On September 25, we participated in a 15-minute unity break (effectively a walk-out) with over 450 residents and fellows at the University of Washington in protest of UW’s dismal contract proposals during our negotiations. It was led by the University of Washington Housestaff Association (UWHA), one of the few unions of resident doctors in the United States.
Living as a resident in Seattle is far more challenging than it was five or 10 years ago. It is now the fifth most expensive city in the United States. Housing is now more expensive here than in any city outside of California. Rent in the neighborhood equidistant to our three major hospitals has more than doubled since 2010, now costing about 42% of a PGY-1 salary.
Residency is already an extraordinarily challenging experience, and this is compounded by the stress of affording rent and making loan payments, typically 10-15% of our base salary. Incredibly, surveys of our own residents revealed that UW resident parents spend between 50% and 100% of their paycheck on childcare. A surprise medical bill can become debilitating. We have received stories of residents delaying car repairs or dental work, or hesitating to spend $500 for a flight to visit family for the first time in a year over the holidays. This is all because we remain $12,000 to $15,000 underpaid compared to 50 peer academic institutions when adjusted for the cost-of-living in their respective cities.
To advocate for the 1,400 residents we represent, our contract proposals included pay raises to make our salaries competitive with peer institutions and a housing stipend reflective of our disproportionately high cost-of-living. We also proposed improvements in access to childcare services and funding, as many residents go further into debt to pay for childcare. We advocated for a reliable safe ride home program to ensure that residents can access safe and affordable transportation to and from our workplaces. Other proposals included scheduling accommodations for our own health care and mental health appointments, modest increases to our meal reimbursement rates (which have been stagnant for over a decade and cover one meal per 12-hour shift), and improved bereavement leave for unexpected family deaths.
Unfortunately, our reasonable, data-driven proposals have been flatly rejected. UW claimed it did not have the financial resources, despite a recent email boasting $2 billion raised in a fundraising campaign. Instead, our employer showed us how little it valued our work and dedication to patients by proposing a cut to our benefits and inflation-adjusted pay — reducing previously agreed-upon 3% yearly raises to 1% for two years, and then 0% for the third year of the contract. It was this devaluing of the work that we do to run UW hospitals that prompted our 15-minute unity break.
Astoundingly, our own graduate medical education (GME) office has been integral in ignoring our concerns and opposing our efforts. We find it a profound conflict of interest that GME members (an assistant dean and the director of housestaff affairs) sit across the bargaining table as part of UW’s labor relations team. Our housestaff have dedicated so much to their jobs and this negotiation process, and they deserve the most basic respect and good faith engagement from their employer.
Some might raise arguments that our appeals are unreasonable or unfounded. These voices repeat the falsehood that residents today have it better now than decades ago. Current residents have approximately $135,000 more in inflation-adjusted medical school debt than physicians in the 1980s. We deal with exorbitant administrative and computer tasks. We start and finish the training process at a more advanced age; more applicants take gap years in order to be accepted into medical school and the training process has become longer. This delays our ability to get married, start families, and become homeowners.
More importantly, these arguments stand on a false premise: that past injustices legitimize a culture of exploitation and “paying your dues.” Even if our predecessors truly had things harder, it does not change the reality that things are still incredibly, unnecessarily hard for residents. “I had to go through it, so you should too” is a deplorable argument. Those who adhere do not belong in positions that oversee the training and mentoring of students and residents, and we have to fight to make that a reality.
We risk a great deal in standing up for ourselves. But the alternative to fighting — maintaining the status quo — takes an enormous toll on all of us. Burnout is widespread, and growing still. Anxiety, addiction, depression and suicide exact a disproportionate toll on physicians, particularly trainees. To win this fight, we first have to fight the feelings of hopelessness and powerlessness within ourselves.
Our experience so far has been undeniably frustrating. However, we feel empowered by the response of over 450 residents and local media amplifying our voice and uniting around our cause. We stand together to fight for ourselves, our colleagues, our patients and those residents who will come after us. We know that when we succeed, it will have greater ramifications for physicians, public employees, and the labor movement not only in Washington state, but nationwide. We are inspired by those who came before us and hope this struggle will inspire and encourage other residents across the country to unionize and stand up for themselves. You do not need to wait until circumstances become untenable, as they have at the University of Washington. All residents across the country are underpaid and overworked.
We have many potential allies in this struggle — the public, the media, some attendings and institutional leaders. But we cannot count on anyone else to stand up and make change for us. We all know how things should be better, and we have all the power we need to make change — all that is left is to have the collective courage to act.
Image credit: UWHA on The Stranger