I'm someone with an illness which forces me to visit the hospital regularly, and to me, the argument that "residents going on strike might break trust between patients" is complete backwards bullshit. I'm often treated on by residents, and every single one of them is sleep deprived, which makes me nervous about the quality of care I'm receiving. My trust in the medical system is already broken at the fault of hospital administrators who overwork the residents. If I see residents fight for more humane working conditions which inevitably results in better quality care, my trust will be increased - not broken!
Same! Not a resident but one time a nurse overseeing my care at the ER mentioned to me that she was on the 18th hour of her shift at 3 AM. Legitimately terrifying because someone that sleep deprived could so easily make a life-threatening mistake.
The claim that if hospitals were to pay residents more, they would be forced to pass on costs to patients - is false. CMS pays out ~100K/year per residency position, whereas residents earn maybe ~$60K. As a matter of principle, every workplace should be unionized because workers should have control over the conditions of their labor
I mostly agree. I don't think it's that hospitals are necessarily forced to pass on costs to patients but that they WILL to make profit. At the end of the day, capitalists own hospitals and therefore are incentivised to exploit workers by understaffing and underpaying, and increasing revenue by price gouging. I mean how do you explain hospitals suing patients for unpaid medical bills.
1. you people really think money comes from nowhere 2. the idea that you need a suit to negotiate what you want in your job, all while equating you to your coworkers, sucks. if people werent so willing to take shit jobs there wouldnt be a need for unions.
I disagree with police unions. The people should have unions regarding the police. Thus, i cannot agree with your principle. I think unions have their place (such as this one). I just also feel all sides argue from self interest, which can have debatable adverse effects for other parties. As a principle, i think most costs in everything could be easily eaten by administration. Healthcare especially, considering the vast differences in administrative pay comparing fee services at private, non-profit, and government funded organizations.
I can say with a high level of confidence which I've never had before that everything in this video stating the concerns about unionizing is false and is anti-union propaganda. As a former unionized worker I have some experience in this field and I can break down why each point is bullshit (disclaimer: the points stated in the video aren't necessarily the content creator's POV but I understand why people get angry about the spread of this misinformation) 1. If residents join unions, costs will be passed on to patients This is false bc this has been happening for decades. The increase in healthcare costs is attributed to price gouging by the various stakeholders (insurance companies, pharma, nonprofit admins, executives, etc.) and the lack of universal healthcare. Our private healthcare system is the most expensive in the world and we get worse health outcomes for it. This is happening regardless of unionization of residents. Additionally, the costs associated with compensating residents (and even attending physicians) is astronomically small compared to the amount of money these healthcare systems rake in. If you really want to cut healthcare costs, you'd be much better off cutting these unnecessary high level admin salaries and various bureaucratic processes that make healthcare delivery needlessly complicated. 2. Collective contractual agreements will limit flexibility. The very reason for a union is so that there is a standard set of benefits and wages agreed upon by both parties to ensure that everyone is content. The members will all have a say in what they want in the contract agreement. Without a union and the threat of a walkout, residents are left to fend for themselves regarding work wages and benefits, which leaves them much more vulnerable and they can be taken advantage of. 3. Animosity b/w residents and hospital staff if they threaten to strike. Who gives a fuck. The hospital staff should be supportive of these workers who work ridiculous hours for less than minimum wage. The resident work schedule is literally based off of a physician who was high off cocaine while working, which allowed him to work such ridiculous hours. If you want patients to be provided with high quality healthcare, then you will also take care of your residents. The idea that this would somehow strain the relationship with patients/communities is also BS. Patient/physician relationships are already strained bc of this corrupt healthcare system which exploits patients and workers. Unions historically have helped correct that wrong. That research study he cited was also just one study and very low quality. I understand that those views aren't necessarily the RUclipsrs view but I wish people would stop being such enlightened centrists about these important issues. Residents are not robots. They deserve to be taken care of in exchange for all they do to take care of patients. Don't ever underestimate the power of collective action
I don’t know who you are but you are really amazing in realizing what residents go through. I was a resident myself and trust me I would not put my worst enemy through that torture.
We as doctors should be standing up and fighting FOR each other not AGAINST one another. For the sake of improving our patients healthcare experience its important that we look after each other and support unionization against predatory hospital admins.
One solution for possible rising patient cost would be to audit these board members, presidents, executives and the bureaucracy that usurp an unholy amount of money from patients and doctors in the name of being "non-profit". Presidents and board members making millions each year sounds pretty profitable to me. And to address the concern about unions inhibiting individual training requirements, each residency specialty should form their own sub unions as well.
They get away with it because to be "Non-profit" they just have to so that their profit margins were a net 0 with everything being put back into the hospital. Of course they find places to put that money but its not back into the providers and nurses.
I don't disbelieve you, that sounds logical -- but hey, could you tell me where to find those numbers/related info? I'm a big public health geek & future doc & future hospital admin of what I intend to be an unusually low-cost-but-remuneratively-operating hospital, so this is very much relevant to my interests ... But frustratingly, I don't generally see this discussed in detail in the parts of the med publishing sphere I've explored so far.
