This piece is written by The Collective for Resident Rights at Yale-New Haven Hospital.
On October 16, 2019, our collective of health care workers at Yale University disrupted the meeting of the Graduate Medical Education Committee. Heads turned and followed us to the front of the lecture hall, where we unfurled our banner declaring “Doctors are Humans Too.”
The room was silent as we read anonymous statements from the 165 Yale health care trainees and workers who had signed our Resident and Fellow Bill of Rights, now unveiled for the first time. In a collective declaration, we called upon our institution to recognize ten fundamental rights. We invited those in the room to support us, and one by one each program director and committee member rose to a standing ovation.
The Collective for Resident & Fellow Rights at Yale was born in the summer of 2018. As interns, in workrooms and in between the onslaught of our clinical work, we bore witness to our colleagues’ stories of depression, brutal work conditions, unsafe patient care, absence of supervision and desperate attempts to access mental health care. We traded tales of those who have completed suicide — no longer surprised that nearly every one of us can name a medical student or physician who killed themselves while in training. The reality of losing a physician to suicide every day, at double the rate of the general population, is unacceptable.
We each came to medicine with the knowledge that it is a deep privilege to care for our patients. In order to be healers, we know that we need to heal ourselves. Drawing inspiration from past and present activists and community organizers, we come together because we believe that collective action is the only way to create the radical, structural changes we need to save our patients’ lives, our colleagues and our own. We believe that we are building on the work of the many who came before us, including the health activism of the Black Panthers, organizing around indigenous rights, immigration, and labor, and the local unions and collectives that we have organized with. As Angela Davis said, “I’m no longer accepting the thing that I cannot change. I am changing the things I cannot accept.” This is one of our core beliefs. We must realize that the problem lies not with ourselves but within the system — which is much larger than any individual.
Transforming our pain into power, the writers of the Bill of Rights declared ten ideals and values that we hope will push the culture of medicine to acknowledge with humility our own humanity as a profession. As an evolving and interdisciplinary coalition that first grew out of primary care and psychiatry, and now includes neurology, pediatrics, medicine, OB/GYN, anesthesiology, emergency medicine, radiology, pathology, dentistry, general surgery, ophthalmology, and more, we believe in our power to continue mobilizing against the injustices that we experience and witness within our place of work.
We now call on all health care workers, patients, and community supporters to sign the Bill of Rights. By signing the Bill of Rights, you claim these ten values as your own too. The writers of the Bill also wrote a version of the Bill of Rights with a preamble and annotations to provide a context for the creation of this historic document.
Since going public, we have gathered support from hundreds more medical trainees, attendings and patients. Below are some of the poignant testimonies as to why a Bill of Rights is personally important to each of them:
Three of my med school classmates died by suicide, two were institutionalized, one was arrested, all for caring too much.
My depression became life-threatening due to extreme work hours, inability to make doctor and therapy visits leading to inconsistent treatment, lack of support from the residency program. “80 hours” and “wellness” [are] nothing more than buzzwords.
I want to live in a world where healers are able to be healthy.
If we sideline the reasons we went into health care and ignore the attacks on our intrinsic humanity, everyone will continue to suffer.
This system is not compatible with mental or physical health. I do not think hospital or government finances and policies are worth the very real loss of resident life we’re seeing around the country.
One of my mentors told me when I began in medicine, your first patient is always yourself; we have to stop enforcing a culture of health for our patients at the expense of the sickness of our residents.
Because this life is brutal.
Because I’ve never felt more dehumanized in my life.
“First do no harm” must begin with ourselves.
We have to do more than just talk about burnout. It’s past time to actually implement strategies to address the causes.
It is time we stand up as physicians, and demand that we be allowed to practice our professions to the best of our abilities.
The Resident and Fellow Bill of Rights
Today, we join the centuries-long tradition of oppressed workers and health care system participants who have declared their rights. We also stand with medical trainees mobilizing around the country to reclaim our humanity from an inhumane system.
Depression, occupational burnout, and suicide afflict physicians nationwide at an alarming rate. Excessive duty hours, insufficient time off, and inadequate supervision endanger both ourselves and our patients. Hospital systems and insurance companies exploit our labor; we spend more time than ever before documenting for billing purposes instead of caring for patients. We are employed by institutions who profit from the communities they purport to serve. Yale-New Haven Hospital consistently makes decisions that impact New Haven without transparency or community consultation. Our existing health insurance system undermines our ability to provide equal and adequate care to all patients. Furthermore, our profession propagates long-standing educational and economic barriers which lead to health inequities. Trainees, particularly individuals who are underrepresented in medicine and/or targeted based on immigration status, continue to face discrimination, fear, and humiliation in their workplace.
We declare that the institutions which hold trainees responsible for patient care must also be held responsible to care for their trainees. We refuse to sacrifice as doctors what we are owed as human beings. We therefore demand the fundamental human rights to life, health, dignity, and the joy of practicing our chosen vocation.
1. Right to work conditions that ensure patient safety:
We have the right to duty hours, team structures, and on-call responsibilities that allow us to safely care for our patients.
2. Decisional accountability to the community:
As residents, we are also members of this community and have the right to hold our institution accountable. We have the right to ensure decisions that facilitate equitable distribution of our labor and institutional resources.
3. Right to a diverse, inclusive training environment:
Our institution must reflect the diversity in our society and purposefully include trainees and faculty from groups underrepresented in medicine.
4. Right to respect and equity:
Our institution must establish policies to combat workplace discrimination based upon physical, mental, or social differences in order to promote a culture of respect, wellbeing, and opportunity.
5. Right to supervision and mentorship:
We have the right to sufficient supervision to protect patient safety. As the next generation of physicians, we have the right to invested and compassionate mentorship.
6. Right to fair and balanced evaluation:
We have the right to appeal disciplinary actions and educational evaluations through an objective, transparent, and democratic process.
7. Justice in health care:
Our training must equip residents to contend with health inequities in order to reduce disparities rather than perpetuate them. We deserve to fully care for all of our patients, regardless of ability to pay.
8. Right to health:
Our institution must promote our health, defined by the WHO as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” We have the right to comprehensive health insurance, including mental health coverage.
9. Right to a living wage:
We have the right to compensation and benefits that are sufficient for ourselves and our loved ones to thrive.
10. Right to democratic representation:
We have the right to represent our interests in the administration of residency programs. We have the right to know how our hospital system makes decisions and allocates resources.
Author’s note: The Preamble was written by the original creators of the Bill of Rights and does not necessarily represent the views of all supporters.
Image courtesy of The Collective for Resident Rights at Yale-New Haven Hospital