MD & DO UW resident strike

[NITRAS]

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Either the spouse works or there isn’t childcare expense. These numbers are very doable.

When I was a residents I didn’t realize that I didn’t provide revenue for the hospital. My attending did. I can see more patients, and generally bill higher by myself than with residents. I get that they feel like they are doing the same work as I do now and get paid a quarter as much, but that is a false notion.

Residency is a short season. Even if they get $15k more per year it realistically won’t change their lives much. Probably just increase their consumption.

$2 meals?! My wife and survived on $50/week. We didn’t eat much meat, but I didn’t lose weight either.

 

[debateg]

What you need to understand is that this is all business in the end:

simple supply and demand.

If the cost of living in cities such as Seattle was truly unattainable on a resident salary, their match rate and quality would suffer.

You better believe that if this happened, they would raise salaries immediately for the next cycle.

That would be a reasonable and completely incorrect assumption. UW's match rates have fallen for 17 years. The residents confronted GME about this and presented data from UCSF demonstrating that match rates track very closely with salary. UW seriously replied that it wasn't their problem. They said they'd only get concerned if match rates got really, really bad, but they demurred when asked how bad rates could get before they took action.

 

[Epilepsy365]

$2 banh mi is a feast. Since when is the standard of a decent meal being a $40-50 Omakase sushi plate?

 

[Green Penguin]

I knew the salary was low relative to COL when I chose UW for fellowship, and I was willing to accept that. But trainees are treated poorly at UW not only in terms of pay relative to COL, but across the board on a variety of issues, at least in comparison to my former residency program in another high COL city (think SF bay area, Boston, NYC, LA).

It is also not entirely true, as some have claimed, that we "knew what we were signing up for". Several of the statements made at interview day were not honored, with a flippant excuse that "oh, that was a misunderstanding".

In other cases, while there was no explicit promise on interview day, I think there was a reasonable expectation of "how things would be". For example, I knew trainees had to pay for parking at UW and the prices for parking passes were publicly available. What I didn't know was that the parking spaces available to trainees are currently completely full with waitlists that extend for months -- in other words, you can't buy a parking pass if you want to right now.

I could list a dozen other things, often little in themselves but dispiriting in combination, to the extent that if I had known the truth my rank list would have been different.

I am not generally a complainer; I was very happy at my residency program, at my medical school, at my college, etc. But I am also VERY VERY happy I chose not to come to UW as a resident and will not be sad when I leave the institution.

 

[Acyl chloride]

Either the spouse works or there isn’t childcare expense. These numbers are very doable.

When I was a residents I didn’t realize that I didn’t provide revenue for the hospital. My attending did. I can see more patients, and generally bill higher by myself than with residents. I get that they feel like they are doing the same work as I do now and get paid a quarter as much, but that is a false notion.

Residency is a short season. Even if they get $15k more per year it realistically won’t change their lives much. Probably just increase their consumption.

$2 meals?! My wife and survived on $50/week. We didn’t eat much meat, but I didn’t lose weight either.

This actually varies by specialty and what hospital system you are working in. A resident seeing patients alone in an outpatient clinic may not bill professional fees, but the hospital does collect a facility for the patients they see (in addition to the money they bring in per year from medicare). Maybe on inpatient you can see more people by yourself, but I somehow doubt you as an attending could simultaneously see 5-6 outpatients. Sure residents are less efficient at many things and are still learning, but residents often cover shifts moonlighting that otherwise would need to get filled by attending or midlevel and function at those levels (and get paid accordingly.) It feels crazy to earn the equivalent of half a resident paycheck for 1 day of such work.

As to your assertion that 15k isn't life changing, I'm sure where you came up with that. You suggest that you were spending 50$ per week being frugal on food expenditures. Imagine increasing that by even 50$ per week and what a change that would have been in terms of both nutrition content and enjoyment. Similarly, for residents whose families live across the country, this can mean the difference from being to afford to go home for a holiday, or travel for a vacation, which I would argue fundamentally improves wellbeing. Are they strictly required for subsistence level living? of course not. I know the naysayers on here will suggest that it's fine for residents to live at poverty level of X number of years because then they will be rich attending, however not every resident comes from the same exact life circumstance such that they can put of gratification that long, just as not every resident can afford to put off fertility till after residency/fellowship.

