of millions of federal dollars allocated to bail out large corporations, and many hospitals substantially profiting off residents, both the government and hospitals can easily increase resident funding, if we are prioritized. I, alongside other American Psychiatric Association leaders, have advocated at the White House for policies that could increase graduate medical education funding, including the Resident Physician Shortage Reduction Act of 2019, which would expand the resident workforce and thus improve inhumane work hours, protections, benefits, and pay. Increased funding at the government and hospital levels would cut this problem at its root.
This pandemic will pass, in part due to the lifesaving efforts of resident doctors, but as we suffer in silence, our inhumane conditions will persist. It’s time to put an end to the exploitation.
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