In this extra segment, recorded with Taylor Beckman, DO, from the "Inherent Problems" series, we discuss how the medical training system exploits students/residents, and acts like a monopoly, paying all residency positions nearly the same amount, with minimal pay increases each year, despite their skill level drastically improving. We give specific examples of how the financial systems integrated into healthcare benefit heavily from this exploitation, and discuss it in the context of NIL for college athletics, which seemingly should pave the way for resident unionization and the allowance of competition to drive wages up and give residents their true share of the pie, or at least a more even share of it.
Thanks for listening. For more social media content, check us out on all social media platforms @Renegadepsych. If you have any comments, questions or challenges to the information we've presented here, if you'd like to be a guest to the show, or if you have general comments, questions, or suggestions, email us at Renegadepsych@gmail.com and follow the link https://renegade-psych.podcastpage.io/ to our website for source material, transcripts, and additional links for my guests. If you feel passionate about our message and what we're trying to do, and you'd like to donate, you can also follow the link in the show notes to our website.
Disclaimer, this podcast is for informational purposes only. The information provided in this podcast and related materials are meant only to educate. This information is not intended as a substitute for professional medical advice. While I am a medical doctor and many of my guests have extensive medical training and experience, nothing stated in this podcast nor materials related to this podcast, including recommended websites, texts, graphics, images, or any other materials should be treated as a substitute for professional medical or psychological advice, diagnosis or treatment. All listeners should consult with a medical professional, licensed mental health provider or other healthcare provider if seeking medical advice, diagnosis, or treatment.
[00:00:00] Hey there folks, it's Dr. Short again.
[00:00:02] I am back to talk a little bit about resident exploitation, the true value of
[00:00:09] a resident and just talk about medical training in general on this series.
[00:00:13] I bring back Taylor Beckman who is graduating from residency in
[00:00:19] Jew and moving on to a cardiology fellowship starting in July.
[00:00:24] First, we talk a little bit about how residency positions are funded.
[00:00:29] Then we talk about how much residents make and compare it to their true value.
[00:00:35] Use a couple of notable examples.
[00:00:39] We also talk about some of the expected roles that residents take on in terms of
[00:00:44] training medical students, despite getting any additional funding for that, as
[00:00:50] well as the absurdity of getting a raise each year of residency of only
[00:00:55] one or $2,000, despite having significant jumps in clinical decision-making
[00:01:02] ability and overall independence as a clinician.
[00:01:06] We finish up talking about a push towards utilization and I compare the
[00:01:14] NIL movement in collegiate athletics to what I think should similarly happen
[00:01:22] within the medical school and residency culture, because essentially what we're
[00:01:26] dealing with is a monopoly on residencies.
[00:01:31] Everybody gets paid roughly the same and the system does not allow for
[00:01:36] natural competition, despite the fact that the work is pretty damn important.
[00:01:43] And one other point that we don't make in our discussion is that the
[00:01:47] journey to becoming a resident is at minimum an eight-year process of paying
[00:01:54] into the system with undergraduate four years and then four years of medical
[00:01:59] training.
[00:02:00] If you're like me and made the decision to go into medicine a little
[00:02:03] bit late in undergraduate, you're talking about anywhere from nine to 12
[00:02:09] years buying into the system before you start to see any payment on the
[00:02:14] other end in residency, which is as we discuss underpaid.
[00:02:20] I hope you enjoy our conversation today.
[00:02:23] Sorry about the audio in this intro.
[00:02:25] I didn't have my good audio equipment and microphone, but the rest of it
[00:02:29] should sound as good as my other series.
[00:02:33] Welcome to Renegade Psych, a nuanced podcast dedicated to informing the
[00:02:37] American public about the flagrant shortcomings of our healthcare system.
[00:02:41] I'm a board certified psychiatrist and along with my guests, break down
[00:02:44] interesting and important topics into several segments to appeal to both the
[00:02:48] general public as well as medical and psychiatric students, residents,
[00:02:52] and practitioners.