It's hard to overlook the theme that underpins the "arguments against": profitability. Look, unions fight for far more than just their members' wages. They set standards for the working conditions that are acceptable, humane, and sustainable for all parties. Another telling aspect of this is how _doctors threatening to not treat patients_ was not in the news. This tells us that we should be asking why it was not on the national nightly news. In fact, just about every unionizing effort gets absolute minimum MSM coverage. Why?
Residents work hard long hours for low compensation, their work bringing in massive amount of revenue for the hospitals. Cut the bullshit CEO / business major / admin exorbitant compensation for doing little to nothing and give residents a fair salary for all their hard work.
I also hate the fact that some non medical majors find their way to admin positions in hospitals and take the lions share of profits, but you also have to remember that some of them, *some*, were once residents and probably worked their way to the top. Should those people be overlooked?
Exactly. As medical doctor (based outside the U.S.), I went through three years of residency training. Residents do a HUGE amount of work. During my training we went on 24-hour duties every 3 days. Every third day we'd be working for a total of 32 hours (24 hours duty plus 8 hours the following day). It only follows that residents should be paid commensurate to the work that they do. Yes, you're getting the benefit of training too but that does NOT mean you should be worked and paid like a slave.
I really hope this trend towards unionization continues. I hope something can be done about the 5 fold increase in administration and middle management in hospitals as well. This certainly correlates with the increased cost in medical care over the past several decades. If you want to manage a care team or a hospital it stands to reason you should be a Doctor.
In the OR or exam room the doctor should get final say. However when it comes to a running a business, which a hospital is whether you like or not, you need someone who understands how a business works
@@mustang8206 Its certainly run as a business right now. but just because there is a bottom line doesn't mean its a business. Look at any NGO, and the rest of the civilized worlds healthcare systems.
As someone who wants to mostly act in administration/nonprofit public health work, but decided I care too deeply about the clinical side to not go to med school, & also felt I couldn't be a worthwhile medical administrator without truly knowing the real trade myself ... Thank you for this comment. It makes me feel validated & encouraged in my choice to do this thing the harder longer way, even though I have zero intention of ever being conventionally employed as a doctor after I finish residency. (Loans can bite me; joke's on them, I've been impoverished & homeless & in debt for years, so I'm already expert at living happily this way! 😆 I'll maintain licensure & practice, just not for my main income, which I don't care about ever elevating beyond a frugal survival minimum anyway. I'll be on the sidewalk those who don't get to see and/or don't trust conventionally employed physicians. Can't wait to be a ballsy resident with nothing to lose, a credible & educated bone to pick with systemic elitism, & a house on wheels in the parking lot that exists as much to make a point as it does for my convenience lol.)
everyone in hospital should be under a union. Residents, NPs, PAs, Physicians, Nurses, CNAs, CMAAs, Imaging techs etc. Healthcare workers need to be working together
Unionization is the first step towards healthcare reform. The criticisms you brought up show that it's part of a larger sociological issues centered more around our healthcare system as well as other social issues outside the hospital that puts pressures on our hospitals. I sort of laughed about the tension resident walkouts could bring to other healthcare staff because it's the same arguments that were leveled against unions in the past despite the growing need for them. In other words, unionization is a great step towards providing physicians more leverage at improving healthcare and protecting their staff. The next steps will be towards addressing larger sociological issues in our healthcare and our society. Towards that end, I'm 100% behind this movement.
Totally agreed. Besides, when's a better safer time for action? Now, after a pandemic, or during the next one? Medical professionals are already considering impacts on colleagues and patients as much as they reasonably can by having held out this long.
Yeah, there will be a lot of tension. When the ppl in the hospital making the most amount of money suddenly have to start doing all that work residents have been doing for a fraction of the salary, they will be upset.
Unions worked wonders in Australia for Doctors. Win after win with regards to working hours, base pay, time off across all levels of training compared to 10 and 20 years ago. The only people that don't want you to form a union are the people taking advantage of you lol.
History has shown that the asymmetric power relationship generally did not end with significant improvements for residents. Having a seat at the table is an equalizer and, over time, could lead to better pay and working conditions for residents.
Agree, residents should unionize whenever possible. They will get good skills in negotiating with hospital systems, which will serve them well throughout their careers as attending doctors. As practices get bought up and the health systems increasingly get larger and more powerful unionization will be more important. Over timethis will hopefully help improve the doctor lifestyle and keep doctors practicing for longer careers. Also from patient safety perspective overworked residents is frankly dangerous (and no we don't need health care systems creating multiple studies examining if it is more dangerous, the sample sizes are too small, its just common sense).
Keep in mind that PA will have a graduate level degree with at minimum 10000 hours of patient care experience before they even start their first job. They also have diagnostic capability and procedure capability, and they are first assist in surgeries for non-teaching schools. PAs also tend to spend more time with patients than a physician does and generally have a higher level of respect for more experienced staff such as veteran nurses. A PA also has around 120k is debt when starting, so their pay is reflective of that too. A resident is not fully licensed nor certified. Not saying you are incorrect, but it’s important to take note of the comparison.
