This piece is written by The Collective for Resident Rights at Yale-New Haven Hospital.

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In just a matter of weeks, the lives of medical professionals and trainees across the country have been turned upside down as we struggle to care for patients within a woefully unprepared health care system. There are not enough beds, ventilators, basic personal protective equipment (PPE), or even morgues. Hospital workers are resorting to wearing trash bags in place of appropriate PPE. Inadequate PPE results in many providers becoming patients themselves. We have already seen that despite being a fairly young and healthy population, without PPE health care workers are far more likely to require ICU-level care and die from COVID-19. As more and more of the health care workforce becomes infected, NYC medical schools are asking students to work as interns, but with no compensation for their labor instead of hiring more moonlighters or advanced practice providers.

Protecting health care workers is essential in this pandemic. Yet, when health care workers speak out about these failures, we have been censored or punished for exercising our right to free speech to advocate for ourselves and our patients. This shameful response from hospitals and our very own residency programs illuminates the vulnerability of our positions within an increasingly corporatized world of medicine. We are asked to sacrifice ourselves in the name of ‘patient care’ while hospital executives are flying to mansions in Florida to wait out this global state of emergency. They make decisions that put us in high-risk situations without input from us, the workers. Their actions speak loud and clear: the real motive lies in the profit from our labor.

The time is now for us to claim and protect trainee rights. In 2019, as a collective of residents at Yale, we wrote a historic document: The Resident and Fellow Bill of Rights, which declares our rights and seeks to reclaim our humanity.

This crisis is exposing both the desperate lack of protections for medical trainees as well as the gaping holes in our entire health care system. The dominant model of for-profit medical care is inadequate to deal with a public health crisis like the COVID-19 pandemic. About 28 million people in the United States have no health insurance and many — especially undocumented patients — are afraid to seek medical care because of extremely high costs of treatment or because the Public Charge rule could endanger their immigration status. When the most marginalized communities are hit by COVID-19, the result is devastating — for all of us.

We are systematically exploited by the health care system, and now administrators are asking us to put our bodies on the line without appropriate protections or compensation. Hospitals depend on our unpaid and underpaid labor, as medical students, residents and fellows. Their need for our labor also means that we have the power to change our work conditions and to call out the health care inequities to which we bear witness. Health care workers across the nation have already taken steps to push for change: They’ve collected millions of signatures petitioning for shelter-in-place policies and adequate PPE as well as spoken out on a dangerous lack of leadership despite efforts to silence them. Almost 200,000 people have signed a petition to the house of representatives to forgive student loan debt for health care workers.

It is time to organize. Our collective voice cannot be silenced.

The Collective for Resident Rights at Yale wrote the following list of demands, under our rights as medical trainees, related to the COVID era. You can find us to share experiences, organize, and process together in Training in the Time of Coronavirus.

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Trainee Bill of Rights in the Coronavirus Era

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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.

• The ACGME 80-hour work week limit must not be exceeded or changed.
• Existing duty hour restrictions and safe patient caps must be maintained.
• Back-up call systems must be created to support frontline teams and deemed appropriate with resident input and approval.
• Trainees retain the right to opt out of clinical duties which fall outside of their scope of practice or experience.
• Personal protective equipment including N95 masks or equivalent respirators must be provided to trainees in adherence to evidence-based standards. Financial or logistical limitations to doing so must be communicated in a transparent manner to all trainees.

Decisional accountability to the community: As residents, we are also members of this community and have the right to hold our institutions accountable. We have the right to ensure decisions that facilitate equitable distribution of our labor and institutional resources.

• Hospital systems must publicize policies and commitments to offering coronavirus testing and treatment to all patients, regardless of insurance or immigration status.
• Hospital systems must assist in local efforts to provide housing to high-risk, non-health care workers and local residents (firefighters, police officers, homeless individuals) who are at higher risk of exposure to or complications from coronavirus infection.
• Given the long-standing bias and inequities in our health care system, hospital policies regarding the rationing of care must have trainee and community representation, input, and approval.