[00:02:53] My primary motivations are to appreciate nuance in major medical
[00:02:57] and psychiatric discussions, educate listeners on the undue and widespread
[00:03:01] influence of big business in healthcare, and provide accurate and
[00:03:04] reliable information on relevant mental and medical health topics.
[00:03:09] While I'm still young and have a lot to learn in my career, I cannot continue
[00:03:12] to stand idly by while so many in my field repeatedly fall victim to
[00:03:17] pharmaceutical interests, misinformation, and manipulation of existing
[00:03:21] data at the expense of Americans health.
[00:03:23] Whether you struggle with your mental health work in behavioral health or
[00:03:27] the healthcare system, or want to better understand our healthcare
[00:03:30] systems over promise and under deliver status quo, my guests and I hope to
[00:03:34] provide public education on some of the most pertinent, underreported
[00:03:37] and controversial issues in psychiatry, mental health and healthcare in
[00:03:41] general.
[00:03:41] Disclaimer, this podcast is for informational purposes only the
[00:03:44] information provided in this podcast and related materials are meant
[00:03:46] only to educate.
[00:03:47] This information is not intended as a substitute for professional medical
[00:03:49] advice.
[00:03:50] While I am a medical doctor and many of my guests have extensive
[00:03:52] medical training and experience, nothing stated in this podcast nor
[00:03:54] materials related to this podcast, including recommended websites, texts,
[00:03:57] graphics, images or any other materials should be treated as a substitute
[00:04:00] for professional medical or psychological advice, diagnosis or
[00:04:03] treatment.
[00:04:03] All listeners should consult with a medical professional, licensed mental
[00:04:06] health provider or other healthcare provider if seeking medical advice,
[00:04:09] diagnosis or treatment, or put more simply,
[00:04:11] you need help like this guy call your own doctor.
[00:04:16] Somebody get this guy some help.
[00:04:25] So in 1983, Medicare made changes to the way that it reimbursed
[00:04:30] hospitals and it funded residencies as a percent of that hospitals care
[00:04:37] expenditures, like a restaurant tip.
[00:04:40] So they haven't updated it since then.
[00:04:42] They tie the funding to the cost of care, which overall incentivizes
[00:04:48] the hospital to charge more for the same procedures for the same treatments
[00:04:54] to charge the patient and their insurance more because then in
[00:04:58] turn they'll get more money for residents, which are cheap labor force.
[00:05:04] It's like a positive feedback loop of profit.
[00:05:08] They charge the patient more.
[00:05:09] They charge the insurance more.
[00:05:11] Thereby they get more funding to subsidize residency positions by
[00:05:17] graduate medical education, which is tied in with Medicare.
[00:05:22] And it also de-incentivizes training physicians to go into primary care
[00:05:29] and to go into rural areas.
[00:05:30] Graduate medical education, which includes residency training, is all
[00:05:34] funded by the government, Medicaid, Medicare.
[00:05:38] You graduate medical school, you become a resident, you're doing your training.
[00:05:42] During this period of time, you're a doctor, you have a temporary license,
[00:05:47] but restricted for you to really practice within your residency
[00:05:50] training program for the most part.
[00:05:53] You're not compensated nearly to what you will be making as an
[00:05:57] attending once you graduate, but definitely above the poverty
[00:06:00] line, usually around $60,000 a year.
[00:06:03] The reason a lot of residents end up complaining about that is when
[00:06:07] you calculate the hours that they're working, you end up making about $15
[00:06:11] an hour for someone that is very highly educated and has
[00:06:15] spent a lot of time training.
[00:06:17] So salary wise hospitals definitely save a lot of money on residents.
[00:06:22] To add to that, you're making 60,000 or usually less than that when
[00:06:27] you start out in your first year.
[00:06:29] And as you go through each year of training, which is either three or
[00:06:33] four or generally five years for most of these programs, your pay goes up
[00:06:37] one or 2000 a year, even though your ability to practice medicine.
[00:06:42] Sky rock as an intern, I get it.
[00:06:45] You should make 55,000 a year.