@@aidanterry8336 you probably typed up this nonsense with a straight face. Residents also have graduate level degree called a medical degree. They are also much more educated in medicine than any PA. I don’t know where you get your information from. This is the type of nonsense people spout to make residents seem lower than nurses or PA. They are called physician ASSISTANTS for a reason. They are simply there to assist. Residents are real physicians
Whatever you say. Honestly, part of it is residents tend to be so pompous that they disregard veteran nurses or highly practiced PAs in the care setting. Residents shouldn’t be forced to work so many hours a week, it lowers the quality of care. If they lowered the hours, that would justify the salary for not being a fully licensed and practicing provider. Also, PA school can be near 200k in debt, so it’s not as dissimilar when you compare the 2 years to the 4 for med school.
@@aidanterry8336 PAs play an important role but quit trying to act they like are better than doctors especially saying things like "they have a better respect for nurses." That's completely subjective. Keep in mind that a resident may not be certified as an attending but they still have more scope of practice after their first few years of residency. They also have an additional 2 years of knowledge and clinical experience out of school that PAs do not. PAs are important but they are not better than a senior resident
While I was a resident (NYC) some decades ago once calculated based upon # of hours worked that a McDonalds employee would make more. I looked at it as a total immersion experience and was happy and eager to be in it. My salary was enough to live on and enough to fly anywhere in the world for the 4 weeks paid vacation/ year. Yes there were some internal grossly unfair scheduling practices because they could not secure a post graduate chief resident so made 3 seniors all chiefs that did not take call for an entire year. The rest of us had to cover the extra call. When we collectively approached admin we were threatened with not finishing the program.
This is one of the biggest hurdles for unionizing residents. The hospital or program can simply threaten to fire the residents involved. This is bad enough for a normal worker, but a resident that doesn't complete residency is not able to work as a physician, and it's nearly impossible to get readmitted to a new residency program after being thrown out of one.
God I cannot frickin' wait to get to this stage of my medical journey. I'm uniquely positioned in that I have experience with advocacy, pathological willingness to chew off my own damn leg rather than compromise on any of my core principles, a near total inability to sustain pretense, and literally nothing to lose. I'm 100% okay with the possibility of being "that would-be doctor who got kicked out of residency for calling them out" because, if it happens, it'll barely knock a little icing off the cake of my life plans (& based on my past, I'd just leverage it into new exciting additional icing anyway). By all means, I'll be THRILLED if the system is improved by then to where this sort of abuse of power is no longer an issue. My career plans include plenty of other arenas for me to fulfill this confrontational disruptive drive, lol. But if it's still an issue, then I truly HOPE I get opportunities to root out & confront & expose it, because I will be far more comfortable doing so than most other residents affected, & that's the kind of position I LOVE to be in. Thanks for sharing your experience. It's absolutely crap that you had to go through that. I'm grateful you tried your best to do what you could; that matters. I hope it's some small consolation that your story helps fuel the fire in people like me to stay the course & follow you down that path so that we can keep hacking away bits of those obstacles for those who come after.
@@ItsAsparageese My humble advice. The system is much bigger than us so keep a positive attitude and learn to enjoy it while you work hard and learn rather than fight it or change it.
Unionization would be the right step in the right direction because the high rates of burnout and suicide among residents is enough to indicate that better working conditions are needed. I believe the structural change you mentioned is the nationalization of the healthcare system as a whole to remove the profit motive which incentivizes the exploitation of workers for their labor among a myriad of issues. Even a socialist nation like Cuba, which has been subject to the US embargo for 50 years, has a nationalized healthcare system and has one of the best healthcare systems in the world. The US can do better
Sorry long reaction :P: The concern that the extra salary will end up on the patients bill is not fair in my opinion. Maybe this is different in the US, but in my country, the salaries of doctors (and other hospital staff) are only a very small part of the expenses in the hospital compared to medications, appliances etc. In my view it is unfair to say that the salaries cant increase but the price of all these medications, especially new types of medications and other hospital appliances can. A story on this topic: A friend (resident) of mine tried to get the registered extra hours payed (not even all of it) because it in his contract. The department acknowledged the hours but flatout refused. Then they said something along the lines of if he wants to specialize in this field, he should keep low about this, and just accept it. He could have won this if he fought this legally, but it was implied that this kind of trouble could impact your future chances of specialization, although it 'wasnt a threat', i quote, and that ofcourse is the biggest fear of every resident here. So he didnt get payed for those all those hours. Therefore I'm pro unionization, seeing as 1 resident alone cannot fight this huge system, not even in 1 hospital department that you worked so hard for. I bet this flexibility and personalized case-by-case approach screws more residents than it benefits us. In my country nurses have a strong union and it helps them a lot, without affecting patient / other staff relationships. I mean yeah, maybe some of these changes a union can make wont be beneficial for you specifically. But for the group as a whole things will improve, like the on call rooms example you gave.
If you threaten a strike and do not unionize then administration will backslide on whatever they agreed to, once they are no longer facing a unified front. If you threaten a strike you have to have every one fully commit to it, including the peds residents, be ready to completely stop any and all care by residents despite feeling like you are abandoning patients (the attendings still remain responsible) and you cannot say you will still take care of emergencies. Otherwise the threat is hollow and administration will wait you out and bombard you with endless debate about how very comfortable THEY are, with how much you work, your work conditions, and how much you get paid. Be wary of the politician among you who is happy to take on a leadership role representing you all, but then uses the position to advantage himself and sell you all down the river.
