Sarah Kleinschmidt

In Colorado, partner organizations will give direct cash payments—between $300 and $1,250 a month—to more than 70 family, friend, and neighbor child care providers, including those who are currently not paid at all but who meet the state’s regulations for license-exempt child care. “These are the women who have shown up over and over again for the broadest group of low-wage workers in this country, families who do essential jobs, work nonstandard or unpredictable hours, or live in areas underserved by the formal child care sector,” says Renew.

So far, Colorado’s project is unique in including licenseexempt providers like Hernandez and Enriquez, both of whom sit on the project’s advisory committee. Partly in response to their guidance, eligibility will prioritize providers who want to stay in the child care field long-term.

Enriquez points out that child care providers often have outof-pocket costs that lower their take-home pay. For example, it typically costs about $90 to renew her CPR certification. “That is about what I make for taking care of one child for a whole week. So this extra money will really make a difference in my ability to maintain my training and purchase materials for my program.”

“We believe that if caregivers are not having to worry about if they can pay their rent or afford food or find another job, they will also be able to improve the quality of interactions they have with the kids in their care, and they will invest time and energy in professional growth,” says McGinn. “We did over a dozen focus groups; every provider we talked to said that if they could just go beyond worrying about their financial survival, they would leap on those opportunities.”

She sees the program as “an investment not just in creating a more stable supply of child care for workers, but also in [improving] the professionalism, well-being, and dignity of the child care workforce.”

Elsewhere in the country, states including Ohio and Wisconsin have compensated child care providers with “hero pay” to supplement low and sometimes unpredictable wages as the COVID-19 pandemic drags on. In Washington, D.C., the city council has stepped up to pay licensed child care workers across the district a one-time $10,000 bonus.

Cynthia Davis, who runs the home-based Kings & Queens Childcare Center in Washington, D.C., has advocated strongly for direct payments. “The truth is,” she says, “when a lot of centers shut down during COVID, we family child care providers are the ones who kept the economy afloat. We reached into our own pockets and worked crazy hours. You can’t ask me to give so much of myself that I can’t provide for my own family. These payments are a way of showing that we are equal, that we are being counted, and we are being seen.”

“Direct cash payments are good for everyone in the child care ecosystem, including employers,” echoes Renew. “But for us at Home Grown, the bigger goal is to influence the policy for child care subsidy and payment systems across the board by demonstrating that when we compensate caregivers equitably and adequately, everyone wins.” y

Anne Vilen writes about child care, education, and mental health from her home in Asheville, North Carolina. Twitter: @Anne_Vilen.

The Job Is Not My Work

Our profit-driven health care system pushes workers to the breaking point. What would it look like to take back our power?

Sarah Kleinschmidt

In an emergency room, there is always work to be done. A toddler requires toys and numbing medicine before I can stitch her forehead, taking care to close the muscles and skin to minimize scarring. Next door, a stubborn grandfather insists that he be discharged home. I hold his hand and tell him that I respect his wishes and am also truly worried that the blood thinners will turn his next fall into a catastrophic event. I’m interrupted by an ambulance bringing a patient in respiratory distress. She nods yes when

I ask if she wants us to place a breathing tube. We quickly bring family to see their mother awake for what might be the last time. In between, the hallways are lined with patients—moaning, vomiting, crying, or just silently waiting to receive care.

This is work that I cherish. As an EMT, then a nurse, and now an emergency physician, I’m satisfied after each shift that

I helped relieve some suffering, whether through medicine, a procedure, an explanation, or simply being present for a patient and their family.

But my job is a different matter from my work. I quickly walk past my patients to get back to a computer. I must document that

I examined at least eight organ systems so that we can bill for a specific reimbursement code. The antibiotics must be ordered within the next 10 minutes or the hospital will be financially punished by Medicare.

The pharmacy is calling because the pre-

Not My Work

natal vitamins I ordered aren’t covered by the patient’s insurance. My computer brings a constant flood of emails and popup boxes. Follow the protocols. Document everything. Bill as much as possible. Work faster, always faster.

Caring for others is sacred work, but our health care system is profane, deeply broken, and driven by capitalist fear and greed. This system relies on workers with good intentions and deep investment in our work, even if our actual jobs are dehumanizing and frequently traumatizing. We are asked to ignore patients as well as our own basic needs in favor of efficiency, bureaucracy, and sometimes profit.

The coronavirus pandemic emphasized this contrast between our work and our jobs, as patients flooded into hospitals, clinics, and nursing homes. Precautions against spreading the airborne virus became yet another set of tasks squeezed into a hectic day. The computer gained a new set of pop-up boxes. Hospitals canceled sick leave, retirement contributions, and other benefits. And yet, the work has gained new depth of meaning. I counsel parents about how to simultaneously care for their infectious children and their immunocompromised elders. I hold iPhones and hands before starting yet another ventilator. I stay present and apologize when we find an advanced cancer or a heart attack that was missed amid the chaos of the pandemic.

It’s no surprise that workers are leaving health care in record numbers. About one in five left their jobs in the first year and a half of the pandemic, according to a report by Morning Consult. Even before that, there was a crisis of exhaustion among demoralized health workers nationwide, according to the U.S. Surgeon General’s recent advisory, Addressing Health Worker Burnout.

On overnight shifts and in hospital staff breakrooms, there’s constant conversation about this dilemma. To leave would mean reclaiming personal autonomy and dignity, but it would also stymie our deep desire to relieve suffering. “I can’t go on like this,” we say, “but I can’t just abandon my patients either.”

I believe we can regain power by learning to separate our work from our jobs and by engaging critically with the institutions that employ us. I now speed through emails about relative value units and new billing initiatives. The new weekly committee to review pharmaceutical policies is a job task I can decline. Saying no to the bureaucratic demands of the job can free us to invest more fully in our work by giving our full attention to the patient, family, or co-worker in front of us.

At times, we may notice direct conflicts between our job and our work. How frequently am I pulled away from human connection and toward the computer? Are protocols forcing me to provide the wrong care? Does this institution have policies that conflict with my values? Moral injury—the participation in unethical actions—is increasingly cited by health workers as a strong contributor to burnout. If it destroys us to see our good intentions subsumed into an immoral system, then what would it look like to protect ourselves and our work?

Our health care system dehumanizes our patients and our communities as well as its workers. Fixing it will require brave actions and visionary thinking. How could we bring together healers and patients in solidarity? How could we structure our time, our spaces, our tasks?

I still have a job. I punch in, click boxes, respond to emails, and nod during meetings. But I’m clear now that my work is my own. It won’t appear on a spreadsheet or be rewarded with praise from the company, but it has its own rewards for me and the people who need care. y

Sarah Kleinschmidt lives in western Massachusetts, where she teaches emergency and wilderness medicine. Twitter: @Dr_Schmidty