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.

• Hospital systems must advocate for favorable recommendation to the United States Citizenship and Immigration Services for trainees on visas serving communities during the coronavirus pandemic.
• Hospital systems must support and accommodate trainees seeking visa extensions during the pandemic.
• If trainees on visas are asked to continue their clinical work, expand their scope of practice, or assist frontline efforts during the coronavirus pandemic, hospital systems must advocate for obtaining work permits for these trainees.
• Working outside their scope of practice or not completing ACGME requirements due to rotation disruptions during the coronavirus pandemic shall not jeopardize future visa sponsorship for trainees on visas.
• In the event of trainee death while performing clinical duties on a visa, hospital systems must guarantee life insurance or provide equivalent compensation for the trainee’s family. In addition, hospital systems must advocate to prevent the deportation of their spouse or dependents.

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.

• Hospital systems must accommodate the needs of trainees whose physical, mental, or social differences increase the health risk of themselves and/or their loved ones during the coronavirus pandemic.

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.

• Supervision during the coronavirus pandemic must continue to be adequate and appropriate, as determined by resident input and approval to fit with local demands.
• Physical contact with patients diagnosed with coronavirus must be limited and shared fairly among members of the health care team.

Right to fair and balanced evaluation: We have the right to appeal disciplinary actions and educational evaluations through an objective, transparent, and democratic process.

• Hospital systems must not retaliate against, intimidate, coerce, or terminate trainees who voice concerns to the institutions or media about matters including, but not limited to, supply of personal protective equipment, trainee deaths, lack of transparency in administrative decisions, or violations of the rights set forth in this document.
• Hospital systems must not retaliate against, intimidate, coerce, or terminate trainees who request more information related to hospital policy, patient care, or workplace safety during the pandemic.
• Hospital systems must not retaliate against, intimidate, coerce, or terminate trainees who decline to perform a task they consider immoral or unsafe to their personhood.

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.

• Coronavirus testing must be provided free of cost to all individuals.
• Coronavirus-related inpatient or outpatient treatment must be free of cost to all patients without health insurance.
• Hospital systems must publicize that ICE agents are not allowed into patient care areas except under very limited circumstances. Hospital systems must provide training to staff and accessible information to patients on policies protecting undocumented individuals who seek health care services.

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.

• Trainees have the right to opt out of clinical duties for reasons including (but not limited to) undue risk to their own health.
• Trainees retain the right to access physical and mental health treatment, including the right to attend necessary medical appointments.
• Hospital systems must provide alternative housing to health care workers at risk of exposure to coronavirus, to limit spread of the exposure to family members and/or cohabitants.

Right to a living wage: We have the right to compensation and benefits that are sufficient for ourselves and our loved ones to thrive.

• Hospital systems must continue paying a living wage and providing benefits to residents who are furloughed, self-isolated, or quarantined during the coronavirus pandemic.
• Hospital systems must compensate for trainees who work beyond their typical duties (i.e. volunteering for another service), through methods deemed appropriate by the trainees (e.g. hazard pay, additional paid time off, etc.)
• Hospital systems must provide life insurance and continue health benefits for families of trainees in the event of trainee deaths related to their performance of hospital duties.
• Must continue to provide disability insurance to all trainees.
• Hospital systems must provide hazard pay to trainees engaging in clinical work during the coronavirus pandemic.

Right to democratic representation: We have the right to represent our interest in the administration of residency programs. We have the right to know how our hospital system makes decisions and allocated resources.

• Trainees must be included in the decision-making process for resource allocation should rationing of care become necessary.
• Trainees must be represented in departmental and interdepartmental meetings addressing the restructuring of rotations, restructuring of call schedules, and distribution of PPE.

Image courtesy of The Collective for Resident Rights at Yale-New Haven Hospital