I agree that while residents are not fully licensed providers but provide significantly more value for the healthcare system than the salary they receive (which is essentially the equivalent of minimum wage). There are far less educated and trained positions in the healthcare team that are compensated better than residents. I would like to think compensation would reflect the duration of training. I don’t advocate for residents to be paid the same as attendings but certainly more than entry level positions or those that require certification for employment.
It’s all about the money, even Pastors now complaining low income in their churches, they are planning to follow a similar union strategy, even god could be expensive, but that’s the world now.
You do realize a large portion of pastors have to work two jobs just to pay the bills. In fact I had a pastor that worked a church that was so poor his paycheck from the church was less than his tithe from his second job as a warehouse worker. I don't think pastors should unionize because their job is to serve not make money, unlike the people that go to med school, but still it is true that they are broke
Hey Kevin, I love all your videos and have found lots of success in taking notes and applying what you say. This is not related to this video, but I'm dying to know if you recommend Cloze deletion cards on Anki or basic flashcards. You stress active recall (better with well written basic flashcards) but Close Deletion cards are much easier/faster to use. Do you prefer one over the other? A mix? Does it depend? love your stuff, thanks.
Society in general has a false belief that the rising costs in healthcare are caused by the safeties being paid to healthcare professionals. This is not true and I support all healthcare professionals having increased wages/salary. The hospital/system has an abundance of resources that could be used to increase pay. I mean they are hiring more mid level providers to decrease costs but certainly don’t mind billing patients the same amount as if they had seen an attending physician. So many people are upset when they see reports of physician salaries and immediately assume that their bills cost so much. Nope, hospitals are run by people with business degrees who are employing more and more management positions who also have business degrees. They operate on the foundation of keeping costs low while driving the highest possible profit. The employees are paid a fraction of the profit made when seeing patients. Residents provide some much value to the healthcare system. While not fully licensed yet, have completed years of rigorous testing and training only to be paid minimum wage. Other than attendings, the knowledge, educational experience and duration of training exceeds any other position on team. Mid levels contribute a vital role in the team compensation for residents is nearly half?
Yes they need to be unionized.They obviously aren’t getting any help from physician groups or hospitals. I completely agree with the unionization of residencies.
So the main disadvantage of the union is disturbing your relationship with the hospital and attendings, who love you? So sayeth the AMA, who have always had the physicians best interests at heart? Um, …Kev?
well, this makes me wonder, is medical school free in Indonesia? if not, how much is the yearly tuition? the main reason it would be unreasonable to not get paid (or to continue to get paid so little given the amount of work) in the US, is that graduates fresh out of medical school have an average debt of US$200K (not even including their undergraduate student debt), which by the time they finish residency may have greatly increased due to interest. I also think that residents in Indonesia and everywhere else should also get paid since they are providing work & revenue to the hospital (they are still getting trained but it is a job nonetheless)
@@mke_gal ofc its not free , the yearly tuition for medical school is around US$ 5k a year , and we do not have those student loan in here , so that's why not everyone can go to medical school even if they are smart , and then the residency will cost almost the same as the medical school. in total medical school + residency (+-14 Semester ) will take around $90.000 accumulated. Yes it is not as high as in the US.
The change should not just in unionization, but more importantly, how to train a doctor/nurse. More I see, more I feel this doctor industry is so shit.
The hospitals get paid from the US govt via medicare and medicaid almost twice as much as they pay the residents... The insurance companies and patients fo not oay their salaries.
Just because you're a resident, does not mean you bear the brunt of unfulfilled hours because the hospital and their bargaining side, sees residents as a means for exploitation...Disney does the same. In other words, a resident is not oblidged to work more than 20 hours nor 40 hours..that's the reality on the ground anyway in most clinics. So just because you think you're a hospital and create abuse tactics pretending that all conditions are urgent, that sooner means the hospital staff is paranoid. Just like a taxi company or spa has many people on a wait list to work, so must a hospital do the same. If the hospital doesn't have the courage and ignores these methods then they too risk the lives of patients so paranoia works both ways, but when it's the hospitals executive committee then they need to be diagnosed as a mental disorder and paranoid or PTSD etc. They are not above the law nor above unions nor above students nor above residents. I think its very interesting that hospital staff think that residents want to work in hospital off the bat. The hospital is not the only place residents nor doctors work...it's a great fantasy though. This story gets more interesting...A Resident by definition is a doctor!! A nurse, NPA and PA are not doctors..that they are not. A nurse, NPA and PA are also not medical doctors in training called residency...a specialty for doctors. So the pay scale too appears to be dumb down and paranoid..haha Sure many executive will be psychotic...in particular the diagnosis can fall through the act of omission, ignoring the rule of law and pay and labor laws and all the definition of what the term doctor means.
*I used to be in a union. The union I was in, the president made more than the literal ceo and extracted way too much union dues from our paychecks for nothing in return. I think residency reform is needed but the "union" word pisses me off*
Why the hell does the Union president making more than a CEO matter? The size of the organization matters a heck of a lot more than their job title. Not only that, but your union collectively bargained for a higher wage and better benefits than youd otherwise have, thats not nothing. You sound irrational. The word union pissing you off sounds more like youre just a child.
you'll be surprised that residents in Indonesia are paying the hospital. 🤣 But the government is working on it to get a rid of this rotten residency system.
