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COVID-19 Burn Out Causing More Resident Physicians to Unionize, Part 2

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

This is part two of a blog series focusing on the effects of COVID burnout in healthcare professionals. Don’t forget to read part one.

The Problem With Residents’ Working Conditions Existed Long Before the Pandemic.

It’s common for resident physicians to work long hours for relatively low pay. They have little or no ability to determine their schedule and are generally locked into positions for up to seven years. Certainly, medical residents have voiced concerns about their work lives long before the pandemic. Some describe years of grueling schedules, sometimes with 24-hour shifts, including 80-hour workweeks. “Residents were always working crazy hours, then the stress of the pandemic hit them really hard,” John August, a director at Cornell University’s School of Industrial and Labor Relations, is quoted as having said.

To learn more about issues that affect residents and fellow physicians, click here to visit the American Medical Association (AMA) Resident and Fellow Section.

Benefits & Drawbacks of Unionizing.

Medical residents looking to unionize often cite such basics as pay and working conditions as top reasons. For reference, first-year residents earned just under $60,000 on average in 2021, according to a survey done by AAMC. At 80 hours a week, one could calculate that residents could very well be earning less than the minimum wage, according to the AAMC data.

Those unionizing typically say wages are too low, especially given residents’ workload, student loan debt, and the rising cost of living.

Additionally, some residents say that unions can have upsides for hospitals and can also help enhance patient care. Patients deserve physicians who aren’t exhausted and preoccupied with the stress of finances. “To take good care of others, we need to be able to care for ourselves. We love being residents and caring for patients. But we can’t do that well if we neglect ourselves,” said a University of Vermont Medical Center resident.

On the other hand, residents unionizing is not without its potential drawbacks. For hospitals, money is an issue. Although federal funding helps pay residents’ salaries, most training expenses come from hospitals. In many instances, because of the pandemic, those funds are now depleted, said Janis Orlowski, MD, AAMC chief health care officer.

Some worry that unionizing can undermine the connections between residents and the physicians who train them. Another primary concern for hospitals is the threat of a strike; although rare, it has been decades since the last one. Many residents also worry that unionizing could undermine patients’ and communities’ trust in them.

Happy Residents, Happy Patients.

For some healthcare workers, the COVID-19 pandemic solidified the importance of a union. Residents have been on the front lines of care but were not always the first to access PPE or lifesaving vaccines. Others are simply looking for acknowledgment of the sacrifices they’ve made while caring for the country’s most vulnerable patients.

However, one thing remains clear; both sides agree that the goal is to become a good physician and get taken care of in the process.

For more information on residency programs, click here to watch one of our video blogs, and make sure to check out our YouTube page.

Contact Experienced Health Law Attorneys Representing Residents, Fellows, and Medical Students.

The Health Law Firm routinely represents resident physicians, fellows and students, including medical students, dental students, nursing students, pharmacy students, and other healthcare professional students, who have legal problems with their schools or programs. We also represent students, residents, and fellows in investigations, academic probation and suspensions, disciplinary hearings, clinical competence committee (CCC) hearings, and appeals of adverse actions taken against them. The Health Law Firm’s attorneys include those who are board-certified by The Florida Bar in Health Law as well as licensed health professionals who are also attorneys.

To contact The Health Law Firm, please call (407) 331-6620 or Toll-Free (888) 331-6620 and visit our website at www.TheHealthLawFirm.com.

Sources:

Weiner, Stacey. “Thousands of medical residents are unionizing. Here’s what that means for doctors, hospitals, and the patients they serve.” AAMC News. (June 7, 2022). Web.

Kwon, Sarah. “Burned out by COVID and 80-hour workweeks, resident physicians unionize.” Kaiser Health News. (May 27, 2022). Web.

Murphy, Brenden. “Why more resident physicians are looking to unionize.” AMA. (June 28, 2022). Web.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law is an attorney with The Health Law Firm, which has a national practice. Its main office is in Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Avenue, Suite 1000, Altamonte Springs, Florida 32714, Phone: (407) 331-6620 or Toll-Free: (888) 331-6620.

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2022 The Health Law Firm. All rights reserved.

COVID-19 Burn Out Causing More Resident Physicians to Unionize, Part 1

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

This is part one in a blog series focusing on the effects of COVID burnout in healthcare professionals. Be sure to check back for part two.