[00:06:46] You don't know what the fuck you're doing and you are really probably
[00:06:50] causing more work for a lot of the residents above you in their third or
[00:06:55] fourth year and the attendings.
[00:06:57] But then as a second year, and definitely as a third year or a fourth
[00:07:01] year, you get to the point where you're essentially operating independently.
[00:07:06] You're not making anywhere close to what you should be making for
[00:07:12] the care that you're providing for the job that you have, the level
[00:07:15] of training and experience that you have.
[00:07:18] It is highway robbery.
[00:07:19] There's a funny little story that I found when doing research for this
[00:07:25] that paints some picture of what residents are actually worth.
[00:07:29] In August, 2019, there was a neurosurgery program, New Mexico, UMN
[00:07:34] lost their accreditation, but for these eight neurosurgery residents,
[00:07:39] the hospital was forced to hire 23 advanced practice providers, which
[00:07:43] are basically non-doctors and P's or PAs nurse practitioners or
[00:07:48] physicians assistants.
[00:07:49] They had to pay each of these neurosurgery nurse practitioners
[00:07:53] around 115,000 a year, twice as much as these residents were making.
[00:07:57] And there's 23 of them versus eight.
[00:08:00] So it ended up costing the university five times as much as they would
[00:08:03] have paid if they had kept the residents.
[00:08:05] You're talking about replacing residents at 60,000 a year who are
[00:08:10] working 60 to 80 hours a week with advanced nurse practitioners that
[00:08:17] are demanding 120,000, but they're not working 60 hours a week.
[00:08:21] They're also not operating in the OR too.
[00:08:23] They're definitely not producing as much.
[00:08:26] So it's just a little bit insight into how much a resident and training is worth.
[00:08:32] It's hard to really pin down exactly how much a residence worth.
[00:08:35] 2013, there was a study that said each resident is bringing in
[00:08:39] $134,000 a year for the hospital.
[00:08:42] I don't think that number is actually including the money the hospital
[00:08:46] saving and tax exemption status as well.
[00:08:49] So the hospital one gets paid money by the government for training
[00:08:54] residents per resident.
[00:08:56] They also get a tax exempt status for being a teaching hospital.
[00:09:01] So they're paying less money in taxes.
[00:09:02] That whole subject about residents not being maybe compensated the way they
[00:09:06] want to brings us to a interesting court case, Paul Jung versus the NRMP.
[00:09:12] This was back in 2004 and the NRMP is the National Residence Medical.
[00:09:19] National Resident Match Program.
[00:09:21] Yes.
[00:09:22] So Paul Jung, he was a internal medicine resident, graduated, started fellowship
[00:09:28] in infectious disease.
[00:09:29] He was working with two of the residents and noticed one day that the
[00:09:34] NRMP, the match process violated antitrust laws.
[00:09:39] The suit was launched on the parameters that fourth year medical students
[00:09:44] were required to apply to the match.
[00:09:46] They had no opportunity to negotiate their terms of
[00:09:49] employment with teaching hospitals.
[00:09:51] The defendants limited the number of residency positions available in
[00:09:54] the U S to teaching hospitals.
[00:09:56] The defendants placed substantial obstacles to the ability of a resident
[00:10:00] to transfer employment from one employer to another during the period
[00:10:03] of residency, meaning that once you have matched it, a program and
[00:10:07] you're in residency, there are many hoops and obstacles that you have
[00:10:11] to get around in order to transfer programs.
[00:10:13] If you feel like you're being treated unfairly, the ACA GME encourage
[00:10:18] required participation in the match as a condition of accreditation
[00:10:21] for institutions offering residencies.
[00:10:24] And the defendant shared information on conditions of employment and
[00:10:27] reviewed them in order to keep salaries low.
[00:10:30] So there was kind of a standardized way that residents were employed,
[00:10:36] treated, work hours were committed and salaries were standardized
[00:10:41] around the country.
[00:10:42] And those salaries for residencies, everybody who goes into residency,
[00:10:47] no matter where you're at in the country, there are just slight
[00:10:50] alterations based on cost of living.