I lost a lot of respect for you in this video. You spent the first half of the video repeating anti-union propaganda with barely any challenge. "Hospitals might stretch residents more thinly?" Are you kidding? The entire point of a union is to resist that. "Patients might lose trust?" No patient wants a tired resident taking care of them. They want someone who is fresh and ready for them. Your anti-union tone is unacceptable. You also cited one piece of research and then said "the evidence." Yeah, that was one study. You didn't say a damn word about the authors or the rest of the research. I am completely disappointed. You may as well post a video called "Pros and Cons of Studying for the MCAT." The real cons of joining a union are getting retaliated against by admin if you have to start a new one. That's all you had to say.
@@mustang8206 The entire point of extensive education and experience is to be able to form expert opinions about things. It's arguably OBLIGATORY for physicians to take stances on issues like this that impact literally every facet of public health.
I hear you, but I don’t believe the author held a negative tone, but rather presented existing arguments against unionization of residents. I think it’s important to discern what the author actually believes - which is stated at the end of the video when he states “I believe [unionizing] is a step in the right direction”.
Collective contracts dont limit the ability of management to improve conditions further. A union contract sets a minimum standard. I genuinely love your videos but for me, this one was a miss.
Could we saw some info about what it takes to be biomedical engineer and what with that education I could do? Like perfusiologist? What options I have in private and public sector of medicine?
Well for one thing colleges only care about what happened in high school and med schools only care about what happened in college so no it wouldn't have an affect as long as you stay out of trouble in high school and beyond
Why do you suppose they would do that? They certainly wouldn't have to, but you're correct, they will choose to do so. Ask why they will do that, and then ask why should we allow them to.
Patients and non-medical staff unfortunately. Pay and hospital sponsored benefits will decrease. Then the staff will be forced to also fight for unions.
@@SoggyBagelz A third of all mistakes residents make is from fatigue; improving working conditions and hours would decrease the amount of errors made and the amount hospitals would have to pay out
My new concern is that hospital executives and their bargaining committees dont speak enough English to even barter any type of negotiation nor create discourse for the negotiation in a unionized bargaining process nor unionized process. Faking English speaking skills and faking proficiency both fail. Passive Agressive demeanor and temper is bipolar and diagnosable easily. Have you heard, I'm laughing inside or dancing inside or smiling inside..versus outwardly displaying a smile or dance. Not saying dance, that could go against someones religion like money goes against communism's slavery.
Airplanes 🛬 overbook to throw out the remaining balance of people. Hospitals 🏥 run their business / fill 📂 their gap wirh residents students. Like the plane ✈ companies does but it is the other way around. I understand that a Dr have to be the best of the most best but I also think 🤔 that the recidency system should be reformed in such a way that "the social work" [of recidency] should be a good and more human "👐 on patient care/work ⚒. 😊
I'm someone with an illness which forces me to visit the hospital regularly, and to me, the argument that "residents going on strike might break trust between patients" is complete backwards bullshit. I'm often treated on by residents, and every single one of them is sleep deprived, which makes me nervous about the quality of care I'm receiving. My trust in the medical system is already broken at the fault of hospital administrators who overwork the residents. If I see residents fight for more humane working conditions which inevitably results in better quality care, my trust will be increased - not broken!
Same! Not a resident but one time a nurse overseeing my care at the ER mentioned to me that she was on the 18th hour of her shift at 3 AM. Legitimately terrifying because someone that sleep deprived could so easily make a life-threatening mistake.
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Yeah it's crazy the amount of stories of residents falling asleep at work because they physically couldn't stay awake any longer
I agree 👍. They do their best. 😊
The claim that if hospitals were to pay residents more, they would be forced to pass on costs to patients - is false. CMS pays out ~100K/year per residency position, whereas residents earn maybe ~$60K. As a matter of principle, every workplace should be unionized because workers should have control over the conditions of their labor
I mostly agree. I don't think it's that hospitals are necessarily forced to pass on costs to patients but that they WILL to make profit. At the end of the day, capitalists own hospitals and therefore are incentivised to exploit workers by understaffing and underpaying, and increasing revenue by price gouging. I mean how do you explain hospitals suing patients for unpaid medical bills.
Amen
I think hospitals are paid about i200k/ resident
1. you people really think money comes from nowhere
2. the idea that you need a suit to negotiate what you want in your job, all while equating you to your coworkers, sucks. if people werent so willing to take shit jobs there wouldnt be a need for unions.
I disagree with police unions. The people should have unions regarding the police. Thus, i cannot agree with your principle. I think unions have their place (such as this one). I just also feel all sides argue from self interest, which can have debatable adverse effects for other parties.
As a principle, i think most costs in everything could be easily eaten by administration. Healthcare especially, considering the vast differences in administrative pay comparing fee services at private, non-profit, and government funded organizations.
I can say with a high level of confidence which I've never had before that everything in this video stating the concerns about unionizing is false and is anti-union propaganda. As a former unionized worker I have some experience in this field and I can break down why each point is bullshit (disclaimer: the points stated in the video aren't necessarily the content creator's POV but I understand why people get angry about the spread of this misinformation)
1. If residents join unions, costs will be passed on to patients
This is false bc this has been happening for decades. The increase in healthcare costs is attributed to price gouging by the various stakeholders (insurance companies, pharma, nonprofit admins, executives, etc.) and the lack of universal healthcare. Our private healthcare system is the most expensive in the world and we get worse health outcomes for it. This is happening regardless of unionization of residents. Additionally, the costs associated with compensating residents (and even attending physicians) is astronomically small compared to the amount of money these healthcare systems rake in. If you really want to cut healthcare costs, you'd be much better off cutting these unnecessary high level admin salaries and various bureaucratic processes that make healthcare delivery needlessly complicated.
