COVID-19 highlights chronic oppressive job conditions [PODCAST]

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“In medicine, the guise of ‘professionalism’ is an example of how an oppressive system has led us to believe that we ought not to advocate for our rights. It would be ‘unprofessional’ to organize for a better health care system for both patients and workers. To work towards personal liberation, Boal calls for a transformational process to bypass the censorship of habit and find ‘antibodies’ to oppression. With this situation so clearly revealed, the COVID-19 crisis has become an unprecedented moment for physician organizing.

Where does this leave the mental health profession and their role in managing this current crisis? We are very much equipped to address individual concerns. But addressing systemic issues does not come naturally to the mental health profession, which was founded in large part on individually-based approaches.

But any approach to mental health today must recognize that if the system we work in is making us sick, then it is not enough to change ourselves.”

Eden Almasude is a psychiatry resident.

She shares her story and discusses the KevinMD article that she co-wrote, “COVID-19 is the symptom. Chronic oppressive job conditions are the disease.”

This episode is sponsored by Elsevier Health. Looking to update your personal or professional medical library? Shop Elsevier Health’s Holiday Sale and save up to 35% on your purchase of medical books! Plus, you can take an extra 5% off your order with code KEVINMD at checkout. Take advantage of the biggest sale of the year from Elsevier, the world-leading provider of medical books and reference materials. Shop us.elsevierhealth.com now through December 31.

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show we have Eden Almasude. She is a psychiatry resident, and she co-wrote the KevinMD article “COVID-19 is the symptom. Chronic oppressive job conditions are the disease.” Eden, welcome to the show.

Eden Almasude: Thank you so much. Glad to be here.

Kevin Pho: So we’ll get into your article in a little bit, but first off, can you share your story and your journey to where you are today?

Eden Almasude: Absolutely. So I grew up in rural southern Ohio and from an immigrant, refugee sort of background family. I think those things really influenced my journey to medicine and to political organizing as well. I actually did African studies before going to medical school, and that really shaped my understanding of the world and global power dynamics. And I went to medical school in Minnesota and am very glad to be in psychiatry now in New Haven, Connecticut.

Kevin Pho: So can you talk about that intersection between your training as a psychiatric resident and political organizing?

Eden Almasude: I believe that the majority of my work as a healer is actually to create structural change in politics and in the community, more so than what I do sort of day-to-day in my main job. And so we know that the primary causes of poor health are structural. They’re political. It has to do with transportation, with unjust immigration policies, food injustice, food insecurity. And so we really want to address the root causes of health issues, including mental health. I believe we need to organize among each other in the community and change the political structures that make us sick in the first place.

Kevin Pho: Now, from a behavioral health standpoint, what are some specific policy changes that we need to improve the conditions there?

Eden Almasude: One key thing is migration. So we know that family separations and deportations tear apart families and communities, and it’s a major issue affecting so many people. There are millions of undocumented Americans in this country. It’s a joy and a pleasure to work with many of them in my work. And having a clear path to citizenship, ending family separations, and ending immigration detention would be a huge game changer in mental health.

Kevin Pho: Great. So let’s transition into the KevinMD article that you co-wrote, “COVID-19 is the symptom. Chronic oppressive job conditions are the disease.” Now, for those who haven’t read that article, can you just walk my audience through it and maybe share a story of why you decided to co-write it?

Eden Almasude: We wrote this article pretty much at the height of the COVID-19 pandemic in the spring, when hospitals were changing policies sort of hour to hour, often very necessary changes, but there was a lot of anxiety and panic. A lot of things were being done to us, in particular thinking about us as residents and fellows, where we had no impact in the decision-making, and our lives were on the line, right? It’s very often trainees who are the frontline health care workers treating COVID-19 patients and putting our lives at risk, and those of our families and communities. And yet many of us felt dehumanized and disrespected, as if we had no say in our job conditions.

And this isn’t new. The disenfranchisement of medical trainees has been a long, pervasive issue throughout medical training, and COVID, like so many other injustices in society, really revealed those fault lines and the deep weaknesses of our health care system.

Kevin Pho: Now, can you share some specific examples where you felt the decision-making adversely affected medical students, and residents for that matter?

Eden Almasude: One issue that came up was decisions being made about the psychiatry residents across years without us even being told, that we were sent to or assigned to different rotations on internal medicine, so entirely outside of our specialty. I know for me personally, and for a number of folks in my program, that was really painful and really highlighted the way that resident voices are entirely excluded. Many of us felt like they just wanted to sort of throw bodies at the issue without concern about sort of what is going on for us.

That’s nothing new, again, in medical training. However, amid a global crisis like this, it’s more important than ever to have everyone involved in decision-making and to really listen to the collective voice of the frontline health care workers who are doing the most difficult work.

Kevin Pho: Now, most of my listeners here are clinicians, but some are not. What are some of the dangers when psychiatry residents have to, on a dime, go and rotate on an internal medicine rotation?

Eden Almasude: One issue is that for many of us, it’s been quite some time since we’ve even practiced internal medicine, since I’ve even prescribed something like metformin, and that’s even, as a resident, pretty close to my core medical training. But another issue is that it’s an entirely different workflow. So on the internal medicine services, everything was being restructured, which was important and very necessary, but we weren’t clued in to what was happening. And it didn’t allow us even a chance to make accommodations for our rotations at that time, to make sure that there was an appropriate transition of care for our psychiatric patients that we were taking care of.

