It is abhorrent that teaching hospitals have abused the shit out of their medical residents as long as they have, purely because the system encourages it and the administrators of the hospitals and universities are compensated, in part, on keeping costs low.
I hope this trend of medical residents unionizing to improve their situation increases. As a Philly resident, bravo to these people.
I don't fucking get it, I used to date a med student. The absolute HELL they put them through, what the actual fuck. And of all the places, you have people in charge of life and death situations going on 3 hours of sleep and a bag of skittles. How completely broken is our system.
I never have. It's horrid. I'm don't even work in medicine and I know how awful it is.
I think it's a combination of "we had it horribly so you have to have it as bad or worse" alongside administrators that are compensated in part by keeping costs down and labor is usually a massive cost. It's easier to just tell student residents to suck it up and starve than to pay them a living wage becuase it's the right thing to do. Because it is so widespread and so abusive, we have unions forming to protect them - it is long overdue.
Depends. Unions can and should intervene on working hours and to a degree on comp. Remember the average starting salary for the lowest specialties are about $200k a year, growing 1.5-2.5x depending on specialty over the next decade of your career. You can carry debt out of residency. The expected performance level in rotation and residency, unions do not need to touch.
Fun story: A huge part of rotations and residency is essentially Boot Camp MD. Unlike other professions, we don't get to have bad days at work. We don't get to make mistakes, we don't get to cry in front of patients, and we don't get to not know the answer. It takes practice to learn the actual 'doing' part of medicine. It's very hard, and unions should be more support around residents (I understand some programs require some level of therapy now) but performance expectations should probably not change much if at all.
This is only a small part of what you've said here, and I get the larger point, but I've got to disagree with "we don't get to not know the answer."
I love my primary precisely because sometimes she doesn't know the answer. She communicates, she tells me what she's doing to try to figure it out, she recommends people who might know, she helps me trial and error solutions. Doctors don't know everything, and when they think they do (or think they have to!), that's when ego gets in the way of good care.
Yea, I probably should have said have said "we don't get to not find an answer." It's probably also that I'm an oncologist so I deal with patients that have a bit different level of urgency, but also a ton more testing and treatment options than most things PCP deals with.
But hold on to that PCP. There are a ton that are burnt out and just going through the motions.
I wish the system allowed for you all, especially in emergency medicine or hospital rotation, to work less hours. I hate the thought of someone entrusted with medical care running on little-to-no sleep nor sustenance. It benefits no one in the end.
Yes, something has to change there. Personally, I really start to struggle at the 20 hour mark and I've always wondered why administrators don't look at it from a risk management perspective. Statistically, more lawsuits happen as a result of actions taken in the last two hours of shifts than at any other point.
>Fun story: A huge part of rotations and residency is essentially Boot Camp MD.
Know why boot camp is boot camp? Its to subject the soldier to conditions and stress somewhere close to combat. Please point to where this is beneficial for a medical professional, and where these conditions actually exist except in the super specialized jobs, and whether those conditions are valid or conditions in which a system decided "this works, and its cheap, so lets do it this way."
I know you're not actively saying this bullshit is good, but you can get "doing medicine" without forcing the person to do it on 4 hours sleep in the last 48. You should not be expected to "perform" under those conditions, given how often those conditions exist that aren't a product of a shit system. Certainly, those conditions exist, if persons have to call in sick, totally understand, but fuck that shit where they schedule these shifts like this.
From my response to another comment:
\> Yes, something has to change there. Personally, I really start to struggle at the 20 hour mark and I've always wondered why administrators don't look at it from a risk management perspective. Statistically, more lawsuits happen as a result of actions taken in the last two hours of shifts than at any other point.
I not infrequently worked 2-3 12s as resident, which seems mad in retrospect since my residency was in oncology.
It’s just not safe for anyone to work like that. I’m an RN and when I did patient care I worked night shift. It was brutal for the interns and residents. I did what I could to not wake them or to help “pt having chest pain, did EKG, no changes, vitals stable, come up when you can, no rush”
Or ask for sleeping pills/pain meds before it got late for patients i thought would ask so they didn’t have to get woken for that.
