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Health Affairs This Week places listeners at the center of health policy’s proverbial water cooler. Join editors from Health Affairs, the leading journal of health policy research, and special guests as they discuss this week’s most pressing health policy news. All in 15 minutes or less.
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That's probably easiest. Health Affairs where health policy advances.
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Michael Gerber
Hello everyone.
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Michael Gerber
And welcome to another episode of Health Affairs This Week, the weekly podcast where Health Affairs editors talk about the latest health policy news. I’m Michael Gerber.
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Jessica Bylander
And I'm Jessica Bylander.
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Michael Gerber
How are you doing, Jess?
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Jessica Bylander
Pretty good.
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Michael Gerber
I want to remind everyone, don't forget you have until the end of the month to enter our You're A Health Policy Wonk contest, so make sure to fill out that form and send us those entries by Wednesday.
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Jessica Bylander
Yeah, and it sounds like we're getting a lot of responses, and we've seen a few and they're pretty funny. So and if you are a health policy wonk, you won't want to miss our next policy spotlight. That's on June 1st, where our editor-in-chief will be hosting Carrie Colla, the outgoing director of health analysis at the Congressional Budget Office.
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Jessica Bylander
So that's going to be at noon Eastern.
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Michael Gerber
And I'm definitely looking forward to that and plan on tuning in. But onto this week, a lot of news in Washington, mostly about the debt ceiling and how it might come crashing down. But we're going to, we're going to skip over that today and actually talk about, start out talking about something coming out of New York where just this week, resident physicians at Elmhurst Hospital Center in Queens in New York City had been on strike and they just resolved the strike after a few days.
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Michael Gerber
And while it was only one hospital in New York, we do think it has a lot of potential meaning and impact for health care and health care workers.
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Jessica Bylander
Yeah, really interesting news coming out of New York. I was interested to see that that was the first strike of physicians in New York City in over 30 years.
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Michael Gerber
Yeah. And it was a hospital, it's interesting, a hospital where the residents who work there are employees of Mount Sinai Health System, one of the big health systems in New York City and nearby areas. But the hospital itself is a public hospital and really was in the news, you know, just over three years ago as one of the first hotspots of the COVID pandemic, where the doctors there, the residents, the nurses and other staff were really on the front lines.
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Michael Gerber
And that was a big part of what they were talking about, these residents, when they were going on strike. For one, they were paid less than the residents at the other hospitals in the Mount Sinai system, about $7,000 less a year. And then they also were asking for things like hazard pay potentially during pandemics or other incidents. And so part of this deal was that they would get an increase in the salary over the next several years, as well as some of those other benefits that they were hoping to get.
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Michael Gerber
And they are represented by a union, a committee of interns and residents. And just to note that this was really only the internal medicine, pediatrics and psychiatry residents, not other specialties. The details of the deal they agreed to this week include wage increases of 18% over the next couple of years. It actually does go back retroactively to last fall.
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Michael Gerber
But interestingly, when these residents, and as we'll talk about, some across the country are going on strike or coming up with these deals. Clearly it only impacts them for a short term, but really could impact future medical trainees who are starting their residency. And I found this really interesting also because I happened to be talking to a neighbor a few days ago whose son actually just graduated medical school and chose his residency partially based on the fact that the program he's going to has a union and he feels that that's important, which I think is a lot different from other physicians
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Michael Gerber
and what my physicians and my family were considering when they were choosing residency programs in the past.
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Jessica Bylander
It's really interesting to choose a residency program based on that. You hear a lot about choosing your specialty based on kind of what it will pay in the future, particularly with how much student loan debt our medical students are graduating with. So that's like a new flavor of determining where people end up. And so I've been reading about this lately as well, and the increase in union activities among medical residents and kind of just learning more about why this has become more and more of a movement.
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Jessica Bylander
So residents have long lamented how much they get paid, as well as the long hours and sometimes limited benefits they face. And the pay is definitely not as much as I would have thought. So while medical residents have finished medical school and gotten their M.D., they're still in training and they're not making those high wages that we typically associate with physicians.
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Jessica Bylander
According to the American Medical Association, the average first year resident makes about $60,000 a year, and that doesn't increase exponentially during those years of residency and that period of time where they're still a resident can last anywhere from 3 to 7 years, depending on the specialty. So meanwhile, as I mentioned, the typical medical student graduates with about $200,000 in debt and a lot are saying they don't even make enough to cover rent in some of the more expensive cities where they're doing their residency.
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Jessica Bylander
I was reading an op-ed that said that some resident physicians in L.A. County had resorted to living in their cars to make ends meet. Child care is another big issue that I've heard about. As you know, many of the residents are at the point in their lives where they're starting to have children and yet they can't afford the cost of child care today.
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Michael Gerber
Yeah, it's definitely an issue. I, full disclosure, I happen to be married to a physician and I met her during residency and we got engaged during residency and she said yes when I proposed. But the second thing she said was, “Do you know how much debt I'm in?” And of course, they have some programs where you don't, based on your salary, you're not paying it off as much.
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Michael Gerber
But it meant she wasn't even putting a dent in that debt during residency. So she was, literally her med school debt’s continuing to go up because she wasn't even covering all of the interest while in residency.
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Jessica Bylander
Yeah, there is this increasing trend toward unionization among medical residents and they've been securing some wins, including that recent news in Elmhurst. So this past February, medical residents for University of California Health, which covers the University of California's six academic medical centers, including UCSF, signed their first system wide contract. And under that contract, residents got a 16% pay increase over two years,
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Jessica Bylander
four weeks of vacation and eight weeks of paid leave. And about 5000 residents are covered under that contract. So it's a big deal, a big development. Not all residents and fellows are in these unions, but the numbers are growing, particularly in the wake of the COVID pandemic. The Committee of Interns and Residents, the largest union covering medical interns and residents in the U.S., grew from 17,000 members in 2020 to 24000 members today.