As you know, residents are new physicians who have recently finished medical school and are spending three to seven years obtaining additional training in a medical specialty. Almost all hospitals practice independently; after all, they are doctors already. And in nearly all hospitals where resident physicians practice, they represent the front line of medical care. On duty all the time, on-call all the time, they are usually the first medical professional to see a new patient who can make a diagnosis and order tests or medications. In addition, resident physicians are generally the first to examine, diagnose, and treat a patient.

In most hospitals, in the past, residents were treated almost as indentured servants, required to work long hours without sleep, pull back-to-back shifts, and remain on call for extensive periods. This was considered a right of passage for resident physicians; a “baptism of fire.” If they couldn’t hack it, they did not deserve to be a physician in the specialty.

More than 80 Hours per Week-a Routine Occurrence.

However, recently (let’s say in the last decade or so), it has been recognized that overworked health professionals cannot provide optimum, safe patient care. This led such organizations as the Accreditation Council for Graduate Medical Education (ACGME), which accredits residency programs in the U.S., to require that such programs and hospitals that residents work in must limit the resident physician’s work hours to no more than 80 (yes, 80) hours per week. It got so bad that at least one state, New York, passed a law stating that it was illegal for resident physicians to work more than 80 hours per week.

However, even before the COVID-19 pandemic, there were hospitals and residency programs that would require their residents to work more than 80 hours a week and to turn in false time sheets showing they had worked fewer. We have had many reports that such programs even meet with their residents before an ACGME inspection (or survey) and tell them they must lie to the investigators (or surveyors) and falsely state they did not work more than 80 hours.

COVID-19 Comes on the Scene.

However, in a real crisis like the COVID-19 pandemic, where patients are coming into hospitals dying right and left, it must be acknowledged that resident physicians and other hospital staff will be working above and beyond the maximum, no matter what. The long hours, the lack of relief, the stress of losing patients, and the stress of exposure to a potentially deadly disease have taken their toll on many resident physicians. Those who have contracted the virus and had to rush their recovery and recuperation to get back to work have, perhaps, suffered the most.

Residents Banding Together to Unionize.

Many resident physicians are now banding together to demand higher wages, better benefits, and working conditions due mainly to the “burnout” they experienced during the COVID-19 pandemic. They join nurses, medical assistants, and other health care workers who are unionizing and threatening to strike. In addition, staffing shortages, the rising cost of living, and the lack of personal protective equipment (PPE) and COVID vaccines have pushed them to their limits.

In some places, New York being a familiar example, resident physicians already had unions representing them in many areas. Now, this is expanding.

Check back soon to read part two of this blog series.

Contact Experienced Health Law Attorneys Representing Residents, Fellows, and Medical Students.

The Health Law Firm routinely represents resident physicians, fellows, and students, including medical students, dental students, nursing students, pharmacy students, and other healthcare professional students, who have legal problems with their schools or programs. We also represent students, residents, and fellows in investigations, academic probation and suspensions, disciplinary hearings, clinical competence committee (CCC) hearings, and appeals of adverse actions taken against them. The Health Law Firm’s attorneys include those board-certified by The Florida Bar in Health Law and licensed health professionals who are also attorneys.

To contact The Health Law Firm, please call (407) 331-6620 or Toll-Free (888) 331-6620 and visit our website at www.TheHealthLawFirm.com.

Sources:

Weiner, Stacey. “Thousands of medical residents are unionizing. Here’s what that means for doctors, hospitals, and the patients they serve.” AAMC News. (June 7, 2022). Web.

Kwon, Sarah. “Burned out by COVID and 80-hour workweeks, resident physicians unionize.” Kaiser Health News. (May 27, 2022). Web.

Murphy, Brenden. “Why more resident physicians are looking to unionize.” AMA. (June 28, 2022). Web.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law, is an attorney with The Health Law Firm, which has a national practice. Its main office is in Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Avenue, Suite 1000, Altamonte Springs, Florida 32714, Phone: (407) 331-6620 or Toll-Free: (888) 331-6620.