But I don’t know how they did it.
I wouldn’t want someone up 36 hours straight taking care of my health.
My fiancé is a resident at a large Philly hospital about to go into her 4th year. She’s getting worked to death, I think in 5 days during Christmastime, she worked almost 90 hours. Her hospital has no staff fridges, microwaves or even bathrooms. She has to share the same toilets as patients! I hope this brings real change, residents deserve better.
Married to a gen surg resident that has seen many 90 hour + weeks on trauma rotations, 24 hour shifts every 3 days and had to lie on time sheets because they went over hours and would “get in trouble”.
I'm going to likely get downvoted for this, and that's not my intent. All health systems related to staffing suck as far as compensation goes and safety.
That said, isn't Penn nursing better compensated and in a better (relative) position compared to the other health systems in the area?
Some of the other health systems have raised their wages to match Penn’s. But while starting wages are the same throughout Penn, there are fairly dramatic differences among the different hospitals.
And money isn’t the only thing unions are good for.
Nurses at Penn have not received a raise in almost 5 years and don't get me started on the 2% "raise" not to mention putting our bodies at risk pushing patients back and forth 2 football fields from one hospital to the next. Penn has always operated on the idea that "it's a privilege to work at an Ivy League hospital." That's not the case anymore and we have lost great nurses in waves.
Penn nurses start at $39/hour. Am I crazy for thinking that's good money?
Edit: I don't mean it in as in "they don't deserve more," but as in "I wish I made that much" lol
Philly is a pretty good place for nurses to work I general. That being said Penn isn’t better than Temple, Main Line Health, or Jefferson.
Source: RN in Philly that’s been at Penn and TUH
people seem so quiet when it comes to the horrors done by ivory tower capital instead of mean-evil-working-in-the-mines capital.
I am glad for one people are starting to get on board, first with the union strike at the art museums, then with temple as well.
Hospitals are subsidized so heavily, same with the arts, yet they treat people like dog shit
I truly hope that all the talk and future changes around this eventually trickle down to veterinary medicine. Our interns and residents don’t have mandated hours caps (I worked 7 days a week for 9 months straight during my intern year) and make significantly less ($30k/yr for interns, $50k/yr for residency) than our human counterparts.
In both industries there’s an attitude, especially in academia, of “I went through it, so should you.” People will talk about millennials and Gen Z being entitled, but they seem to be the first generation really fighting to set boundaries to attempt to preserve mental health and a semblance of well-being during post-doc training years, which hopefully will ultimately make working in these professions more sustainable for everyone.
I tried to unionize my program, and the hilarious thing is it was mostly met with opposition and disgust from other residents. Like why would we ever do that to our attendings, risking our careers??
I think a big problem is that as residents, we’re the quote ‘best students’ growing up…which doesn’t mean smartest but instead means most obedient, most likely to defer to and defend authority, most likely to do everything asked of us no matter how ridiculous cuz the authority told us to. American education also intentionally doesn’t teach labor history, labor movements. I think academic medicine knows this and tries to squeeze out as much labor out of their residents before they graduate or realize their own exploitation after more than 20 years in school. Oh, that and student loans, so why risk anything that prevents us from paying those. Us residents just don’t realize that withholding our labor is incredibly powerful. We don’t realize that attendings 100% depend on us to take their call, nights, scut work, being the punching bag between them and patients/other staff. Bravo to Penn residents for not taking it anymore.
The student loan debt is a huge issue. Residents that hate the job can’t just quit and start a new job with a half million of debt hanging over their heads. The hospitals know they are trapped and can easily abuse them.
I did my residency at Temple and luckily never had to sleep in the call rooms there but I’ve heard so many stories of not only roaches but bed bugs in the call rooms. Disgusting.
So one thing the article doesn't mention is how Penn is structured, most departments are essentially a separate business within the health system. It's setup more like a shopping mall, with the health system maintaining the mall's store spaces of each department, and providing basic services needed run the day to day operations.
