Medical residents signed up to live in the hospital, not to die there

I saw a tweet recently from a medical resident training at another hospital that really hit home for me: “In response to a rumor that health care workers who treat COVID patients will be prioritized for vaccination in our health system, one of my co-residents asked unironically, ‘Does that include us?’”

“Resident” is a word coined in the twentieth century when physicians in training often physically lived (“resided”) at the hospital. At the medical center where I work, there are nearly 200 of us, and although we no longer live at the hospital full-time, it can often feel like we do. A sizable contingent of us are always here, staffing nearly every department; no matter what time of day, when someone arrives at the hospital needing treatment, a resident is almost always the doctor they will meet first.

Complaining about demanding schedules and onerous workloads is something residents have always done, almost as a way of bragging — see how tough and dedicated we are? But, that said, we still have some legitimate concerns in these areas, especially regarding compensation.

Many of us have graduated medical school saddled with $200,000 and more worth of debt, facing at least three years where we are unable to barely make a dent in reducing it. We accept our modest salaries, understanding that our training, supervision, and insurance coverage also form part of our compensation. Still, to be paid approximately $16 an hour for demanding, very intense work that involves overnights, weekends, and holidays, without any possibility of negotiations, seems like a tradition from the past that badly needs re-thinking, particularly in a time of the pandemic.

The unprecedented demands of dealing with COVID-19 have impacted everyone in health care, but let me concentrate for a moment on what it’s done to residents like myself. During the early days last spring, we were either told to stay ready on backup duty as a kind of emergency reserve or deployed directly to the hospital’s front lines.

Once there, we risked multiple exposures to patients with symptoms suggestive of coronavirus, often without being issued the proper protective gear. Despite public CDC guidelines that stated otherwise, we were often told by employee health departments to adopt a “mask and monitor” approach after confirmed high-risk exposures — a risky strategy, to say the least.

With little access to rapid testing, it was impossible to know whether we were infected (and infectious) at any given time, so we could no longer guarantee a doctor’s fundamental commitment to “do no harm” as we rounded on our hospitalized patients — and this fundamental uncertainty continues even now.

The patient care we provide to our patients has become harder and harder throughout the year, not just because of conditions inside the hospital or our patients’ needs. Our children are often at home instead of in school; some of us have health conditions that put us at risk; like everyone, we’re worried for our parents and grandparents; with inflexible schedules, we often can’t arrange to quarantine safely.

Speaking personally, I was buoyed in the pandemic’s early days by the sense I was one of those “heroes” who did their share merely by showing up for work every day. Sadly, the events of 2020 have gradually eroded this feeling. As we fought to protect patients from the assaults of the virus, we witnessed an election where nearly 75 million Americans voted for a president whose every action seemed intent on spreading the virus even further. Even worse, seeing so many people flouting guidelines on mask-wearing and social distancing makes us question whether or not we’re wasting our time.

But I’ll ask another, closer-to-home question here. Were medical residents like myself naive to believe that our hospital employers would do everything they could to protect us?

It’s not too late for this. A good beginning would be a coordinated testing program, not a haphazard one, allowing us to feel safer around our colleagues and patients. The relaxation of strict national guidelines allowing a total of 20 days off (including interview time, vacation time, and sick time) would help those feeling sick yet anxious about missing even a day of residency and make the right decision to stay at home. Another key step will be to ensure that vaccine prioritization will include those working on the front lines, without any uncertainty.

Along with this, our pay should reflect the risks we are taking merely by showing up to work every day. Regrettably, the administration in our hospital, in response to a local election referendum mandating an increase in the minimum wage during this emergency, emailed the staff that “hazard pay is extraordinarily difficult to put into place,” and hence won’t be happening. I would challenge whoever wrote that memo to spend a twelve-hour shift in head-to-toe protective equipment, putting themselves directly at risk — and then use those words again to describe a wage increase that workers in the hospital truly deserve.

Here at the medical center, I witness daily the heroic work of my resident colleagues, the nurses, and the housekeeping staff. If we are routinely tested, our schedules made more flexible, have wages increased to reflect our contribution, and are prioritized for the vaccine, we will be able to recommit ourselves to caring for our patients, with at least some of the pressure off our backs.

If we don’t receive this support, my peers and I are at risk of joining the hundreds of health care workers across the country who have died from coronavirus, including, to name just one, a 28-year-old OB-GYN resident in Houston named Adeline Fagan, who spent the final months of her life working in the emergency department of her hospital treating coronavirus patients.

Residents like myself are proud that we’re seen as heroes, but we don’t want to be martyrs. Protect us more. Pay us more. Trust us to do the rest. As residents, we signed up to live in the hospital, but not to die here.

The author is an anonymous family medicine resident.

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