By The Health Law Firm|2024-03-14T09:59:17-04:00October 14, 2023|Categories: Medical Education Law Blog|Tags: appeal of termination by residency program attorney, CCC hearing defense attorney, graduate medical education (GME) program appeal attorney, graduate medical education GME program hearing attorney, legal counsel in graduate medical education (GME) dispute, legal counsel in termination by residency program, legal defense attorney for resident CCC hearing, legal representation for residency fellowship program, legal representation for residency program discrimination, legal representation in residency program adverse action, legal representation in residency program contract termination defense counsel, medical school litigation legal counsel, residency fellowship program hearing attorney, residency fellowship program termination hearing lawyer, residency program adverse action appeal attorney, residency program adverse action defense attorney, residency program contract termination defense attorney, residency program grievance attorney, residency program legal dispute attorney, residency program litigation attorney, resident physician defense attorney, resident physician suspension probation defense attorney, reviews of The Health Law Firm attorneys, The Health Law Firm reviews|Comments Off

Medical Residency and Fellowship Program Problems: Do’s and Don’t’s of Dealing with Graduate Medical Education (GME) Programs

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

Medical residents and fellows, often when experiencing problems with their graduate medical education (GME) programs, wait until it is too late to think of consulting with an experienced healthcare attorney regarding possible solutions. Even when it may appear to be too late, it may not actually be too late to recover.

Try to take appropriate actions and make informed decisions at the earliest possible stages; try not to wait until you have received a notice terminating you to consult with an experienced health lawyer.

Medical Residents and Fellows Play Two Different Roles and Have two Different Sets of Rights.

Always remember that, as a resident or fellow, you actually have two different positions and two different sets of rights apply to you.

First, you are a learner (similar to a student) in an education program. In a teaching hospital or other GME program, you have certain academic rights afforded to you by virtue of this academics arrangement. These may arise from the requirements imposed by certifying bodies such as the Accreditation Council for Graduate Medical Education (ACGME) or the American College of Obstetrics and Gynecology (ACOG). Such standards are usually embodied in both the program’s GME Manual/Handbook and in the separate Residency or Fellowship Program Manual/Hanbook for that medical specialty program. These will include the right to file grievances regarding adverse decisions and the right to hearings and appeals (and other “due process rights”) on adverse actions and decisions.

Whether the adverse action is a failing grade in a rotation, placement on probation, placement on a personal improvement plan (PIP), a requirement to remediate a course, exam or rotation, or a termination from the program, it is important to know what your rights are and to exercise them, at the earliest possible time.

Second, you are an employer of a hospital or institution, as well. You have a written employment contract. You have rights such as to be free from discrimination of various forms. You have the other rights all employees have as set forth in numerous state and federal laws, as well as in the employer’s employee handbooks, manuals and policies and procedures.

If you are being sexually harassed, then you should file a complaint with your employer’s Human Resources Department followed by one with the federal Equal Employment Opportunity Commission (EEOC) or equivalent state agency (such as the Florida Commission on Human Relations Commission or FCHR). If you are being forced to work in a hostile work environment because of discrimination based on your race or nationality, then you should also file a complaint as above. If you have any type of mental or physical handicap or disability or any type of mecial condition which may affect your ability to perform (ADHD being the most common one we have seen) then you should give your employer notice of this and request reasonable accommodations to help you (most employers have online forms or forms available from the Human Resources Office for this. But do this at the earliest possible opportunity, preferably, at the very start of your residency or fellowship.

Be sure you obtain, review and save copies of all of the handbooks, manuals, and policies and procedures discussed above.

Know What the ACGME Says Your Program’s Obligations Are to You as a Resident or Fellow.

Also, review what the ACGME says your program must be doing to properly perform its role as a teaching institution. Go onto the ACGME website and review these requirements. These include, for example, providing regular and meaningful feedback on your performance and being sure you are given the proper opportunities to know what your perceived deficiencies are and to correct them.

If these are not embodied in the institution’s GME Program Manuals/Handbooks, then the program is deficient and may be subject to losing its accreditation.

Advise Your Program Director and the Head of the GME Program If the Program’s Obligations to You Are Not Being Met.

If you are not receiving timely and appropriate feedback on your performance, both formal and informal, give written notice to the Program Director, with a copy to the GME Office requesting that it be placed in your GME file.

If you receive an adverse evaluation because of bias or prejudice, immediately give written notice to the Program Director, with a copy to the GME Office requesting that it be placed in your GME file.

If you are given warnings, counseling, adverse evaluations, remediation or performance plans that are based on incorrect facts, immediately rebut these, in writing, using neutral and objective statements. Provide a copy of this to the Program Director, with a copy to the GME Office requesting that it be placed in your GME file, attached to the document it rebuts.