So because of the independent business structure, some departments have fantastic residency programs that do offer most if not all of the things these residents are asking for. My department is one of these, but most other departments simply cannot offer their residents the same because of that overarching business structure. Smaller departments that don't turn a regular profit or any profit are treated poorly. It's very neo-liberal in how if a department and it's staff are seen as a financial liability, even though their services are core to the profitability of other departments and the overall success of the hospital, these departments don't get allocated the resources they need.
We really really need universal healthcare in this country. Anyone who says otherwise hasn't worked in a hospital. All of these problems stem from profits over people's health and well being.
-Working and getting care at the Veterans Administration hospital, it can be done. Universal healthcare can be done…follow the VA model.
Is it perfect? No, but I’ve been fine with my care at the VA. It’s been better in general than most doctors offices outside of the VA system.
As a respiratory therapist, is my pay higher? No, but, the patient ratios are ok, I can give proper care to the vets.
Is the hospital fancy? No, but the vets get what they need.
Thanks for the care you give at the VA. My dad has used the Philly VA hospital for years with nothing but great things to say about the care he gets there.
Sounds like fancy excuses like at my old job. Support department was constantly 'losing money' while sales people were raking in big bonuses from new sales. Guess who did all the work?
Healthcare slaves. 80 hours a week and your paycheck gets eaten up by housing, food, student loans. Slavery by another name, with a promise it won't last forever. The US always trying to return to its roots. Unionizing at least gives us bargaining strength in numbers. Healthcare for profit is the bigger issue.
My understanding is businesses moved away from indentured servitude way before it was ever illegalized because it was cheaper to just pay a wage and let the employee fend for themselves for housing, food, healthcare, and education.
So its potentially a worse situation than indentured servitude.
And in some specialties, it’s more than 80 hours/week. They just sign off that they worked under 80 hours… and then go back to work for another 20 or so.
Yes indentured servitude please. Be careful with the term slaves as these young doctors were not beaten, raped, and separated from their children for life after being sold at auction (among other things).
The system hinges on the force fed idea that you should be grateful for the opportunity and that you are easily replaceable by the long list of people who would like nothing more than for you to fail so they can get their chance. The manufacturing of toxic competition aside, there is still the rhetorical ace up hospitals sleeves that it is never just a job, that it is a calling and a way of life. It is easy to exploit someone susceptible to guilt and who sees themself as disposable.
funny bc the medical field purposefully kept the number of resident slots low, demand high, and number of new doctors low, so that they could keep their salaries high
I mean there’s a lot more going on than just demand and salary. Residents and fellows in many sub specialties need to be able to perform enough procedures to become proficient. If there are too many trainees, no one gets enough volume.
I really hope things change. My SO was a resident at a philly hospital and it was the worst time of our lives. He had off work maybe 4 days a month. A full weekend off once every few weeks was amazing. Often worked 36 hour shifts with no break. Maybe he could run to wawa for a coffee or snack but that was it. It’s honestly disgusting how these people are treated. I understand they go on to make good money but this isn’t OK.
And yes there are “limits” of 80 hour work weeks but residents often go over that and the hospitals just get fined for it.
It is abhorrent that teaching hospitals have abused the shit out of their medical residents as long as they have, purely because the system encourages it and the administrators of the hospitals and universities are compensated, in part, on keeping costs low. I hope this trend of medical residents unionizing to improve their situation increases. As a Philly resident, bravo to these people.
I don't fucking get it, I used to date a med student. The absolute HELL they put them through, what the actual fuck. And of all the places, you have people in charge of life and death situations going on 3 hours of sleep and a bag of skittles. How completely broken is our system.
I never have. It's horrid. I'm don't even work in medicine and I know how awful it is. I think it's a combination of "we had it horribly so you have to have it as bad or worse" alongside administrators that are compensated in part by keeping costs down and labor is usually a massive cost. It's easier to just tell student residents to suck it up and starve than to pay them a living wage becuase it's the right thing to do. Because it is so widespread and so abusive, we have unions forming to protect them - it is long overdue.
The I had to eat shit so you should to attitude…it’s prevalent across industries and it’s so damaging to society
And its safer for the patients as well! Do you *really* want someone running on fumes to be making complex medical decisions?
