“What should we do?” I asked my partner. I looked down at our dog, who was limping in pain and whose treatment was just quoted at nearly $1000. Just yesterday, our brakes collapsed, and repairing our car would also be a hefty expense. He sighed, knowing we didn’t have the money for either but definitely not both. My partner and I are both resident physicians in San Francisco and here we were on the phone, him at work and me in a vet’s office, trying to finesse our finances to handle these emergencies. We essentially make about minimum wage, so two financial hits like this in a month when we live paycheck to paycheck was devastating. “I don’t know,” he replied. “I’ll leave it to you.”
Resident physicians are recently graduated doctors who are training in their chosen specialty. It is a grueling 3 to 7-year period in our careers where we work 60 to 80+ hours a week treating the overwhelming majority of patients in academic and community health care sites. We do this while earning an average of $64,000 a year. Many of us moved to a new city to start this job, incurring up to $10,000 in moving costs that we often just put on credit cards because we haven’t been earning an income during medical school. More than half my paycheck goes to rent, and it is all too common for my co-residents and me to forgo basic necessities like groceries or gas to pay our bills. If it weren’t for our union-afforded meal stipend or housing allowance, I could not afford to live in San Francisco. Looming over my head is the $400,000 in educational debt I accrued to become a doctor, above the $250,000 national average. At the same time, we are making life and death decisions for our patients and struggling to exist— and it is soul-crushing. I became a doctor because I love to help people, but it’s hard to pour from an empty cup.
The fact is that all health care workers are struggling. Over half reported burnout, and we have seen a large exodus from the industry since 2020, with even more exits projected in the next few years. The reason why is larger than each of us. The U.S. Surgeon General explains that “burnout manifests in individuals, but it’s fundamentally rooted in systems.” We as a society have pushed health workers to their limits, especially in the last few years, while failing to provide adequate support. Resident physicians are particularly struggling, having high rates of burnout and even suicide before the pandemic. The market norms embedded in our corporate health system seek to maximize profits by squeezing as much labor out of workers while minimizing costs like employee compensation, benefits, and protections. And patients suffer because the providers they depend on are stretched thin. We’ve been hailed as superheroes as we’ve carried our communities throughout the pandemic but the truth is we’re also just human.
Senate Bill 525 would provide for a $25 minimum wage for health care workers in California. For salaried, overtime-exempt workers like resident physicians, it would be twice that rate, meaning a yearly salary of $104,000. Yes, $104,000. It’s time we envision a better life and question what a true living wage is in today’s modern world. In this incredibly rich nation, we should be able to not only etch out an existence but to truly thrive. That means enough to cover our basic needs and being able to establish a sense of stability. It means being able to live without the torment of economic insecurity. And to not miss out on major milestones like starting a family, buying a home, or building a retirement. We worked hard to get where we are and we ask for that work to be acknowledged. It is time for all of us to demand the worth of our dignity as human beings.
Securing that dignity is, of course, exponentially harder for those without access to wealth and resources. A recent article in the New England Journal of Medicine detailed the challenges of diversifying the physician workforce— which has been demonstrated to improve patient outcomes since doctors who can relate to their patients can better establish trust and account for unique cultural norms in treatment. As a Black physician, it breaks my heart to think that I am deterring aspiring Black doctors when talking about the struggle of residency. But it would be disingenuous to tell them that I am doing well financially and to pursue a career where I feel taken advantage of. SB 525 would change that by making residency financially feasible and humane. Paying health care workers a wage that reflects their value would open medicine to more than those with generational wealth. It would mean we can encourage the workforce behind us when we need them the most.
Our dog’s treatment ended up being yet another expense we put on credit without any prospect of paying off while we’re in training. Fixing the brakes maxed out one of our cards. SB 525 has made me feel hope that I won’t encounter hard choices like this. I am overjoyed at the prospect of frontline health care workers’ compensation finally being matched with the value we bring to this system, though it is frustrating that it has required legislative action. That frustration fueled me to write this piece and will continue to fuel my work toward a more just, equitable, and resourced health care system. We health care workers are dynamic beings with full lives like everyone who comes through our hospital. SB 525 will provide for a real living wage that respects our humanity so we can focus on being the best doctors for our patients.
Kelley Butler is a family medicine resident and member, the Committee of Interns and Residents/SEIU.