2. Collective contractual agreements will limit flexibility.
The very reason for a union is so that there is a standard set of benefits and wages agreed upon by both parties to ensure that everyone is content. The members will all have a say in what they want in the contract agreement. Without a union and the threat of a walkout, residents are left to fend for themselves regarding work wages and benefits, which leaves them much more vulnerable and they can be taken advantage of.
3. Animosity b/w residents and hospital staff if they threaten to strike.
Who gives a fuck. The hospital staff should be supportive of these workers who work ridiculous hours for less than minimum wage. The resident work schedule is literally based off of a physician who was high off cocaine while working, which allowed him to work such ridiculous hours. If you want patients to be provided with high quality healthcare, then you will also take care of your residents. The idea that this would somehow strain the relationship with patients/communities is also BS. Patient/physician relationships are already strained bc of this corrupt healthcare system which exploits patients and workers. Unions historically have helped correct that wrong. That research study he cited was also just one study and very low quality.
I understand that those views aren't necessarily the RUclipsrs view but I wish people would stop being such enlightened centrists about these important issues. Residents are not robots. They deserve to be taken care of in exchange for all they do to take care of patients. Don't ever underestimate the power of collective action
I don’t know who you are but you are really amazing in realizing what residents go through. I was a resident myself and trust me I would not put my worst enemy through that torture.
Thank you!!!! I wanted to say all this and you said exactly what I was thinking.
We as doctors should be standing up and fighting FOR each other not AGAINST one another. For the sake of improving our patients healthcare experience its important that we look after each other and support unionization against predatory hospital admins.
One solution for possible rising patient cost would be to audit these board members, presidents, executives and the bureaucracy that usurp an unholy amount of money from patients and doctors in the name of being "non-profit". Presidents and board members making millions each year sounds pretty profitable to me.
And to address the concern about unions inhibiting individual training requirements, each residency specialty should form their own sub unions as well.
They get away with it because to be "Non-profit" they just have to so that their profit margins were a net 0 with everything being put back into the hospital. Of course they find places to put that money but its not back into the providers and nurses.
The cost of Physicans has matched inflation but the cost of Hospital Afmin has raised 3000% in the last 50 years. Too much fat in the board room.
I don't disbelieve you, that sounds logical -- but hey, could you tell me where to find those numbers/related info? I'm a big public health geek & future doc & future hospital admin of what I intend to be an unusually low-cost-but-remuneratively-operating hospital, so this is very much relevant to my interests ... But frustratingly, I don't generally see this discussed in detail in the parts of the med publishing sphere I've explored so far.
It's hard to overlook the theme that underpins the "arguments against": profitability. Look, unions fight for far more than just their members' wages. They set standards for the working conditions that are acceptable, humane, and sustainable for all parties. Another telling aspect of this is how _doctors threatening to not treat patients_ was not in the news. This tells us that we should be asking why it was not on the national nightly news. In fact, just about every unionizing effort gets absolute minimum MSM coverage. Why?
Residents work hard long hours for low compensation, their work bringing in massive amount of revenue for the hospitals. Cut the bullshit CEO / business major / admin exorbitant compensation for doing little to nothing and give residents a fair salary for all their hard work.
I also hate the fact that some non medical majors find their way to admin positions in hospitals and take the lions share of profits, but you also have to remember that some of them, *some*, were once residents and probably worked their way to the top. Should those people be overlooked?
Exactly. As medical doctor (based outside the U.S.), I went through three years of residency training. Residents do a HUGE amount of work. During my training we went on 24-hour duties every 3 days. Every third day we'd be working for a total of 32 hours (24 hours duty plus 8 hours the following day). It only follows that residents should be paid commensurate to the work that they do. Yes, you're getting the benefit of training too but that does NOT mean you should be worked and paid like a slave.
I really hope this trend towards unionization continues. I hope something can be done about the 5 fold increase in administration and middle management in hospitals as well. This certainly correlates with the increased cost in medical care over the past several decades.
If you want to manage a care team or a hospital it stands to reason you should be a Doctor.
Care team yes. A hospital no.
In the OR or exam room the doctor should get final say. However when it comes to a running a business, which a hospital is whether you like or not, you need someone who understands how a business works
@@mustang8206 Its certainly run as a business right now. but just because there is a bottom line doesn't mean its a business. Look at any NGO, and the rest of the civilized worlds healthcare systems.
As someone who wants to mostly act in administration/nonprofit public health work, but decided I care too deeply about the clinical side to not go to med school, & also felt I couldn't be a worthwhile medical administrator without truly knowing the real trade myself ... Thank you for this comment. It makes me feel validated & encouraged in my choice to do this thing the harder longer way, even though I have zero intention of ever being conventionally employed as a doctor after I finish residency.
