Video produced and edited by Paula Pecorella and Meg Herschelin
Tens of thousands of U.S. doctors currently work for less than minimum wage. They are medical residents — vital to America’s hospitals, working 80 hours a week, but exploited by the for-profit health system. They’re now unionizing at a historic rate for a better deal. We spoke to some of the doctors leading this organizing effort. Below is a full transcript of the video.
Philip Sossenheimer: And I don’t think a lot of people realize that the hospital really is run by a bunch of 20 to 30-year-old, fresh out of training doctors. If you come into the hospital in the middle of the night, the people who are gonna be taking care of you are residents and fellows.
Philip: Being a medical resident means that you’re in your first year, or you know first few years, of being a physician. So after graduating medical school, you are in the hospital working and learning about how to be a doctor. And the reason that it’s called a resident is because people used to literally live in the hospital, because you spend so much time working.
Monique Hedmann: Interns in their first year of residency training often work more than 80 hours a week, at wages that equate to less than minimum wage. And this is coming out of medical school with often a greater than $300,000 of educational debt. And then in a city like Los Angeles, you’re working these crazy hours, doing the best that you can to take care of patients while you’re also struggling to maintain financially in one of the most expensive cities in the country.
Kaley Kinnamon: Medical residents tend to make somewhere between $50,000 and $70,000 a year. Tuition tends to run around $50,000 a year. And then for living expenses on top of that, most people are taking out loans because they aren’t able to work during med school. It’s just too time-consuming.
Monique: I graduated medical school with now about $275,000 of educational debt. I have no idea how I’ll be able to pay that off. You know my first year of residency, most of the time I only had maybe one day off per week, and most days I was working greater than 13 or 14 hours a day.
Philip: We work about 80 hours a week. That’s our cap on our work hours, although it’s a well-known phenomenon, especially in some of the more difficult residencies and surgical subspecialties, many people will work over that cap, and I do think there’s systemic underreporting.
Kaley: Medical residencies are typically funded through the CMS, or Center for Medicare and Medicaid Services.
Philip: Hospitals get around $100,000 per resident to fund their training per year, and that’s in addition of course to money that residents bring into the hospital through their billable labor.
Monique: Only a fraction of that money actually goes towards salary and benefits for those residents.
Philip: You know, I know people who are in my program who are leaving medicine, or who when they finish residency are planning on not staying in medicine because it’s not the job that people thought that it was.
And the response to burnout hasn’t been to reflect meaningfully on what causes burnout and how we can make it better, the response instead has been to create online modules that we have to take in our free time to teach us about how we need to sleep more. I’m not kidding you, when I was going through my orientation for residency, one of the questions in these online modules that we had was about what we should do during our free time, and the options were: spend time with your loved ones, pick up a hobby, do some extra work to make extra money, or sleep. And the only right answer was to sleep.
Spending time with your loved ones was not the right answer to the question of how to spend your free time in residency. And that’s not a sustainable way to run a business and it’s especially not a sustainable way to run something like health care where you don’t want empty shells of people taking care of patients.
Basically, residents can’t offer their services on the free market. They can’t go out and find a job that pays them what they’re willing to pay, they can’t say this what I think that I’m worth, I wanna find a hospital that pays me what I’m worth, because we’re specifically exempted from antitrust laws, and all of the hospitals collaborate to set standards for pay and working conditions. So residency is essentially outside of our American capitalist ideal of the free market running itself efficiently.
Residents have very little leverage in the ways they can negotiate for their working conditions.
If we don’t like our job, we can’t just quit because we’ll never be able to be a doctor.
Kaley: In order to be able to take care of patients we need to be able to take care of ourselves as well and I think that a big part of being able to take care of ourselves in residency is being able to advocate for ourselves, which is something that unionization is gonna help us with.
Phillip: Everybody who I know who’s unionizing is excited to find ways to improve patient care standards and to bring the focus of health care back from the bottom line to the patient.
Monique: Even though residency has been historically an exploitative experience, we wanna send the message that it doesn’t have to be and that we as residents do not have to accept disrespect. The work that we do is valuable and it should be valued appropriately. We have power. Our medical labor is powerful.