[00:10:52] But we're all making a similar wage.
[00:10:55] It is a very fixed wage that, like you said, it violates anti-trust laws.
[00:11:02] So the NRMP publicly denounced this lawsuit.
[00:11:07] So they didn't really have much of a case.
[00:11:09] This lawsuit ends up going to courts.
[00:11:12] And as soon as the courts were found in favor of the plaintiffs,
[00:11:16] the lawsuit ended because Congress enacted legislation as a rider,
[00:11:19] basically a bill planted on another bill that was being passed called the
[00:11:23] Pension Funding Equity Act that exempted participation in a matching
[00:11:28] program from federal anti-trust laws.
[00:11:30] So the NRMP publicly denounced this saying that there's no case, but
[00:11:35] then went and lobbied to Congress saying-
[00:11:37] After they lost the case.
[00:11:38] Yeah.
[00:11:39] Y'all need to help us out because we're a large corporation.
[00:11:42] We're giving you a lot of money and you need to save us here.
[00:11:44] The rider was called confirmation of anti-trust status of graduate
[00:11:47] medical resident matching programs.
[00:11:50] The bill contained in the rider was passed into law by President George
[00:11:53] W. Bush on April 8th, 2004.
[00:11:55] And this new law prohibited using allegations related to the match
[00:11:59] to support any anti-trust claim.
[00:12:02] Basically stating that this is evidence that the NRMP was definitely
[00:12:07] in violation of anti-trust laws.
[00:12:08] The fact that the NRMP had to go behind their backs and say,
[00:12:11] you need to pass a law.
[00:12:12] They went up the quote unquote corporate ladder to the folks who have
[00:12:17] the influence in government and said, Hey, this could crumble or this
[00:12:22] could affect the profit margin drastically.
[00:12:25] It is so much like NIL in college athletics, a system where on the
[00:12:33] surface or superficially we're giving these kids a free education.
[00:12:37] And with residency, we're giving them their education.
[00:12:40] They're learning how to be a doctor.
[00:12:42] The reality is that what they are getting that they don't like to talk about,
[00:12:47] they're getting forced cheap labor in a monopolized system.
[00:12:52] You've got the potential for each of these residency programs to use the
[00:12:58] money that they have to recruit the best candidates that would
[00:13:03] make for a hell of a system.
[00:13:05] I would argue that you would need a base, a low number that they
[00:13:09] would be forced to pay somebody at minimum.
[00:13:11] But why can't programs like colleges and universities now recruiting athletes,
[00:13:18] they can go out and spend money on the best athletes.
[00:13:22] It is a free market system.
[00:13:24] America is supposed to be all about the free markets.
[00:13:28] Yet you've got these groups of medical graduates.
[00:13:33] The system already has them by the balls financially because they're in
[00:13:37] 200, 300, $400,000 worth of debt.
[00:13:41] And then they don't even have the opportunity to unionize.
[00:13:45] They don't have the opportunity to fight for a competitive wage, to go
[00:13:50] to a place that is willing to pay them more and then let other people
[00:13:56] who aren't as competitive and don't have as good of a track record,
[00:14:00] aren't as high quality of a candidate to fill the other spots.
[00:14:04] It is no different than NIL, except that you're talking about athletic
[00:14:10] ability with college athletics and you're talking about intellectual
[00:14:14] ability and your ability to practice medicine effectively with residency.
[00:14:20] So it is a fucked up system that everybody gets paid the same and
[00:14:25] it's no, no, no, it's what's best for you as the resident.
[00:14:30] And maybe it's because athletics get more publicity that this hasn't
[00:14:34] come to light before, but I don't know.
[00:14:35] It's funny you mentioned unions too, before I start talking about the
[00:14:40] unionization phenomenon that's been going on after that court ruling in
[00:14:43] 2004, six months later, the first work hours restrictions that came out of
[00:14:50] the NRMP were enacted by the AAMC where there was a 80 hour work week
[00:14:56] restriction that was placed on residency programs and it sounds,
[00:15:01] oh, you can only work 80 hours a week.