(Loans can bite me; joke's on them, I've been impoverished & homeless & in debt for years, so I'm already expert at living happily this way! 😆 I'll maintain licensure & practice, just not for my main income, which I don't care about ever elevating beyond a frugal survival minimum anyway. I'll be on the sidewalk those who don't get to see and/or don't trust conventionally employed physicians. Can't wait to be a ballsy resident with nothing to lose, a credible & educated bone to pick with systemic elitism, & a house on wheels in the parking lot that exists as much to make a point as it does for my convenience lol.)
everyone in hospital should be under a union. Residents, NPs, PAs, Physicians, Nurses, CNAs, CMAAs, Imaging techs etc. Healthcare workers need to be working together
Unionization is the first step towards healthcare reform. The criticisms you brought up show that it's part of a larger sociological issues centered more around our healthcare system as well as other social issues outside the hospital that puts pressures on our hospitals. I sort of laughed about the tension resident walkouts could bring to other healthcare staff because it's the same arguments that were leveled against unions in the past despite the growing need for them. In other words, unionization is a great step towards providing physicians more leverage at improving healthcare and protecting their staff. The next steps will be towards addressing larger sociological issues in our healthcare and our society. Towards that end, I'm 100% behind this movement.
Totally agreed. Besides, when's a better safer time for action? Now, after a pandemic, or during the next one? Medical professionals are already considering impacts on colleagues and patients as much as they reasonably can by having held out this long.
Yeah, there will be a lot of tension. When the ppl in the hospital making the most amount of money suddenly have to start doing all that work residents have been doing for a fraction of the salary, they will be upset.
Unions worked wonders in Australia for Doctors. Win after win with regards to working hours, base pay, time off across all levels of training compared to 10 and 20 years ago.
The only people that don't want you to form a union are the people taking advantage of you lol.
History has shown that the asymmetric power relationship generally did not end with significant improvements for residents. Having a seat at the table is an equalizer and, over time, could lead to better pay and working conditions for residents.
Agree, residents should unionize whenever possible. They will get good skills in negotiating with hospital systems, which will serve them well throughout their careers as attending doctors. As practices get bought up and the health systems increasingly get larger and more powerful unionization will be more important. Over timethis will hopefully help improve the doctor lifestyle and keep doctors practicing for longer careers. Also from patient safety perspective overworked residents is frankly dangerous (and no we don't need health care systems creating multiple studies examining if it is more dangerous, the sample sizes are too small, its just common sense).
It's interesting to go through 4 years of medical school and make it to residency to make less than PAs. Seems twisted to me
Keep in mind that PA will have a graduate level degree with at minimum 10000 hours of patient care experience before they even start their first job. They also have diagnostic capability and procedure capability, and they are first assist in surgeries for non-teaching schools. PAs also tend to spend more time with patients than a physician does and generally have a higher level of respect for more experienced staff such as veteran nurses. A PA also has around 120k is debt when starting, so their pay is reflective of that too. A resident is not fully licensed nor certified. Not saying you are incorrect, but it’s important to take note of the comparison.
@@aidanterry8336 you probably typed up this nonsense with a straight face. Residents also have graduate level degree called a medical degree. They are also much more educated in medicine than any PA. I don’t know where you get your information from. This is the type of nonsense people spout to make residents seem lower than nurses or PA. They are called physician ASSISTANTS for a reason. They are simply there to assist. Residents are real physicians
Whatever you say. Honestly, part of it is residents tend to be so pompous that they disregard veteran nurses or highly practiced PAs in the care setting. Residents shouldn’t be forced to work so many hours a week, it lowers the quality of care. If they lowered the hours, that would justify the salary for not being a fully licensed and practicing provider. Also, PA school can be near 200k in debt, so it’s not as dissimilar when you compare the 2 years to the 4 for med school.
@@Sam-oc2zw Residents do the work of a PA until their 3rd or 4th year depending on speciality
@@aidanterry8336 PAs play an important role but quit trying to act they like are better than doctors especially saying things like "they have a better respect for nurses." That's completely subjective. Keep in mind that a resident may not be certified as an attending but they still have more scope of practice after their first few years of residency. They also have an additional 2 years of knowledge and clinical experience out of school that PAs do not. PAs are important but they are not better than a senior resident
While I was a resident (NYC) some decades ago once calculated based upon # of hours worked that a McDonalds employee would make more. I looked at it as a total immersion experience and was happy and eager to be in it. My salary was enough to live on and enough to fly anywhere in the world for the 4 weeks paid vacation/ year. Yes there were some internal grossly unfair scheduling practices because they could not secure a post graduate chief resident so made 3 seniors all chiefs that did not take call for an entire year. The rest of us had to cover the extra call. When we collectively approached admin we were threatened with not finishing the program.
This is one of the biggest hurdles for unionizing residents. The hospital or program can simply threaten to fire the residents involved. This is bad enough for a normal worker, but a resident that doesn't complete residency is not able to work as a physician, and it's nearly impossible to get readmitted to a new residency program after being thrown out of one.
God I cannot frickin' wait to get to this stage of my medical journey. I'm uniquely positioned in that I have experience with advocacy, pathological willingness to chew off my own damn leg rather than compromise on any of my core principles, a near total inability to sustain pretense, and literally nothing to lose. I'm 100% okay with the possibility of being "that would-be doctor who got kicked out of residency for calling them out" because, if it happens, it'll barely knock a little icing off the cake of my life plans (& based on my past, I'd just leverage it into new exciting additional icing anyway).