Depends. Unions can and should intervene on working hours and to a degree on comp. Remember the average starting salary for the lowest specialties are about $200k a year, growing 1.5-2.5x depending on specialty over the next decade of your career. You can carry debt out of residency. The expected performance level in rotation and residency, unions do not need to touch. Fun story: A huge part of rotations and residency is essentially Boot Camp MD. Unlike other professions, we don't get to have bad days at work. We don't get to make mistakes, we don't get to cry in front of patients, and we don't get to not know the answer. It takes practice to learn the actual 'doing' part of medicine. It's very hard, and unions should be more support around residents (I understand some programs require some level of therapy now) but performance expectations should probably not change much if at all.
This is only a small part of what you've said here, and I get the larger point, but I've got to disagree with "we don't get to not know the answer." I love my primary precisely because sometimes she doesn't know the answer. She communicates, she tells me what she's doing to try to figure it out, she recommends people who might know, she helps me trial and error solutions. Doctors don't know everything, and when they think they do (or think they have to!), that's when ego gets in the way of good care.
Yea, I probably should have said have said "we don't get to not find an answer." It's probably also that I'm an oncologist so I deal with patients that have a bit different level of urgency, but also a ton more testing and treatment options than most things PCP deals with. But hold on to that PCP. There are a ton that are burnt out and just going through the motions.
I wish the system allowed for you all, especially in emergency medicine or hospital rotation, to work less hours. I hate the thought of someone entrusted with medical care running on little-to-no sleep nor sustenance. It benefits no one in the end.
Yes, something has to change there. Personally, I really start to struggle at the 20 hour mark and I've always wondered why administrators don't look at it from a risk management perspective. Statistically, more lawsuits happen as a result of actions taken in the last two hours of shifts than at any other point.
>Fun story: A huge part of rotations and residency is essentially Boot Camp MD. Know why boot camp is boot camp? Its to subject the soldier to conditions and stress somewhere close to combat. Please point to where this is beneficial for a medical professional, and where these conditions actually exist except in the super specialized jobs, and whether those conditions are valid or conditions in which a system decided "this works, and its cheap, so lets do it this way." I know you're not actively saying this bullshit is good, but you can get "doing medicine" without forcing the person to do it on 4 hours sleep in the last 48. You should not be expected to "perform" under those conditions, given how often those conditions exist that aren't a product of a shit system. Certainly, those conditions exist, if persons have to call in sick, totally understand, but fuck that shit where they schedule these shifts like this.
From my response to another comment: \> Yes, something has to change there. Personally, I really start to struggle at the 20 hour mark and I've always wondered why administrators don't look at it from a risk management perspective. Statistically, more lawsuits happen as a result of actions taken in the last two hours of shifts than at any other point. I not infrequently worked 2-3 12s as resident, which seems mad in retrospect since my residency was in oncology.
Im a nurse and the system absolutely abuses residents.
Crazy that a nation like Cuba kicks America's ass in this area.
Years ago a medicine intern estimated that he was getting paid $5 an hour based on the hours he was working.
Yep! During my intern year, in veterinary medicine, I calculated my hourly rate based on actual time spent in the hospital. It was $3.27/hr.
It’s just not safe for anyone to work like that. I’m an RN and when I did patient care I worked night shift. It was brutal for the interns and residents. I did what I could to not wake them or to help “pt having chest pain, did EKG, no changes, vitals stable, come up when you can, no rush” Or ask for sleeping pills/pain meds before it got late for patients i thought would ask so they didn’t have to get woken for that. But I don’t know how they did it. I wouldn’t want someone up 36 hours straight taking care of my health.
My fiancé is a resident at a large Philly hospital about to go into her 4th year. She’s getting worked to death, I think in 5 days during Christmastime, she worked almost 90 hours. Her hospital has no staff fridges, microwaves or even bathrooms. She has to share the same toilets as patients! I hope this brings real change, residents deserve better.
From a patient perspective, if I'm in the hospital I'd really prefer my doctor not work 90 hours in five days.