Honestly I don't really understand this mentality of residents needing to just suck it up and deal (because back in my day we walked up hill in the snow both ways), or eat ramen and live in a shoebox because that's somehow virtuous. The numbers presented aren't saying residents should be driving fancy sports cars and living in luxury condos... we are talking about being able to afford an entry level studio-1 bedroom apartment, occasionally order takeout when you are post call and too tired to cook, and for the parents out there, actually afford to have the other spouse work vs being obligated to stay at home because childcare is too expensive. Maybe if you are doing a primary care residency that is only 3 years and don't do a fellowship then time wise it's a drop in the bucket for some, but we are also fighting on behalf of many who are residents/fellows for 4-8 years when all is said and done. That's a long time to eat your "$2 banh mi" every day and call it a feast.

 

[debateg]

The union is mostly complaining about resident exploitation, not abuse. Residency programs across the country have all gotten together and decided to pay wages that have not come up with cost of living. They can do that because residents, unlike nearly every other professional job, cannot negotiate their salary. If you join any company, you will need quite a bit of training lasting 6 months to a year, and you will have a supervisor who continues to help you, likely for the rest of your career. You can still negotiate your salary, benefits, etc. Residents cannot do any of that.

If you don't like your engineering job, you can quit and go somewhere else. Residents cannot do that. It's easy to blame CMS which does shoulder part of the blame, but programs like UCSF and UCLA have managed to come up with their own funding to help offset this. Programs have also decided to work residents to absurd hours, and even after solid data suggests that working fewer hours does not harm patients or hurt education, people still argue that residents should work more.

What the union has not spoken about directly is abuse. Abuse is also rampant in medicine, and not just residency. A recent article (JAMA. 2019;322(6):576-578. doi:10.1001/jama.2019.8616) showed that more than 13% of IM residents experienced bullying, 5.3% of which were physically harassed. Let that sink in. For a institution like UW with 1,400 people, 9 of them have been physically harassed if the rates are the same across other specialties. I am aware of at least one instance of a resident at UW who vomited on rounds and was only sent home when it was discovered that they had a fever to 103F. They showed up to work because they were previously punished by their program for calling in sick.

Go type "bullying and residency" into PubMed and read all the depressing articles. And you can go down the rabbit hole and read about how terrible faculty are treated too, and evidence for underlying sexism and racism driving this.

We work in a toxic environment. It's sad. On the bright side, I do think there is a movement among some of the more progressive administration to put an end to that.

 

[Green Penguin]

$2 banh mi is a feast. Since when is the standard of a decent meal being a $40-50 Omakase sushi plate?

Can you point me to the $2 Banh Mi? Because Banh Mi is one of the few things the UWMC cafeteria actually has, ironically enough, and it's $7.

 

[Epilepsy365]

Can you point me to the $2 Banh Mi? Because Banh Mi is one of the few things the UWMC cafeteria actually has, ironically enough, and it's $7.

Yelp the menu for Saigon Deli and similar places. $2.50-3.00 banh mi. Was $2.00-2.50 a few years ago.

 

[Green Penguin]

Yelp the menu for Saigon Deli and similar places. $2.50-3.00 banh mi. Was $2.00-2.50 a few years ago.

This is getting way off topic and I originally replied to the Banh Mi trope that's been going through this thread as a joke, but I'll "bite" one more time.

Yelped. It appears Saigon Deli has been more expensive than that since at least 2017. But the real fantasy in the Banh Mi idea isn't the access to a $2 Banh Mi, it's the idea that a trainee would have enough time to leave the hospital to go out for lunch anywhere. No, delivery doesn't work either since we don't actually choose what specific time we get our lunch breaks, they just come when there's a lull in the work, so planning around a delivery time is not feasible. And I can already hear someone saying "bring your lunch" ...to keep it in your non-existent refrigerator, or your (shared) locker perhaps?

And I assume lunch is the meal in question, since Saigon Deli isn't open any hour when a trainee is likely to not be at work...

Ok, enough from me on the completely irrelevant topic of Banh Mi.