[00:15:03] It's actually, you can only work on average 80 hours a week over a four
[00:15:07] week span.
[00:15:08] And the reason why they're called residents is because back in the day,
[00:15:14] you used to take up residency in the hospital for certain rotations.
[00:15:19] You would sleep in a little call room in the hospital and then
[00:15:23] you'd wake up and you'd see all the patients and then you'd go to
[00:15:26] your room and you would wait for your pager to go off and you'd
[00:15:30] go take care of urgencies and emergencies.
[00:15:33] So you're talking about people who are working insane hours, who are some
[00:15:39] of the most intellectually capable people in America, yet the system
[00:15:44] has them by the balls.
[00:15:45] It goes even deeper than that though.
[00:15:47] As a resident, you are spending a good amount of time training
[00:15:53] medical students underneath you.
[00:15:56] Taylor, how much extra did you get paid for the time that you spent with
[00:16:00] medical students trying to help shape and form them into what you would
[00:16:05] consider to be a good resident and a good physician eventually?
[00:16:08] You're getting paid for this?
[00:16:10] No.
[00:16:11] I got paid by the medical school for teaching certain classes, but on a
[00:16:15] day-to-day basis, there are medical students that go see their own
[00:16:20] patients, they don't see them independently.
[00:16:22] They're asking you if what they did is correct.
[00:16:25] But then you've got to spend your time.
[00:16:28] You're already overloaded with documentation and doing the work that
[00:16:32] is being billed under the attending physician, but you also are expected
[00:16:37] to go back and educate the medical student on all of the medical and
[00:16:42] psychiatric aspects as well as the system itself.
[00:16:47] If you ask the average medicine resident, where did you get most of
[00:16:51] the on-training knowledge that you received in residency?
[00:16:54] And they will say from other residents.
[00:16:56] Absolutely.
[00:16:57] A hundred percent.
[00:16:59] And I'm not saying attendings don't teach, but the vast majority of
[00:17:02] time you're spending at the hospital is with other residents.
[00:17:05] The attendings are not there that often to be honest.
[00:17:08] And that's who you're learning from.
[00:17:10] Other people that have seen more and different things than you,
[00:17:14] they're the ones teaching you.
[00:17:16] So we teach ourselves and it's just a responsibility that
[00:17:18] we have to keep passing it along.
[00:17:20] So you're getting paid $60,000 to work 80 hours a week to teach medical
[00:17:27] students, to run the hospital at night.
[00:17:32] And that 80 hours a week again, as an average over four weeks.
[00:17:36] So you can work 120 hours one week, as long as it over four
[00:17:40] weeks, it averages out.
[00:17:42] And it goes deeper.
[00:17:43] There's more to add to that.
[00:17:44] There are some programs that do not allow you to do what's called
[00:17:48] moonlighting, where you work outside of your residency position.
[00:17:52] And it's awesome as a resident, if you have time to do that, because
[00:17:56] you're getting paid much closer to what you're going to get paid as
[00:17:59] an actual physician in your second year of residency, if you've completed
[00:18:04] the national required exams and pass those, then you can apply for
[00:18:09] your full medical license.
[00:18:11] You can go operate as an independent physician outside of this program that
[00:18:16] you are mandated by the system to complete, even though you're already
[00:18:20] seeing other patients by yourself making real money, but some programs
[00:18:26] say, no, you're not allowed to do that.
[00:18:28] Or we restrict you to only moonlight within our program and cover
[00:18:34] different shifts in the ER on some night when you don't have coverage.
[00:18:38] And for that, there are some good residency programs that allow
[00:18:42] internal moonlighting and they pay them like they should be paid.
[00:18:45] But there's other ones that are like, oh, we'll pay you $70 an hour.
[00:18:49] And as a resident, you're like, oh my God, that's awesome.
[00:18:53] $70 an hour.
[00:18:55] And then a couple of years later you get out and you're like, Oh, I'm
[00:18:58] making $250 an hour as a independently practicing physician.