Kevin Pho: So when you made this transition, did they give you any additional training and maybe perhaps review some internal medicine concepts before doing it live?

Eden Almasude: I can’t really speak to that myself, to be honest. I was on an inpatient psychiatric service and doing a lot of night shifts during that height of the pandemic here, so I ended up not going to medicine. I did volunteer for the hospice and palliative care unit, but at that time it was more important to cover nights at the psych hospital.

Kevin Pho: Now, what should have been done? I think from a hospital standpoint, they were short a lot of workforce, and taking psychiatry residents, for instance, and putting them in internal medicine would probably be the easiest thing that they could have done. Now, in your view, what’s the right way to approach that?

Eden Almasude: I want to just have some understanding for the difficulty of making really quick decisions in an emergency situation. And so to me, it really highlights the need for a long-term, systemic change of the medical system, such that there are labor protections for residents, such that we have a greater voice in how these decisions are made. In that moment, it was very difficult to do otherwise, because of decades of a process of increasing administration and management of health care rather than physician leadership within the hospital system.

That really points me towards thinking about unionization and other forms of organizing among residents and fellows, and the ways in which we actually, as a collective, need to join together, decide the issues that are most important to us, that most impact patient care, and fight for those within the administration. And that can look a lot of different ways, so there’s a lot of space for creativity and imagination in how that would look in every individual context here.

Some of the things that we have been struggling for in our resident collective have been thinking more about hate speech, racism, and other forms of discrimination that we experience in the hospital; having a greater say in some of the hospital policies that are implemented; and, for example, making sure that all residents have access to complete health insurance, including mental health insurance, which unfortunately most residents don’t.

Kevin Pho: Now, I know that there are some residency programs that do have unions across the country, and I believe they’re only a minority. As far as you know, are those unions effective in protecting the rights of residents?

Eden Almasude: I guess I’m not entirely sure, because I’m not part of a resident union, so I don’t think I can say either way. The Committee of Interns and Residents is the largest physician union. I believe there are about 16,000 residents who are unionized through the CIR, and we are not one of them. However, we’ve been organizing for the last two and a half years to have a greater voice within our department, and the collectivity is really important in order to prevent a backlash. What we don’t have there is the sort of legal recognition of a union that is provided by CIR. And the experiences of residents in those unions are certainly varied as well and depend on their own internal structure.

Kevin Pho: Now, what are some of the challenges for residents to create a union within the program?

Eden Almasude: One of the biggest issues is that the hospital administration doesn’t want residents to unionize. And so greater labor protections for medical trainees are against the interests of the CEOs and administrators of the hospital, who primarily run these as for-profit institutions, who leech off of marginalized communities in the area, and who basically profit off of people being sick. Residents make money for the hospital every year. And so employing a resident to work 80 hours a week is much cheaper than employing an attending or perhaps several NPs or other health care workers. And so although they talk oftentimes about how they cannot increase our salaries or provide further benefits, it’s actually not true, right? Because they are actively profiting off of every resident that is in the hospital system.

Kevin Pho: So if you’re a resident in a non-unionized program and you feel that your rights are infringed upon, what kind of recourse do you have, and where can you turn for support and advice?

Eden Almasude: One of the biggest things is to talk to your co-residents, to join together, talk about what’s going on and what you can do about it. And I know that for me personally, that has meant so much in getting through this system. Working with my co-residents, being in solidarity, working for change together, it’s really what got me through intern year and what continues to give me hope for change in the future as well. When things are difficult, when we feel that things are completely out of control and out of our hands, coming together, having a single voice, working alongside someone else for the same goal is deeply meaningful. And amid the pandemic, that was really what gave me hope to continue as well.

Another sort of source for coming together, especially if maybe you’re in a small program where it’s difficult to find like-minded people: We have a Facebook page, Training in the Time of Coronavirus, where folks can connect with other residents and fellows all across the country and talk about what issues we’re facing and how we can challenge our health care system to be better for all of us as trainees and for our patients.

Kevin Pho: We’re talking to Eden Almasude. She’s a psychiatry resident, and she co-wrote the KevinMD article “COVID-19 is the symptom. Chronic oppressive job conditions are the disease.” Eden, we’re speaking in the beginning of November, and we are on the cusp of another nationwide surge in cases. Has anything improved in the summer, and how do you anticipate the rights of residents being protected going forward?

Eden Almasude: One thing that we sort of have going for us at this time is that we’ve been through this before, to some extent. And certainly this next spike is going to look different, but I think as medical trainees, we’re somewhat more prepared. And the veil has been lifted for many of us to see how our hospital systems responded to us, to see them for how they really are. And that has made a lot of people more aware of their position within this hierarchy and this exploitative system as a whole.

And so I think that there’s a greater class consciousness among medical trainees, understanding our place as workers, and all of us together as health care workers, and that is key. So I think that there’s greater possibility for joining together, for unionization, or for other forms of collective action, because we run so much of the hospital system. We know that they can’t function without us, and that means that there’s a great deal of power in our hands, and we need to see and trust in that power that we have.

Kevin Pho: And my last question, Eden: What is your take-home message that you want to leave with the KevinMD audience?

Eden Almasude: The biggest thing in my mind is to come together with other people, to figure out a strategy, to do some power mapping, and to realize that we do have a voice and we can make change. Even when things seem impossible and they seem deeply entrenched in the system, we know from history, and from the history of the labor movement, that things have changed dramatically, right, over the decades. And we can fight for that change. We can be that change within health care.

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

Eden Almasude: Thank you so much.

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