On September 25, 2019, about 500 residents at the University of Washington (UW) participated in a 15-minute unity break across multiple clinical sites in response to stalled contract negotiations. The walkout was organized by the University of Washington Housestaff Association, a non-profit organization and labor union made up entirely of volunteer residents and fellows working to promote issues important to residents at affiliated hospitals of the University of Washington.

Kisha Clune, MD is a PGY-4 psychiatry resident at the University of Washington. She is lead negotiator for the University of Washington Housestaff Association. 

Ashley Cheek, the in-House Social Media Manager, conducted a phone interview with Dr. Clune to discuss the events that led to the walkout by UW residents. 

Editor’s note: This interview has been edited for brevity and transcription. 

---

Cheek: Hi Kisha! Thank you so much for taking the time to speak with us about the University of Washington Housestaff Association walkout. Please give us some insight into the events that led up to the walkout.

Clune: Thank you! We did a solidarity break on September 25 because we were struggling to have meaningful contract negotiations. In January 2019, we were eligible to start negotiating our next contract, since our current contract was set to expire July 1, 2019. Unfortunately,  University of Washington stalled and blocked efforts to start negotiating for nearly seven months by saying that negotiations could only be done during business hours for the convenience of their negotiating team. The precedent was that contract negotiations were held outside of business hours so that residents could spend as much time at the bedside as possible in order to avoid disturbing patient care. We spent months pushing against that, but ultimately our contract expired and we were forced to compromise and meet partially during business hours so that we could start negotiating.

Nearly two months after our contract had expired, we began negotiations but we still struggled to have meaningful conversations with UW. Their initial financial proposals were all at or below the level of our previous contract. That doesn’t even keep up with inflation, much less bring compensation up to the level of the national standard for residency. We made detailed, well-researched proposals asking for a cost of living stipend, childcare, safe-ride home programs, and other things that would bring UW up to the standard of our peer institutions. However, they did not respond to those proposals at all.

Cheek: What are some of the issues up for negotiation in the new contract?

Clune: The details of the contract included improved childcare resources. All UW residents with kids share an annual $50,000 fund that is equivalent to less than two days of Seattle daycare per year per resident family (and this is assuming only one child per family). Also, daycare alone is not a sufficient source of childcare, as residents often work odd hours — hours outside of typical daycare hours. Frankly, many workers in Seattle struggle with the expense and availability of childcare. We have additional disadvantages, including matching only a couple of months before we relocate to Seattle. The average daycare waitlist in Seattle is two years; obviously residents have no way of being on a waitlist before they match.

We are also negotiating the compensation offered by UW for its residents. Currently, the cost of living in Seattle has increased a record amount in the past 10 years (over 4.2% annually) without resident compensation changes. Rent in Seattle went up 69% from 2010 to 2018. Because of our on-call duties, residents at UW have to live in the most expensive neighborhoods in Seattle to be near the hospitals we staff, but no accommodations have been made for our soaring cost of living. Other residencies, particularly in expensive cities in California and New York, have accommodated their residents accordingly with stipends to offset the cost of living. We at UW are paid over $12,000 less than our colleagues when accounting for cost of living. Additionally, incoming residents are graduating from medical school with record levels of debt nationwide. UW must take this into account, along with rent, childcare, etc. when determining compensation.

These shortcomings in our contract results in UW effectively selecting the richest and whitest residents — those who can actually afford living here. Without a partner in tech, a wealthy family, or a privileged background, living in Seattle is a challenge. We are worried about providing the best care to our patients, as it is well studied that a diverse population of providers is necessary to provide the best care. We are concerned that UW will not attract such a resident population.

Cheek: Could you explain some more about the stalled contract negotiations from a financial standpoint?

Clune: After the previous resident contract with UW expired, we presented a very detailed proposal for bringing us up to the standard of our peer institutions. We did extensive research on comparables to other institutions. We were only offered financial proposals at or below those of our expired contract. When questioned about the financial proposals, with emphasis on inflation and the cost of living, UW offered no response.

We asked Mindy Kornberg, Vice President for UW Human Resources, why we were offered compensation below our previous contract’s annual 3% raise and below even the level of inflation. (The current UW offer is a 1% increase in the first year, 1% increase in the second year, and 0% increase in the third year). We received this response, “That was an opening offer. That’s the first number.” We’ve asked repeatedly for their next proposal for three months now and they have not provided it. Finally, our frustration led to the solidarity break.

Cheek: Was there any significance to the 15 minutes chosen for the solidarity break?

Clune: Our priority is to be at our patients’ bedsides; a 15-minute solidarity break is about the amount of time you might spend to go buy a cup of coffee. Even though we want to be at the bedside, doing what we came here to do, which is treating our patients and learning, we also needed to stand together and show UW and our community the importance of these issues. We hope our great show of solidarity, with nearly 500 residents walking out of clinical sites across the city, that UW will recognize how important this is too.

Cheek: We have had a lively debate on Twitter about the walk-out in the past weeks. What is your response to individuals who question the necessity of the strike and paint the residents involved as needy & whiny? In particular, @RickMorgan9 stated, “I support decent work conditions particularly for these non-union workers. Student debt needs to be addressed. That is not the fault of UW. The cost of living is thanks to tech. We had no work hour restrictions and no childcare, suck it up[.]” What is your response?

