Since May 16, the resident physicians and fellows of three of the largest hospitals in Los Angeles have made time between our long shifts to visit voting tables and to cast ballots online in a historic vote to authorize a labor strike. If our contract negotiations with L.A. County don’t end in a resolution before the end of the month, the more than 1,300 of us could be the first members of our union, the Committee of Interns and Residents (CIR/SEIU), to strike in more than 30 years.
In his MedPage Today article last week, “Do Interns and Residents Ever Really Go on Strike?” Milton Packer, MD, sought to uncover exactly how common it is for frontline doctors like us to participate in labor strikes, laying out some examples, including his own experience striking as a CIR member in 1975. While we appreciate Packer’s analysis and his interest in our fight, there’s a much more urgent question: Why are L.A. County residents ready to go on strike now?
Let’s start with some context. Along with our fellow residents, we’ve been on the frontlines of the COVID-19 pandemic from the beginning, going above and beyond every day to keep these vital safety-net hospitals running. We are proud to care for L.A.’s most underserved communities of color.
Our union membership has allowed us to fight for both our patients and ourselves. For example, we created a patient care fund that helps us get vital equipment for our hospitals. Still, we do not have what we need to continue offering the exceptional care our patients deserve while also caring for ourselves and our own families. The cost of living has skyrocketed in L.A., while many of us barely make minimum wage when you account for our typical 80-hour work week. There is also a large gap between the starting salary of a resident working for L.A. County compared to some other hospitals in Los Angeles, even though we all face the same high housing costs.
In this environment, there have been some County residents who have had to resort to living in their cars to make ends meet. It also affects our ability to attract doctors who look like the communities we serve — which we know impacts patient care — as residents belonging to underrepresented groups in medicine are more likely to have financial burdens that push them towards better paying residency programs.
Throughout a months-long bargaining process, we’ve simply asked for the pay and benefits we need to address this crisis in our residency programs and to live and work in L.A. But on multiple occasions, the County negotiators have canceled bargaining sessions at the last minute, failed to make movement on or outright rejected key contract proposals — from economics to a diversity, equity, and inclusion proposal — and otherwise engaged in what we allege to be unlawful conduct and bad faith bargaining.
The County decision-makers on the Board of Supervisors and the L.A. County CEO have left us with no choice but to start voting to authorize an unfair labor practice strike. It’s not a decision we take lightly — we just cannot wait any longer for the County to do the right thing.
We’re far from being the only resident physicians who have felt compelled recently to take action to improve residency and patient care. Residents and fellows at USC-Keck just won their National Labor Relations Board election to unionize with CIR last month, right after residents unionized at Stanford Medical Center, Greater Lawrence Family Health Center, and the University of Vermont. And currently, resident physicians and CIR members throughout the University of California hospital system as well as at One Brooklyn Health, St. Mary’s Medical Center in San Francisco, UMass Memorial Health, and more are fighting hard for the strong union contracts they need with their employers.
It’s not hard to see why frontline doctors are driven to organize: Residency has always been challenging, but the landscape has changed since 1975, from the demands on residents and the way care is delivered, to this system-rocking pandemic, to the rising cost of living, and overwhelming student loan debt we carry.
As Packer mentions in his piece, his 1975 salary in 2022 dollars would be more than many residents make today, including those of us in L.A. County, and his housing and meals were also subsidized. At the same time, the average undergraduate debt in 1975 was just over $5,000 (in 2021 dollars) compared to more than $31,000 in 2021; the average medical school debt in 1978 was $53,648 (when adjusted for inflation in 2021) versus $215,900 now.
Between trying to stay afloat financially and contending with the persistent hazing culture and labor exploitation that is commonplace in medical training, it’s no wonder that residents nationwide experience startlingly high rates of depression, burnout, and even suicide — all of which impact patient care. Some are also leaving the profession, or considering doing so, especially women and people of color.
Thankfully, residency isn’t all that has changed in the past 4+ decades. This movement of frontline physicians using our labor power to change our workplaces and improve access and equity in healthcare is unlike anything we’ve seen before. Not all of us are contemplating a strike, but resident physicians’ labor activism has reached a fever pitch, and our employers and people everywhere should take note.
In L.A., we’re ready to go on strike because the status quo is untenable for ourselves and our patients, and the County is past due in bargaining with us in good faith. Already, bright, young doctors who graduated from medical school in the past couple weeks are scrambling to find apartments they can afford. They deserve to be treated with dignity during their medical training, and the people of L.A. deserve to have talented doctors who look like them — and who aren’t stressed about meeting basic needs, like paying their rent.
Let’s be clear: If we do strike in L.A. County, it won’t be the “first meaningful labor action among interns and residents in nearly 50 years,” as Packer writes; it will just be the latest surge forward in a giant — and unstoppable — wave.
Monique Hedmann, MD, MPH, is a second-year family medicine resident at Harbor-UCLA Medical Center and a CIR Regional Vice President. Mahima Iyengar, MD, is a first-year internal medicine-pediatrics resident at LAC+USC Medical Center and a CIR Regional Vice President.