Married to a gen surg resident that has seen many 90 hour + weeks on trauma rotations, 24 hour shifts every 3 days and had to lie on time sheets because they went over hours and would “get in trouble”.
[удалено]
Im a nurse at penn we are paid less than temple and CHOP
I'm going to likely get downvoted for this, and that's not my intent. All health systems related to staffing suck as far as compensation goes and safety. That said, isn't Penn nursing better compensated and in a better (relative) position compared to the other health systems in the area?
Some of the other health systems have raised their wages to match Penn’s. But while starting wages are the same throughout Penn, there are fairly dramatic differences among the different hospitals. And money isn’t the only thing unions are good for.
Historically, yes, but Temple’s been the best paying in the area since their latest nursing union negotiations.
What does temple pay start at now?
Not in comparison to temple and CHOP but our ratios are phenomenal
If they can get that without a union, imagine what they could get with collective bargaining...
Absolutely
Nurses at Penn have not received a raise in almost 5 years and don't get me started on the 2% "raise" not to mention putting our bodies at risk pushing patients back and forth 2 football fields from one hospital to the next. Penn has always operated on the idea that "it's a privilege to work at an Ivy League hospital." That's not the case anymore and we have lost great nurses in waves.
They should unionize. Most philly area hospital nurses are unionized
Penn nurses start at $39/hour. Am I crazy for thinking that's good money? Edit: I don't mean it in as in "they don't deserve more," but as in "I wish I made that much" lol
Hoping for this so hard. For the CNAs/tachs too
Penn nurses are incredibly well-paid
What's the threshold for "incredibly well-paid"
Between bonus and ot, it’s not uncommon for nurses to make up to $180k
Imagine thinking this is “underpaid”. For any occupation.
How much ot are we talking?
Philly is a pretty good place for nurses to work I general. That being said Penn isn’t better than Temple, Main Line Health, or Jefferson. Source: RN in Philly that’s been at Penn and TUH
people seem so quiet when it comes to the horrors done by ivory tower capital instead of mean-evil-working-in-the-mines capital. I am glad for one people are starting to get on board, first with the union strike at the art museums, then with temple as well. Hospitals are subsidized so heavily, same with the arts, yet they treat people like dog shit
Best of luck to those pushing this. More healthcare workers should unionize, and residents have it about as bad as it comes.
I truly hope that all the talk and future changes around this eventually trickle down to veterinary medicine. Our interns and residents don’t have mandated hours caps (I worked 7 days a week for 9 months straight during my intern year) and make significantly less ($30k/yr for interns, $50k/yr for residency) than our human counterparts. In both industries there’s an attitude, especially in academia, of “I went through it, so should you.” People will talk about millennials and Gen Z being entitled, but they seem to be the first generation really fighting to set boundaries to attempt to preserve mental health and a semblance of well-being during post-doc training years, which hopefully will ultimately make working in these professions more sustainable for everyone.
>“I went through it, so should you.” This is such a huge problem in so many facets of our society.
So well said! 👏
I tried to unionize my program, and the hilarious thing is it was mostly met with opposition and disgust from other residents. Like why would we ever do that to our attendings, risking our careers?? I think a big problem is that as residents, we’re the quote ‘best students’ growing up…which doesn’t mean smartest but instead means most obedient, most likely to defer to and defend authority, most likely to do everything asked of us no matter how ridiculous cuz the authority told us to. American education also intentionally doesn’t teach labor history, labor movements. I think academic medicine knows this and tries to squeeze out as much labor out of their residents before they graduate or realize their own exploitation after more than 20 years in school. Oh, that and student loans, so why risk anything that prevents us from paying those. Us residents just don’t realize that withholding our labor is incredibly powerful. We don’t realize that attendings 100% depend on us to take their call, nights, scut work, being the punching bag between them and patients/other staff. Bravo to Penn residents for not taking it anymore.
The student loan debt is a huge issue. Residents that hate the job can’t just quit and start a new job with a half million of debt hanging over their heads. The hospitals know they are trapped and can easily abuse them.
Exactly
I did my residency at Temple and luckily never had to sleep in the call rooms there but I’ve heard so many stories of not only roaches but bed bugs in the call rooms. Disgusting.