[00:19:05] And they were paying me $70 an hour because they knew I didn't know any better.
[00:19:08] We at UofL, at least in the medicine program, do you have the opportunity to
[00:19:13] moonlight externally through urgent cares?
[00:19:15] And once you start billing and making closer to what an attending salary is
[00:19:21] like, you start actually realizing how much money you are worth to that
[00:19:27] hospital because the stuff I'm doing in that clinic versus in the hospital,
[00:19:32] it's the same work.
[00:19:34] And it makes that pill a lot harder to swallow when you realize, wow,
[00:19:37] this is what I could be making if I will be making in just a year.
[00:19:42] How is it different than college athletics?
[00:19:45] Yeah.
[00:19:45] Literally.
[00:19:46] Yes.
[00:19:46] Athletic programs, athletes in college started to unionize, started to
[00:19:50] recognize the worth and how much money they were generating from TV revenue,
[00:19:57] from sales of jerseys and different memorabilia.
[00:20:02] And finally that damn broke.
[00:20:05] Now they're still not probably not making what they should, but they're
[00:20:10] making a decent wage that is consistent with how good they are at what they're
[00:20:15] doing.
[00:20:16] Yet we are still stuck in the 1990s with, Oh no, the powers that be,
[00:20:22] they know what's best for you.
[00:20:24] No, they know what's best for them.
[00:20:26] And what's best for them is continuing to keep residents constrained
[00:20:33] in this system, making far less than what they're worth.
[00:20:37] Even though there are hundreds of thousands of dollars of debt and Oh, by
[00:20:41] the way, throughout residency, what's happening to your debt?
[00:20:46] Interest is accruing.
[00:20:47] You're only making $60,000 a year and you're three or $400,000 in debt.
[00:20:53] And that number just keeps going up and up in the vast majority of the
[00:20:57] loans that you're paying is just going towards the interest on your debt.
[00:21:00] Exactly.
[00:21:03] So you mentioned the word union in the last four or five years since I've been
[00:21:09] in training, I've started to see residency unionization pop up is a big topic.
[00:21:14] I started out in California has grown since then, especially with the COVID
[00:21:19] epidemic.
[00:21:20] I was in my second year of residency about at the halfway point and it
[00:21:24] really irritated me that there were all these things that I was mandated to
[00:21:29] do.
[00:21:29] I was in the hospital.
[00:21:31] The attendings sometimes weren't in the hospital, especially if they were at
[00:21:35] risk, but there was no risk to my health.
[00:21:38] There was no risk to my family's health or me bringing COVID home to my
[00:21:42] family.
[00:21:43] I was mandated to work in person.
[00:21:46] I was told that you don't need an N95 mask.
[00:21:50] I'm not telling you that I definitively do need an N95 mask.
[00:21:54] I'm saying, I don't know and I would rather take precautions, but there
[00:21:58] was a shortage of N95 masks, probably because all the attendings had them.
[00:22:02] And so, you know, I mean, you're being treated like a peon, you're doing all
[00:22:06] the work and then something like COVID hits and our residency program talked
[00:22:11] about, we talked about making some demands about how we were being treated
[00:22:19] with that pandemic.
[00:22:20] But at that point, you're two years in, you're financially deep in the red
[00:22:25] and you can see the light at the end of the tunnel of being finished and starting
[00:22:29] to dig your way out of debt.
[00:22:31] So it's really hard to get a group of people that are in four different years
[00:22:36] of their training as a first year, I would have been all for unionizing.
[00:22:41] But towards the end of my second year, I was probably still if everybody
[00:22:44] was like, we're doing it, I'd have been like, I'm jumping.
[00:22:46] But the third and the fourth year residents, especially the ones that are
[00:22:49] about to graduate.
[00:22:50] Already have job offers.
[00:22:51] You see the light at the end of the tunnel and you're saying-
[00:22:53] They don't have any incentive to unionize.
[00:22:55] Yeah.
[00:22:55] And they don't want to make waves.
[00:22:56] They don't want to cause trouble for myself because I see the light.