 

[deleted480308]

The cost of living has gone up dramatically over the last 4-5 years, in particular with tech raising the average income. The same 1 bedroom in Capitol Hill that cost 800$ per month in 2008 now costs 1800+, especially since the light rail opened. Average Rent in Seattle & Rent Prices by Neighborhood - RENTCafé Residents are required to live within 30 min of the hospital which necessitates them living in more expensive areas. Is it possible to pay your rent on this salary by living somewhere super cheap and eating 2$ meals? Sure, but that argument neglects the basic premise of the union's argument. Asking to be paid a fair salary for your labor does not make you a prince or princess. Hospitals rely on resident labor. Historically, residents have been treated as indentured servants based on the promise of attending salary at the end, which is how guilds used to function. This is an unsustainable model and jeopardizes the diversity of residents who are able to train in high COL cities. I really don't understand this mentality of "back in my day we did X." We should all be asking how we can do better to help medical students and residents become the best doctors possible without sacrificing their health and personal finances to do so.

We could show them zillow, which has tons of apts within price range. Or a map of the country which has tons of more affordable cities

 

[Mass Effect]

I find it humorous that some are still going around in circles trying to convince people that the salary is no big deal when those same exact posters would have been up in arms when they were residents if they received a pay cut.

 

[VA Hopeful Dr]

I find it humorous that some are still going around in circles trying to convince people that the salary is no big deal when those same exact posters would have been up in arms when they were residents if they received a pay cut.

Did the residents receive a pay cut?

 

[Acyl chloride]

Did the residents receive a pay cut?

The residents did not receive a raise this year because the contract expired. That is essentially a pay cut based on inflation. That doesn't even count cost of living continuing to increase.

I'm going to stop replying for a while because it feels like the same posters are just being dense because they think residents don't deserve to be well paid and are disagreeing with COLA and housing data that even UW as an institution doesn't disagree with us on.

Also to the poster who keeps talking about Zillow. I am not arguing that there aren't apartments out there for less somewhere in Seattle. However, just because something is posted on Zillow doesn't mean it will actually end up renting for that price or is real or available when residents need to move in. Residents have limited ranges of locations they can live in based on call responsibilities. Residents aren't just living in expensive apartments because they are lazy. Apartments tend to be scarcer and in higher demand in June/July when residents have to move, and often this is from across the country on a few months notice. Many of the older buildings that used to be affordable have been torn down and replaced by more expensive rentals. Residents didn't ask for this, it happened to accommodate the influx of 20 something year old tech workers with 6 figure salaries who were being brought in to the city.

We even have a buy sell rent group to try to pass down good deals to other residents and the numbers you are talking about just aren't as plentiful as you are claiming/or are in places I'm pretty sure you wouldn't have been comfortable living in (even as a resident) and just to be clear this is coming from someone who has lived in places in NYC that you had to flip the breaker every time you plugged in too many appliances. I don't think it's unreasonable for people being asked to work the kind of schedules residents do to want to at least live in buildings that are safe, functional, and not too far from the hospitals they staff.

Again we've talked about how resident choice is limited by the match and also by training needs. I know our department chair when I was in med school explicitly told us not to consider the salary because the training would last you your whole career. If residents could easily swap locations during any training year if they find the city unaffordable, however many above have already posted that except in extremely rare circumstances, it's a one shot deal with the match. Part of the issue with UW we've discussed is that salary used to be on the low end, but somewhat comparable to other residencies across the countries in this regard- COL in the city of Seattle has skyrocketed disproportionately compared to other cities, but the salary has not kept up. Residents who matched her 4-5 years ago made an informed decision based on numbers that were radically different.

 

[debateg]

Keep in mind that when UWHA was forming, UW told the residents they were targeting stipends 5% above the average of all teaching hospitals. Keep in mind, that in 2015, Seattle was the 6th most expensive city in the country. So UW's position is that residents don't deserve to be paid a wage that accounts for the high cost of living, but they should be grateful that UW doesn't pay them substantially lower than average. Apparently, someone thought that was a good argument.

If you do that math, UW is trying to cut salaries back to the level in 2015. So they still believe that residents in Seattle should be paid the same as residents in an average cost of living area like Omaha, Nebraska. Oh wait, University of Nebraska pays their PGY-1s $58,690. UW pays their $58,224 which is less. Keep in mind that UW's current salary was forced on UW by collective bargaining. Imagine what it would be if UW got their way!

 

[Mass Effect]

Did the residents receive a pay cut?

According to one of the articles they did.

 

[Mass Effect]

I'm going to stop replying for a while because it feels like the same posters are just being dense because they think residents don't deserve to be well paid

They used to think residents deserved to be well-paid...when they were residents. Bet they also would have been up in arms that UW is allegedly not following ACGME rules in supplying rides after call shifts...when they were residents.