If you have personal problems, family problems, medical problems or other problems that are affecting your ability to perform, then ask for as much time off as you may conceivably need to take care of these, even if it means taking unpaid time off or an extended leave of absence. It is much better to address this type of issue up front and make up missed rotations and exams than to ignore them and fail. To learn more, click here to read one of my prior blogs on this issue.

You Need to Recognize Problems and Take the Appropriate Actions, Too.

If you have medical problems which affect your performance, seek the correct type of treatment from the appropriate medical specialist, and stay in follow-up treatment. If you have ADHD with which you are coping, you need a good psychiatrist to help you manage it, not a family practice physician. If you are dealing with post-traumatic stress disorder (PTSD), you need a good psychiatrist to help you manage it, not an OB/GYN or mental health counselor. But you also need to apply for reasonable accommodations.

If you are not the brightest person to ever graduate from medical school and you are in the best, hardest, most sought after residency program, maybe you are in over your head. Maybe you should consider changing to a different program before you are terminated form this one.

I represented a resident once who had been diagnosed with cancer twice while in residency. Twice he went through chemotherapy and radiation treatments and defeated the cancer. He also attempted to return to the program, to resume a very demanding schedule and not take time off to properly recuperate. He could have and should have taken a year’s leave of absence for each cancer he had.

He wound up being terminated. He did not recognize his limitations or ask for appropriate accommodations. On the other hand, he was lucky to be alive and to be a doctor, regardless of failure to complete his residency.

Take Action to Protect Your Rights and Request the Appropriate Remedies.

Know your rights under your GME program. Seek the advice of experienced legal counsel at the earliest possible time, even if only to review your options and help decide on a course or action.

Know and exercise your rights as an employee, but remember, you are a special type of employee. Seek the advice of experienced health care legal counsel at the earliest possible time, even if only to review your options and help decide on a course or action.

These problems and issues are ones for a board certified healthcare lawyer, not an employment lawyer, contract lawyer, trial lawyer or criminal defense lawyer. Know the difference. Click here to read about the qualifications of a board certified healthcare lawyer.

You must Exhaust Your Remedies Within Your Program First, If You Decide You must Sue in Court Later.

Don’t believe that you can just go out and sue in court and achieve what you want. First, courts are very reluctant to second guess academic decisions made by teaching institutions. They just don’t like to be in the business of second-guessing clinical professors and academicians. They don’t have the training and knowledge to do so, in many cases. Second, courts expect that you have gone through any internal administrative remedies that you may have within the program (called “exhaustion of administrative remedies”). This includes grievances, appeals, academic hearings and due process provisions. A court will not entertain a case until you have done so, so you may as well go ahead and get this done. To read what our firm does in the area of complex litigation, click here.

However, if you are in a program in a state or federal hospital or university program, you will have greater due process of law rights available to you to enforce in court under the U.S. Constitution and state laws than what you would have in a private institution.

Also remember that in court litigation, your GME handbook or manual, your Program handbook or manual and your program’s or hospitals policies and procedures will be your “GME contract” which you can enforce, in addition to your written employment contract.

Remember That External Complaint Mechanisms Are Also Available That May Help Remedy Your Situation.

We discussed filing discrimination and harassment complaints with ouside agencies such as the EEOC and the state human relations commission (such as teh Florida Commission on Human Relations). However, you can also file a complaint with the ACGME or other accrediting body, if the program is not meeting its standards. For information on how to do this, click here.

The U.S. Department of Health and Human Services (HHS), Office of Civil Rights (OCR), may also be an appropriate place to file a complaint, under many circumstances. For examples, click here.

For more information on what we, as healthcare lawyers, can do to help you, please visit this article on our website.

Contact Experienced Health Law Attorneys Representing Medical Students, Residents and Fellows.

The Health Law Firm routinely represents medical students, residents and fellows who run into difficulties and have disputes with their medical schools or programs. We also represent other health providers in investigations, regulatory matters, licensing issues, litigation, inspections and audits involving the DEA, Department of Health (DOH) and other law enforcement agencies. Its attorneys include those who are board certified by The Florida Bar in Health Law as well as licensed health professionals who are also attorneys. Our attorneys can represent you anywhere in the U.S. and anywhere in Florida.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law is an attorney with The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Avenue, Altamonte Springs, Florida 32714, Phone: (407) 331-6620.

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