[00:22:59] I just got to make it a couple more months and then this will all be over.
[00:23:02] That's what it's going to take.
[00:23:04] Cause when Northwestern unionized, I think it was their football or maybe
[00:23:07] it was their entire athletic program.
[00:23:09] When Northwestern unionized, it wasn't long until NIL came into fruition.
[00:23:13] And it's the same shit here.
[00:23:15] Like you said, it's just not as public with us.
[00:23:18] We're not being nationally televised.
[00:23:20] Look at Taylor do this heart calf.
[00:23:23] Yeah.
[00:23:23] I think COVID was the big breaking point for a lot of programs.
[00:23:26] ICUs are overloaded.
[00:23:28] All the medical floors are overloaded with patients in the
[00:23:31] heat of the COVID pandemic.
[00:23:33] Residents are the ones that are going in and seeing these people in person.
[00:23:37] A lot of attendings, I'm not saying all of them obviously, but I saw a
[00:23:41] lot of attending standing outside the rooms and just talking on the phone
[00:23:44] to the residents because they didn't want themselves to get sick because
[00:23:47] they were making more of the medical decisions about a lot of things.
[00:23:50] So the residents are the ones putting themselves at risk.
[00:23:53] They're being pulled from other rotations that are generally thought
[00:23:56] to be less intensive, less hours and forced to work extra ICU months
[00:24:02] because the hospital needs it.
[00:24:03] The hospitals, ICUs are overloaded and they're not seeing any
[00:24:08] additional compensation.
[00:24:10] They're not seeing any additional vacation time.
[00:24:12] They're not seeing any additional breaks.
[00:24:14] And the rhetoric that they're fed is this is what you signed up for.
[00:24:19] You're a hero.
[00:24:21] Here's an extra pizza party.
[00:24:22] It's all fear-based.
[00:24:23] It's all fear-based.
[00:24:24] You're mandated, and I don't want to go too deep into this, but you're
[00:24:28] mandated to take a vaccine that has not been around for more than a few
[00:24:33] months that we don't have any longterm outcomes for, but you're told, no,
[00:24:39] you have to do this to continue your residency training.
[00:24:42] I was somebody who had COVID twice before the vaccine became available.
[00:24:48] And they tried to mandate me to take the vaccine, but to me as a medical
[00:24:53] professional, I know that natural immunity, once you've had an infection,
[00:24:57] your body develops a memory for that infection or for even different sub
[00:25:03] types of that infection or different evolutions of that infection.
[00:25:07] So I knew that I was twice immunized naturally.
[00:25:11] And yet I've got people telling me, no, you have to do what we tell you.
[00:25:15] You're a child and I'm your daddy and you have to behave and follow my rules
[00:25:21] or else you're not going to graduate.
[00:25:22] And then you're not going to have a job.
[00:25:24] And then what are you going to do with your $300,000 in the red?
[00:25:28] So since the COVID pandemic, there's been a widespread movement
[00:25:32] for residency unionization.
[00:25:34] I think most of the residencies in California have already unionized.
[00:25:38] There's been a movement, a big movement up in the Northeast as well.
[00:25:42] All of the New England residencies, most of the ones in New York,
[00:25:46] Northwestern has unionized.
[00:25:48] So this is happening at big name program.
[00:25:50] There's actually a website, committee of interns and residents.
[00:25:53] They're like an overarching nationwide union program.
[00:25:57] They have a drop down of over 50 residency programs that have already
[00:26:00] unionized, so hopefully that movement continues.
[00:26:03] And the reason you want a union, obviously you want collective bargaining
[00:26:06] is the biggest thing.
[00:26:07] Individually, you don't have a voice or much of a voice.
[00:26:11] But when you add all of the residents as a whole saying,
[00:26:16] The system would fall apart without us.
[00:26:18] Yeah.
[00:26:18] It would absolutely fall apart.
[00:26:21] Definitely.
[00:26:21] The hospitals would not be able to see as many patients, do as many procedures.
[00:26:26] You're talking about attending physicians who are managing multiple different
[00:26:31] residents who are each splitting out and seeing patients.