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Jessica Bylander
Earlier this month, most of the residents and fellows at the University of Pennsylvania voted to unionize, and that they just joined a slew of other residents at other programs who are joining unions. There's mixed opinions of whether unionization is the right move. Some in medical education have argued that since residents are still technically in training, they're gaining that expensive training while also receiving a stipend.
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Jessica Bylander
But that argument doesn't seem to resonate with many, particularly when you do have residents caring for patients and providing a much needed workforce to health care institutions. So there's a big debate, you know, whether unions create an adversarial relationship with physicians who are training them or whether other avenues could be a better means of getting their needs and concerns addressed.
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Jessica Bylander
Of course, many residents in the past several months as this has been going on, it's been saying those other avenues aren't really taken as seriously as when a union comes to negotiate.
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Michael Gerber
I think it's important also to remember that while they are in training, you know, they're still bringing in revenue. They are seeing patients and in hospitals, you know, the term resident dates back to when they actually lived in the hospital and sort of came to be to help staff hospitals so that they serve a dual purpose. And I think they're as much there to keep the health care system afloat as they are to get the training that they're getting.
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Jessica Bylander
And you flagged some other recent news that speaks to another way health care workers are poised to have more protections around their working conditions. And that's in Minnesota, right?
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Michael Gerber
Yeah, so sort of a transition, not talking about residents anymore, but the governor of Minnesota and the legislature there just enacted a law that creates a nursing home workforce standards board. So this board is composed of three government agency reps from the Departments of Human Services, Health and Labor and Industry in the state of Minnesota. And then three representatives of nursing home employers and three people representing nursing home workers or worker organizations.
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Michael Gerber
So the governor will appoint those members and then this board will meet regularly to investigate nursing home work standards and to actually create some rules. They are authorized to establish minimum standards for nursing homes, to protect the health and safety of workers and to establish wage standards so they could set a minimum wage potentially for nursing home workers across the state.
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Michael Gerber
It's really the first board of its kind, as far as I can tell. So I think no one's quite sure exactly how it'll work. They did put some rules in that law that say, you know, they can't just double the minimum wage for workers and expect nursing homes to just suddenly have to pay that. Basically, if they do an analysis and find that there are rules or their wage standards exceed what nursing homes can pay based on the payment rates that the nursing homes receive from the state and from commercial payers, then those rules won't go into effect until the legislature actually appropriates those funds, increases the payment rate to then increase the pay.
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Michael Gerber
So unclear exactly what impact this will have, but clearly the unions were in support of this and feel that it will give nursing home workers potentially better pay, better benefits and more rights.
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Jessica Bylander
That's interesting because when you were talking about this, I thought, you know, is this a way kind of around unionization and would it take some of the power away from workers? But as you said, the unions are in support of this initiative. So clearly they feel that the goals of this board are aligned with the goals that a union would have for this workforce.
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Michael Gerber
Right. We'll see. It could just get, I could see there being a lot of trouble trying to get things passed by the board and then figure out how to, whether the legislature will fund those rules or not or where they can find the funding for it. But I think only time will tell. It is interesting, you know, Health Affairs published a study just about a year ago that did find that nursing homes that were unionized had lower mortality rates for the residents of the nursing homes and lower worker infection rates from COVID-19 for a period during 2020 and 2021, when two of the major COVID waves were hitting.
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Michael Gerber
So the study didn't look at the exact mechanisms behind those findings, but it could be related to, you know, unionized nursing homes might have higher pay, better benefits, it might mean workers weren't traveling back and forth to multiple jobs, had better sick leave, access to better PPE. And it could be that a board like this can help bring those things to a greater number of nursing homes.
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Jessica Bylander
Yeah, I just think with the growing union activity that we talked about earlier and these other moves in health care, it'll be really interesting to study kind of how that impacts the quality of life for workers as well as how it impacts patient care. You know, I was looking in terms of the residents and there's really not a ton of research out there, but a 2019 study of surgical residents found that when residents were unionized, they did have, you know, more vacation benefits, higher housing stipends.
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Jessica Bylander
But a lot of the other important outcomes that you would want to be tracking, including burnout, suicidality, job satisfaction and salary were the same whether the residents were unionized or not. So definitely looking toward more research on that, can't generalize just from that one study, but it's something to check out.
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Michael Gerber
Yeah, it definitely, definitely to keep an eye on those outcomes as well as I think that the bigger outcomes for the health care system in general of whether paying residents more will enable more of them to go into some of the lower paying fields after residency like primary care, mental health, where we definitely need more clinicians out there and have a shortage.
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Jessica Bylander
Well, Michael, I can't leave without wishing you a happy EMS week. I know that's a field that you worked in for many years.
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Michael Gerber
Thank you, Jess. Yeah. As a former full time paramedic and currently still certified, I do appreciate it and want to share the same sentiments with all the other frontline EMS personnel and everyone who supports them out there. Speaking of health care workforce in areas that are dealing with some of these same issues of workforce shortages and low pay and benefits, it's certainly a good chance to recognize the role they play in our health care system.
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Jessica Bylander
Yeah, well, I think that's a great place to wrap up. Thanks, everyone for listening to another episode of Health Affairs This Week. If you like this episode, tell a friend, leave a review and subscribe wherever you listen to podcasts.