What Does Labor Day Have To Do With Doctors?
Labor Day was founded in the late 1800’s as a way to thank
American workers (as Peter J. McGuire, a cofounder of the American Federation
of Labor put it): “who from rude nature have delved and carved all the grandeur
we behold.” There is some debate
about who originated the concept of the holiday, but one truth remains:
“All other
holidays are in a more or less degree connected with conflicts and battles of
man’s prowess over man, of strife and discord for greed and power, of glories
achieved by one nation over another. Labor Day…is devoted to no man, living
or dead, to no sect, race, or nation… It
constitutes a yearly national tribute to the contributions workers have made to
the strength, prosperity, and well-being of our country.”
Resident physicians are on my mind with Labor Day
approaching. I know that they are toiling away in hospitals across the nation,
and many of them do not get to take Labor Day off for vacation. Physicians work for 3-7 years after
graduating from medical school, and are paid (on average) about the equivalent
of a home health aide or a medical secretary but work about twice the hours
during residency. In fact, if you calculate
out the salary by the hours they work, resident physicians are paid about $9
-$10/hour which is roughly $1.50 more than minimum wage.
Not surprisingly, resident physicians have joined unions to
lobby for more reasonable wages and caps on the number of hours they must work
per week. The national cap is now at 80
hours per week – about 20 hours more than a truck driver is allowed to work
(for “safety reasons”). Research from Harvard
suggests that errors made by overworked residents increase by 700% when they
have worked more than 24 hours in a row.
Residents from the University of New Mexico, for example, received wages in the lowest 1% for resident physicians in their region, and
were denied a salary increase until they recently joined forces with CIR (the Committee of Interns and Residents) to
negotiate more reasonable salaries and working conditions. The New
Mexico contract adds one more CIR chapter to the more
than 70 hospitals — each with multiple residency programs — that are part of
CIR.
Founded in 1957 to improve patient care and resident working
conditions, CIR has remained true to those two goals throughout the decades. In
1975, CIR won an end to every other night on-call in New
York City, and created the first-ever Patient Care Fund in Los Angeles, where
residents could purchase equipment or create innovative programs to help
patients. Campaigns to prevent needle stick accidents by moving to safer needles,
or needle-less equipment, have also improved working conditions for residents.
CIR has been on the forefront of safe and humane work hours
for residents, helping to win the 80 hour regulations in New York State
in 1989, which became the foundation for the 2003 national guidelines. But
evidence shows that this is still too many hours, and so the advocacy around
hours continues unabated.
So please have safe travels on your Labor Day weekend – we
wouldn’t want you to wind up at a hospital where the residents work more than
24 hours in a row for ~$9/hour. Resident
physicians are one group of laborers who don’t have much to celebrate yet this
Labor Day. But with CIR’s help, next
year might be a little brighter.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
Very well said Val. I started residency in 1975, and I remember well the hard work of the CIR to help resident physicians with humane (and safe) working conditions. Amazingly, more than 30 years later, this battle is still being fought. Some residency programs complain that the “limitation” of having residents work “only” 80 hours a week is causing disruptions in their training programs. I do not believe that any other countries have workloads for resident physicians anywhere close to the U.S. model. You would know, but Canada may be similar. I know that in Europe, and in all the countries that follow the “British” model of medical education, resident physicians work more like graduate students and apprentices.
I think there is merit in the hard work and responsibility taken by U.S. resident physicians, and your mentioning them on Labor Day is quite appropriate. I hope with time we will find the right balance. Patient safety and quality of care must come first.
Rock on, Val! As a current resident in a New York City hospital, and a New York regional vice president of CIR, I appreciate the recognition of the hard work over long hours that residents put in day and night, every day of the year; and of what CIR has accomplished in the work-hours realm.
And just as Val stated, CIR continues to advocate for work-hours reform: you’ll be hearing more from us about further improvements in limiting how long residents work each day (who knew there were more than 24 hours in a day?) or week…all in the name of patient safety and healthcare, and the well-being of those doctors, too.
This is one of those ‘traditions’ that has been the cause of so much heedless suffering on the part of patients and physicians, both. How does it feel to discover that you may have made a fatal, or near fatal error, because you are so tired and stressed you cannot think straight? How does it feel to learn that your loved one who died was treated by someone who was in the 29th hour of a sleepless work session?
So– Qui bono? Who benefits? I think we know the answer…and the dirty little secret is this: when you attempt to accumulate capital from the pain and suffering and desperation of others, what is to prevent you from crafting a strategy to maximize profit–regardless of the consequences in pain and suffering? Of course, here is where actuarial science comes in. The statistics will dictate cost effectiveness. But individuals lie at the bottom of those statistics, sometimes in graves. And over the graves stand weeping relatives, crying out to God, “Why, why, why did this have to happen?” It had to happen because the decision makers love money more than they love for public benevolence. They will protest it isn’t so! But actions speak louder than their protests…policies say it all.
The workman is worthy of his hire. But should everyone’s need for health care be an opportunity to form capital? Should this be seen as a lucrative, ruthless business opportunity? Because until people stop trying to capitalize on someone’s desperate need for life saving treatment–No Revolution in Health Care is possible!!!!!!