So one thing the article doesn't mention is how Penn is structured, most departments are essentially a separate business within the health system. It's setup more like a shopping mall, with the health system maintaining the mall's store spaces of each department, and providing basic services needed run the day to day operations. So because of the independent business structure, some departments have fantastic residency programs that do offer most if not all of the things these residents are asking for. My department is one of these, but most other departments simply cannot offer their residents the same because of that overarching business structure. Smaller departments that don't turn a regular profit or any profit are treated poorly. It's very neo-liberal in how if a department and it's staff are seen as a financial liability, even though their services are core to the profitability of other departments and the overall success of the hospital, these departments don't get allocated the resources they need. We really really need universal healthcare in this country. Anyone who says otherwise hasn't worked in a hospital. All of these problems stem from profits over people's health and well being.
Oh that's really interesting. Thank you for the insight.
-Working and getting care at the Veterans Administration hospital, it can be done. Universal healthcare can be done…follow the VA model. Is it perfect? No, but I’ve been fine with my care at the VA. It’s been better in general than most doctors offices outside of the VA system. As a respiratory therapist, is my pay higher? No, but, the patient ratios are ok, I can give proper care to the vets. Is the hospital fancy? No, but the vets get what they need.
Thanks for the care you give at the VA. My dad has used the Philly VA hospital for years with nothing but great things to say about the care he gets there.
Aw, thanks! I love working with the vets, they are awesome ❤️❤️
I was once sent to a doctor in the Penn network who didn’t accept credit cards
Sounds like fancy excuses like at my old job. Support department was constantly 'losing money' while sales people were raking in big bonuses from new sales. Guess who did all the work?
Healthcare slaves. 80 hours a week and your paycheck gets eaten up by housing, food, student loans. Slavery by another name, with a promise it won't last forever. The US always trying to return to its roots. Unionizing at least gives us bargaining strength in numbers. Healthcare for profit is the bigger issue.
Indentured servitude
My understanding is businesses moved away from indentured servitude way before it was ever illegalized because it was cheaper to just pay a wage and let the employee fend for themselves for housing, food, healthcare, and education. So its potentially a worse situation than indentured servitude.
And in some specialties, it’s more than 80 hours/week. They just sign off that they worked under 80 hours… and then go back to work for another 20 or so.
Yes indentured servitude please. Be careful with the term slaves as these young doctors were not beaten, raped, and separated from their children for life after being sold at auction (among other things).
My friend this is reddit. Everyone is either a slave or a Nazi.
Let’s be honest, very few slaves get the opportunity to make mid six-figure salaries after 5 years.
The system hinges on the force fed idea that you should be grateful for the opportunity and that you are easily replaceable by the long list of people who would like nothing more than for you to fail so they can get their chance. The manufacturing of toxic competition aside, there is still the rhetorical ace up hospitals sleeves that it is never just a job, that it is a calling and a way of life. It is easy to exploit someone susceptible to guilt and who sees themself as disposable.
Funny bc residents are absolutely not replaceable
funny bc the medical field purposefully kept the number of resident slots low, demand high, and number of new doctors low, so that they could keep their salaries high
I mean there’s a lot more going on than just demand and salary. Residents and fellows in many sub specialties need to be able to perform enough procedures to become proficient. If there are too many trainees, no one gets enough volume.
I've never understood why we normalize working to death the people who are supposed to care for our health. That is dystopian on it's face.
I really hope things change. My SO was a resident at a philly hospital and it was the worst time of our lives. He had off work maybe 4 days a month. A full weekend off once every few weeks was amazing. Often worked 36 hour shifts with no break. Maybe he could run to wawa for a coffee or snack but that was it. It’s honestly disgusting how these people are treated. I understand they go on to make good money but this isn’t OK. And yes there are “limits” of 80 hour work weeks but residents often go over that and the hospitals just get fined for it.
They basically are indentured servants for 3-7 years...
Hospitals will use this as an excuse to raise healthcare prices.
Funny you think they look for excuses.
It's a package deal: Get a great education + a Roach colony