How can residents have their rights protected in times of crisis? Rose Olson looks to labor organizing efforts for some answers

Not even the masks on our faces could hide our shared shock. The governor of New York, Andrew Cuomo, had just announced that work hour restrictions for resident doctors would be suspended during the coronavirus pandemic. Just up the coast in nearby Boston, my fellow residents and I sat in silence. Would this same story unfold in our hospital?

In the midst of this crisis, more is being asked of resident doctors like myself and, for the most part, we are dutifully obliging. My co-residents and I understand that personal sacrifice is often a necessary part of this job. It’s why we devoted the better part of our 20s to spending Saturday nights in silent libraries and 28 hour shifts in intensive care units. Resident doctors also share a deep sense of professional duty–we meant every word we recited of the Hippocratic Oath.

Yet in the face of mounting demands and dwindling personal reserve, our capacity may reach its limit. At what point do increased expectations become exploitation of our professional ethic? And in times of crisis, how do we ensure that residents’ rights are being protected? 

Residents arguably supply the cheapest and most flexible physician labor in hospitals. Many residents have been redeployed to staff covid-19 floors where they face the risk of occupational exposure to SARS-Cov-2, the virus that causes the coronavirus disease. Given the national shortage of personal protective equipment (PPE), many health professionals have had to work without adequate protection. With almost daily news stories of physicians dying from covid-19, residents worry for their own safety, and the potential impact on their families and patients. 

Even before this pandemic, there was a high prevalence of depression and suicide among residents. Yet now some residents have to live with the fear that they are vectors and will transmit the virus unknowingly to others. Many are also facing increased isolation, especially those who have moved away from family and loved ones to prevent potential exposure. 

Many educational opportunities have also been disrupted or cancelled, such as elective rotations, which are crucial for professional development and readiness for unsupervised practice. It is still unclear how the crisis will affect national graduation dates and requirements for resident physicians.

Perhaps most concerning is that many of these rapidly changing expectations and safety hazards have not been met with recompense. Residents are the lowest paid doctors and many work up to 80 hours per week, leaving them with less security in the event of an emergency. Additionally, there is an increased opportunity cost of coming to work—for example, the price of commuting when public transportation is reduced or shut down, or the cost of childcare when work hours are extended, and older caretakers can no longer safely be around children. Some resident doctors have advocated for hazard pay, although this has been criticized by hospital leadership in some cases, with the professional ethics of residents even being called into question. 

And what if a resident contracts covid-19 at work and becomes critically ill? Or has a relapse of a psychiatric illness due to the overwhelming stress? What would fair compensation look like, then?

Some solutions may be just down the hospital corridor. Nursing professionals in the US have a long and successful history of using organized labor to bring about changes in hospitals, often through unions. It is not entirely clear why physicians’ efforts at labor organizing have been far more sporadic.

Perhaps physicians feel labor organizing should be reserved for blue collar workers, not more well compensated professions like medicine. Or maybe it’s a shared physician value of service to others that makes advocating for physician rights seem selfish or unprofessional. Perhaps it’s because doctors are by nature risk averse, and fear that these activities would negatively impact their professional reputation. Or it could be that doctors simply do not have the bandwidth to take on another task. Whatever the cause, the paucity of labor organizing may be a lost opportunity to improve physician and patient wellbeing.

History shows us that, although infrequent, there have been well executed, successful examples of physician labor organizing efforts, largely led by residents and interns. In 1989, the Committee of Interns and Residents (CIR) helped establish one of the most prominent concessions in US physician organizing history by shaping New York limitations on resident work hours to 80 hours per week. In 1975, resident doctors in Los Angeles, New York City, and Chicago organized strikes that ultimately resulted in improved resident wages and working conditions, as well increased attention to patient care concerns.

Resident unions have had other notable successes in the negotiation of more equitable resident parental leave policies, improved pay parity, and patient advocacy for improved care. While some resident unions have been positively received by hospital leadership, this has not been true everywhere. Some residents active in unionizing efforts have been reprimanded by both hospital administrators, as well as respected physicians at their hospitals. 

Despite the controversial reception that resident organizing efforts have sometimes had in the US, new resident unions continue to form. In 2017, residents from the University of California at San Francisco completed a months’ long campaign and became the largest chapter of residents to join a union in CIR’s history. Perhaps the time is ripe for more groups of resident physicians to follow suit.

Resident doctors love what we do, but it comes at a price. These increased expectations in the covid-19 era may be temporary, but their impact on residents’ lives could be permanent. Strategic labor organizing could be one way to better protect residents’ safety and wellbeing.