Medicine and Resident Unions

Residency and fellowship are challenging times physicians must pass through to practice medicine. It is well known how arduous this challenge is, but it is another experience to be able to empathize with it. Every physician you have met has gone through this. My journey has been eleven years in the making: four years of undergraduate education, four years of medical school, and three years of internal medicine residency. Other residencies range from three to seven years. Many of my colleagues work longer, pursuing fellowships of typically two to three years on top of residency and some even further specializing a year after that fellowship. To reach this goal one typically would have to be amongst the best of their class in high school, among the best in undergraduate, and then thrive in the medical school process. In medical school, you are taught through the sheer volume of knowledge that your time is not your own, that your time belongs to your studies. Time that belonged to family, friends, experiences, and memories is instead tucked away into the next exam. We became accustomed to 12-hour long study sessions almost as if it were preparation for the 12-hour shifts that would soon follow. Once we survived the slew of notoriously difficult tests, some of the most difficult in higher education, we were congratulated and thrown into the arena of residency and fellowship. For many, residency comes with baggage; many take two hundred and fifty thousand dollars or more in student loans, others must move to whichever state offers a residency spot if they have not already moved for medical school.

With our union, we have helped increase pay to increase affordability of housing and childcare.

Historically, the roots of American residency were crafted by Dr. Willliam Osler at Johns Hopkins in the 19th century, but such programs did not grow in national popularity until after World War 2. We were called residents since we used to reside in the hospital. It was simply assumed that immersion in nothing but work would produce an effective doctor. Residency changed after cases of sleep-deprived residents working more than one hundred hours a week ended up in lawsuits. The Libby Zion case in 1984, a missed serotonin syndrome diagnosis that led to a death, pushed for regulated work hours of less than eighty hours weekly. This was recommended by the Association of American Medical Colleges in 1988, but not until 2003 did the Accreditation Council for Graduate Medical Education mandate these hours nationally.

During residency, the resident or fellow is vulnerable. The typical resident or fellow now has 1 day off a week, 12+ hours shifts, limited pay considering expectations of the job, no overtime pay, rare holidays, poor funding for childcare, etc. The hospital receives a certain amount of governmental funding for each accredited resident, of which only a portion goes to the resident’s salary. The hospital benefits from the available labor with governmental pay and the residents are rewarded an education — such agreements last up to 7 plus years depending on the residency or fellowship. The resident has just spent a significant portion of their life working toward a goal and they have enormous debt, almost so large as to suspect purposeful inflation to keep the resident moving forward. Keep in mind that it is difficult to even declare bankruptcy on such kinds of school debt. If you are seen as a troublemaker, you run the risk of gathering complaints and becoming expelled from your residency, the sort of black mark that is difficult to ever reverse. To worsen matters, residency tribulations were exacerbated by the outbreak of COVID-19. During this time, residents worked more and more intensive care unit shifts with patients suffering high mortality rates, spent more time with infected patients with limited personal protective equipment (nursing staff faced the worst of this burden), and electives and breaks were compromised. This was the push that led UMass as well as thousands of residents across the country to unionize.

In unionizing, we can stand together on a more even playing field and argue for changes we wish to see. With our union, we’ve helped increase pay to increase the affordability of housing and childcare. We have language in our contract to make vacation times longer. We have modified the terms by which residents are investigated if they have been accused of wrongdoing. We have become a platform on which unfair circumstances can be addressed purposefully. We no longer have to solely hope for institutional change through management. As residents, we hold power through the Accreditation Council for Graduate Medical Education (ACGME). Collectively, we can affect the accreditation of programs through our yearly surveys and now have the power to submit grievances for contract breaches. Currently, residency as an institution in America is unlikely to change without increasing available medical school and residency spots and decreasing the costs throughout training. The inertia to change should not keep residency difficult. Many residencies have made good strides to improve the working conditions of residents but much more work needs to be done. My hope is that medical education one day is not thought of as such a herculean task– that this system can grow into a system of greater ease and accessibility while maintaining its training quality that protects our patients.

Physicians are privileged to do what few can. The ability to stabilize, guide, and potentially cure the ill is gratifying and meaningful work. The growth I have experienced since my training began is hard to imagine; I have learned many wonderful things through working with my attendings, fellows, and co-residents. This wisdom and work are meant to be passed down to the next generation and, through our Union, I hope to give the next generation of physicians tools to make the path a little easier.

Jasmin Zvornicanin, MDPGY3 Internal Medicine Resident at UMass Chan Medical School and Union DelegateEmail: Jasmin.Zvornicanin@umassmemorial.org