Whenever my residents complain about poor treatment or abuse, either in the system or directed at them personally, I tell them "remember this moment. Remember how you felt. Don't ever do it to anyone else."

I think this applies to all the residents out there fighting this fight. One day, you'll be the one in charge. Advocate for those following in your footsteps because most people won't.

 

[longhaul3]

Can you point me to the $2 Banh Mi? Because Banh Mi is one of the few things the UWMC cafeteria actually has, ironically enough, and it's $7.

That is a terrible banh mi. The UWMC cafeteria is probably the worst hospital cafeteria I've ever eaten in.

 

[VA Hopeful Dr]

They used to think residents deserved to be well-paid...when they were residents. Bet they also would have been up in arms that UW is allegedly not following ACGME rules in supplying rides after call shifts...when they were residents.

Whenever my residents complain about poor treatment or abuse, either in the system or directed at them personally, I tell them "remember this moment. Remember how you felt. Don't ever do it to anyone else."

I think this applies to all the residents out there fighting this fight. One day, you'll be the one in charge. Advocate for those following in your footsteps because most people won't.

A ride home is an actual rule? I honestly had no idea, must be fairly new as I'm not that old.

I think we got yearly raises, around an extra 1-1.5k/year. So after tax maybe $30 per paycheck. Had we not I really don't think I would have noticed.

Most of the complaining we did was about how the schedule was changed to accommodate the 2011 work hour changes and how we had to cover the various services instead of the interns.

 

[Mass Effect]

A ride home is an actual rule? I honestly had no idea, must be fairly new as I'm not that old.

I think we got yearly raises, around an extra 1-1.5k/year. So after tax maybe $30 per paycheck. Had we not I really don't think I would have noticed.

Most of the complaining we did was about how the schedule was changed to accommodate the 2011 work hour changes and how we had to cover the various services instead of the interns.

Yes, there's an actual rule. Came out 2017, I believe. I think it matters how much you get paid, but what matters even more is if you don't get that increase. This whole thing was 100% within the hospital's control.

 

[VA Hopeful Dr]

Yes, there's an actual rule. Came out 2017, I believe. I think it matters how much you get paid, but what matters even more is if you don't get that increase. This whole thing was 100% within the hospital's control.

I guess.

My second year the hospital changed the free food policy. It went from food whenever you were working to food only when on call. I remember most of us being kinda mad for a few weeks, then we just kinda forgot about it.

It does sound like UW could have done more by their house staff, I don't think anyone is arguing that point.

 

[Mass Effect]

I guess.

My second year the hospital changed the free food policy. It went from food whenever you were working to food only when on call. I remember most of us being kinda mad for a few weeks, then we just kinda forgot about it.

It does sound like UW could have done more by their house staff, I don't think anyone is arguing that point.

I don't know, I think some are actually arguing that.

 

[Acyl chloride]

They used to think residents deserved to be well-paid...when they were residents. Bet they also would have been up in arms that UW is allegedly not following ACGME rules in supplying rides after call shifts...when they were residents.

Whenever my residents complain about poor treatment or abuse, either in the system or directed at them personally, I tell them "remember this moment. Remember how you felt. Don't ever do it to anyone else."

I think this applies to all the residents out there fighting this fight. One day, you'll be the one in charge. Advocate for those following in your footsteps because most people won't.

I actually used to work in medical education before deciding to go back to school. On of my motivations for doing the training myself was to have people take me seriously when I said the system was broken vs "you haven't been through it so you don't understand." So for many years I have sincerely believed that residents and med students are treated poorly by the system that claims to be doing so in the service of education. After listening to a lot of lecture on adult learning theory and all that fun stuff, I am completely convinced that most of these structural issues are not done for an actual purpose, but simply because of that "we've always done it that way" principle. I also feel strongly about being an advocate to higher pay and better working conditions in particular for those folks, like many on this thread who don't even think they are being mistreated and thus would never advocate for themselves.

 

[BidingMyTime]

It absolutely is possible to live in seattle on 58k

Excellent point. There are many people in Seattle living there on far less than that. In fact, there are people in Seattle living there on 0 salary, completely on government subsidy. I think there is a case to be made that residents should be paid more, but COL is not one of those points.