Clune: I think that residents need to work in humane conditions for their own wellbeing. It is well researched that depression, burnout and suicide are prevalent in the resident population, which is a very serious matter. You can’t ask people to just suck it up. This is a public health issue for both patients and residents. If you talk to people outside of medicine and explain that you, as a resident, regularly work 28-hour shifts wherein you are responsible for life and death decisions, you receive looks of shock and appall in return. And that’s the norm in residency in this country. A lot of people agree that the culture of residency nationwide needs examining, but that’s not even what we’re asking for here.

We are fighting for UW to come up to the national standard in their treatment of residents; we’re not asking for the impossible. Residents deserve to work in humane and livable conditions.

Cheek: For all the naysayers, there were so many more advocates and supporters. What really struck you from a support standpoint?

Clune: Just the level of community support from workers of all types. It was also heartening to hear my former medical school classmates, who are in residencies across the country, talking about this solidarity break and thinking about their own working conditions. I realized that I am surrounded by a compassionate group of people (residents from all walks of life and various geographical zones) who are very thoughtful and care about public health. You realize that bringing this conversation into the medical realm is completely in our jurisdiction as physicians and it is so nice to see the impact we can have in reclaiming our health and that of our patients and community.

Cheek: There was interest in regard to UW attendings’ involvement with the strike. How much support did you receive from UW employees?  

Clune: There was a lot of solidarity from various UW employees. Many came and stood in solidarity with us.

Cheek: I found it to be such a striking admission that a third of residents have fallen asleep while driving and 50% have had accidents/near-accidents while driving. Specifically, nearly 75% of UW residents are burned out. If I may ask, how has your health been affected by the working conditions at UW or what have you witnessed firsthand?

Clune: Residency is an isolating experience. Many residents move across the country and are “plopped” into a city without support networks. They see and experience intense situations that are moving and at times devastating.

Some of the hardest times I have faced have been when I was working long hours overnight on call alone, particularly in the VA hospital with no call room (which is against ACGME requirements). I pulled a sleeping pad into the floor of the resident room, and felt isolated and demoralized. Sharing my experience with other UW residents has been invaluable in maintaining a sense of purpose and hope when working conditions don’t make us feel valued. Organizing ourselves in the UWHA has been so important for a feeling of solidarity and for giving us a voice at the table to help change working conditions that are unsafe and unacceptable.

As a psychiatry resident, I have more time than some of my counterparts; therefore, it is so important to me to take that time and advocate for my colleagues who don’t have the time to do so for themselves. Our whole organization is run by us — volunteer residents and fellows. It’s a lot of work, but I think we all feel that this organizing is important for our whole graduate medical education community.

Cheek: I want to discuss the issue of “reimbursement rejections” for safe rides home for residents. The ACGME Common Program Requirement is that residency programs must provide “adequate sleep facilities and safe transportation options for residents who may be too fatigued to safely return home.” What is happening at UW?  

Clune: So, one of the major reasons they reject reimbursement is if we attempt to use the safe-ride home program during regular business hours. They say this is because public transportation is available for our use instead of the safe-ride program. But, in effect, it is a loophole that makes us ineligible for reimbursement most of the time.

For instance, on inpatient months, we work 28-hour shifts on a q4 basis, and we always get off during business hours. We have eight hours of protected time off between shifts. An hour and 30-minute bus ride on public transportation versus a 20-minute car ride makes all the difference when you are exhausted and you have to make the same trip back to work in eight hours time.

Cheek: Can we speak about the 80 hours of childcare per week? How do parents even begin to fathom that cost? How are they surviving? 

Clune: It is very difficult. I know a lot of resident parents whose partners have had to quit their jobs because they can’t get off a daycare waitlist or it’s impossible to find childcare that covers 80 plus hours a week, at all hours of the day and night. Situations like this can put healthcare in jeopardy, derail the partner’s career aspirations, and put families into precarious financial situations. We have heard from many resident families, especially two resident households, that go into debt each month to keep their families afloat. These are sacrifices that should not have to be made.

Cheek: We’ve touched on this throughout: if you could put it into a statement, what is the resolution that you are seeking from UW?

Clune: We want our contracts to be comparable to the national standard in regard to compensation and to value resident, patient, and community safety through initiatives like the safe ride home program, and vacation/leave time. We want childcare accommodations to improve so that it is manageable to be both a parent and a resident. We want recognition that our safety and our health matter, and that both have a huge impact on patient care as well.

Cheek: How has UW responded to the strike (if at all)? 

Clune: They haven’t responded at all. We had a negotiation session the very next day and received no response. 800 residents signed a petition and sent it to Dr. Paul Ramsey, CEO of UW Medicine. The UW negotiation team said that they had not heard a response from him. No new financial offers were given. No counter proposals to meaningful proposals were given. We were only offered very minor language changes.

Cheek: What do you want readers to know about UWHA and/or the walkout?

Clune: Residency can be isolating and can leave you feeling disempowered. Essentially, you have no choice in your residency. You are unable to negotiate your contract before signing. You work crazy hours and deal with difficult situations on a regular basis. The unity of us standing together has so many merits. It shows that the norm of residency does not have to involve feeling devalued and powerless. Just because this is the status quo does not mean that this is the only way.

Cheek: Thank you so much Kisha! Thank you for sharing your experiences with us. We hope that the UW residents receive the resolution they are seeking.  

Clune: Thank you!

Image credit: Photo courtesy of Dr. Kisha Clune and UWHA.