[00:26:35] The entire system would collapse without the residents.
[00:26:38] And this idea scares a lot of these residency programs, a lot of these
[00:26:43] larger hospitals brings us to this case of Loma Linda denying their residency
[00:26:48] program the right to unionize.
[00:26:51] So Loma Linda found out that its residents were trying to unionize and
[00:26:55] they were met with swift legal action in hopes of forestalling the
[00:26:59] union election.
[00:27:00] They at first retaliated by saying that we're reclassifying residents aren't
[00:27:06] allowed to unionize because they're students and students can't form a
[00:27:11] union, which is absurd since residents are paid a salary.
[00:27:15] You can't be a student being paid a salary.
[00:27:17] The other thing that Loma Linda tried to come out and say, and they're a
[00:27:21] hospital system that is seven day Adventist, but a lot of large hospital
[00:27:25] systems claim some religion.
[00:27:27] There is no religious teaching or indoctrination that goes on at their
[00:27:31] residency whatsoever, but they're saying since we are a religious organization
[00:27:35] that we can't have unionization amongst our employees.
[00:27:40] The federal courts also rejected this notion.
[00:27:43] I think that recently Loma Linda was able to unionize, but this is just
[00:27:47] an example of unionization happening and it is scaring hospital systems and
[00:27:51] residency programs because they know that without us, like you were saying,
[00:27:56] the system would fall apart.
[00:27:57] If we get together and do collective bargaining, we have a lot of power.
[00:28:01] At any individual institution, because you're talking about UofL, I don't
[00:28:07] know how many total residents we have, but it's got to be in the
[00:28:11] several hundred.
[00:28:13] And if everybody agreed or even half of, or even 25% of those residents
[00:28:19] said we're going to unionize, all of a sudden you don't have
[00:28:22] coverage for your hospitals.
[00:28:24] And it happens immediately.
[00:28:26] Yeah.
[00:28:27] And there's different ways to do that too.
[00:28:29] You can still treat the patients and do all the treatments you're
[00:28:34] going to do beforehand.
[00:28:36] I've seen one example where residents agree to not sign any notes.
[00:28:41] So without any notes, so every interaction within medicine is
[00:28:46] documented so that billing can be done.
[00:28:48] If you don't do the documentation, the notes, then no actual billing
[00:28:53] can be done.
[00:28:53] So you're still taking care of the patients doing everything you would
[00:28:55] before, but you don't sign any notes.
[00:28:57] So it's to the insurance companies.
[00:28:58] It's like there's no interaction that ever happened.
[00:29:00] And if you're one person doing that, they're going to release you
[00:29:03] from the residency program.
[00:29:05] But if you have 10 of your 40 residents doing that, not only
[00:29:10] does that look bad when they're trying to attract new residents,
[00:29:13] they have to report that of our 10 would be graduates, only six of them
[00:29:18] graduated and then the medical students start saying what happened
[00:29:21] to the other ones?
[00:29:22] But I think that's the answer, at least within residency.
[00:29:27] You got to unionize.
[00:29:28] If you unionize, then you force these powers to recognize the influence
[00:29:34] that you have as a collective group.
[00:29:36] There's pros and cons to unionization.
[00:29:38] And if you're a history buff at all, you can see what happened in
[00:29:41] the seventies with the car industry.
[00:29:44] But when capitalism swings too far one way and you get these giant
[00:29:49] conglomerates and these giant corporations, and you have a large
[00:29:52] labor force that is being exploited.
[00:29:54] And that's what doctors are nowadays, especially residents.
[00:29:56] Yes.
[00:29:57] Doctors.
[00:29:57] Nowadays we're a labor force.
[00:29:59] Yeah.
[00:29:59] If you're employed by a hospital that you need to get together
[00:30:03] and collectively bargain in order to protect your own rights.
[00:30:05] Yeah.
[00:30:05] It's absolutely labor exploitation.
[00:30:10] Somebody get this guy some help.
[00:30:12] Thanks for listening.
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