15 Minutes Into Our Future?

San Francisco continues to originate things I had never bothered to imagine:  Medical residents, interns walk off the job at UCSF Medical Center over failed contract talks.”

“Resident physicians, interns and clinical fellows walked off their shifts for 15 minutes Tuesday at noon to draw attention to failed contract negotiations between their union and the University of California San Francisco Medical Center.  Union organizers called the protest a ‘Unity Break.'”  The residents say they are underpaid, and underrepresented.  The residents are demanding to have union representation at any grievance proceeding (commonplace at neighboring hospitals, apparently).  ” While the hospital did offer more money with the overall package, union representatives say it was not enough to provide their members a living wage in San Francisco’s rental market.”  One of the fellows mentioned is hilariously concerned that the low wages harms the “diversity” of programs:  “My co-residents were pretty diverse people, like me they didn’t come from money and they were here on their own. Now almost everybody coming here is only here because they are married to somebody in tech….it changes who comes here.”  (Listening to a young doctor in San Francisco bleat about “diversity” is likely the very definition of irony, given what I suspect is the utter lack of diversity in thought out there.  But hey, I like to stereotype).

In fact, with an instinctive antipathy toward Information Age collective bargaining in general, it is tempting for me to make fun of these kids as a bunch of whiners and slackers too wimpy to have gutted it out before resident weeks were capped at 80 hours.  The union sponsoring this protest is the Service Employees International Union, a well-moneyed, nasty group of knee cappers that made headlines thugging political opponents in the 2012 general election.  The SEIU must look at a bunch of left wing, crybaby residents as a gift from the Goddess, tailor made to suit their ongoing push for social justice, including single-payer health care.  And yet…

What if the residents have a point here or there?  There is a long-established tradition of hospitals improving their bottom lines via cheap resident labor, reasonable in exchange for imparting a difficult and lucrative education.  But we have all known individuals who ran afoul of their residency program, sometimes unfairly, and had their entire future threatened.  Should they have an outside force speak up for them, given that the parent hospital’s interests are more aligned with their residency program?  What if a program determines that a resident needs evaluation and rehab for substance abuse, or for being disruptive by punching an EHR?  Might the hospital and residency program be suspected of having a, shall-we-say, not entirely unbiased viewpoint while evaluating the alleged miscreant?  It’s a question.

And what of finances?  Residents have the obligation of due diligence, and should evaluate their prospective living circumstances before sending in the Match wish list.  But economies fluctuate, and prices change.  A resident might very well want to live near an expensive inner city like Brooklyn or San Francisco to be near the action, and presumably, training excellence.  In the larger public discourse, I reject stupid, arbitrary phrases like “a living wage.”  But in a semi-indentured servitude e.g. residency, it is not practical, and often physically impossible, to either move or moonlight.  What then?  Do residency programs have a duty to see that their students can afford decent housing? 

And does this speak to the large body of physicians beyond residency?  I don’t think all collective bargaining is bad, and it arose from a time in this nation when it was sorely needed.  But wouldn’t self-serving union muscle intruding into patient care be ultimately bad for everyone except the union?  As crony-corporatism and growing numbers demanding health care as a “right” drive us into single-payer, what avenue will be left to physicians but to unionize?  Thoughts?

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