By all means, I'll be THRILLED if the system is improved by then to where this sort of abuse of power is no longer an issue. My career plans include plenty of other arenas for me to fulfill this confrontational disruptive drive, lol. But if it's still an issue, then I truly HOPE I get opportunities to root out & confront & expose it, because I will be far more comfortable doing so than most other residents affected, & that's the kind of position I LOVE to be in.
Thanks for sharing your experience. It's absolutely crap that you had to go through that. I'm grateful you tried your best to do what you could; that matters. I hope it's some small consolation that your story helps fuel the fire in people like me to stay the course & follow you down that path so that we can keep hacking away bits of those obstacles for those who come after.
@@ItsAsparageese My humble advice. The system is much bigger than us so keep a positive attitude and learn to enjoy it while you work hard and learn rather than fight it or change it.
Unionization would be the right step in the right direction because the high rates of burnout and suicide among residents is enough to indicate that better working conditions are needed. I believe the structural change you mentioned is the nationalization of the healthcare system as a whole to remove the profit motive which incentivizes the exploitation of workers for their labor among a myriad of issues. Even a socialist nation like Cuba, which has been subject to the US embargo for 50 years, has a nationalized healthcare system and has one of the best healthcare systems in the world. The US can do better
It will be the death of doctors. Private system going in, socialist system to follow. You are screwed.
Sorry long reaction :P: The concern that the extra salary will end up on the patients bill is not fair in my opinion. Maybe this is different in the US, but in my country, the salaries of doctors (and other hospital staff) are only a very small part of the expenses in the hospital compared to medications, appliances etc. In my view it is unfair to say that the salaries cant increase but the price of all these medications, especially new types of medications and other hospital appliances can.
A story on this topic: A friend (resident) of mine tried to get the registered extra hours payed (not even all of it) because it in his contract. The department acknowledged the hours but flatout refused. Then they said something along the lines of if he wants to specialize in this field, he should keep low about this, and just accept it. He could have won this if he fought this legally, but it was implied that this kind of trouble could impact your future chances of specialization, although it 'wasnt a threat', i quote, and that ofcourse is the biggest fear of every resident here. So he didnt get payed for those all those hours. Therefore I'm pro unionization, seeing as 1 resident alone cannot fight this huge system, not even in 1 hospital department that you worked so hard for. I bet this flexibility and personalized case-by-case approach screws more residents than it benefits us. In my country nurses have a strong union and it helps them a lot, without affecting patient / other staff relationships. I mean yeah, maybe some of these changes a union can make wont be beneficial for you specifically. But for the group as a whole things will improve, like the on call rooms example you gave.
Most doctors in the UK are in a union, how effective the union is, is a different matter...
If you threaten a strike and do not unionize then administration will backslide on whatever they agreed to, once they are no longer facing a unified front. If you threaten a strike you have to have every one fully commit to it, including the peds residents, be ready to completely stop any and all care by residents despite feeling like you are abandoning patients (the attendings still remain responsible) and you cannot say you will still take care of emergencies. Otherwise the threat is hollow and administration will wait you out and bombard you with endless debate about how very comfortable THEY are, with how much you work, your work conditions, and how much you get paid. Be wary of the politician among you who is happy to take on a leadership role representing you all, but then uses the position to advantage himself and sell you all down the river.
Pay midlevels less, and pay residents more. problem solved
Midlevels deserve to be well paid. Lose your superiority complex
agreed
I agree that while residents are not fully licensed providers but provide significantly more value for the healthcare system than the salary they receive (which is essentially the equivalent of minimum wage). There are far less educated and trained positions in the healthcare team that are compensated better than residents. I would like to think compensation would reflect the duration of training. I don’t advocate for residents to be paid the same as attendings but certainly more than entry level positions or those that require certification for employment.
It’s all about the money, even Pastors now complaining low income in their churches, they are planning to follow a similar union strategy, even god could be expensive, but that’s the world now.
You do realize a large portion of pastors have to work two jobs just to pay the bills. In fact I had a pastor that worked a church that was so poor his paycheck from the church was less than his tithe from his second job as a warehouse worker. I don't think pastors should unionize because their job is to serve not make money, unlike the people that go to med school, but still it is true that they are broke
every worker ought to be unionized.
Hey Kevin, I love all your videos and have found lots of success in taking notes and applying what you say. This is not related to this video, but I'm dying to know if you recommend Cloze deletion cards on Anki or basic flashcards.
You stress active recall (better with well written basic flashcards) but Close Deletion cards are much easier/faster to use. Do you prefer one over the other? A mix? Does it depend? love your stuff, thanks.
“You are all Valuable Providers.”
Workers of the world unite 🚩✊🏽
Society in general has a false belief that the rising costs in healthcare are caused by the safeties being paid to healthcare professionals. This is not true and I support all healthcare professionals having increased wages/salary. The hospital/system has an abundance of resources that could be used to increase pay. I mean they are hiring more mid level providers to decrease costs but certainly don’t mind billing patients the same amount as if they had seen an attending physician. So many people are upset when they see reports of physician salaries and immediately assume that their bills cost so much. Nope, hospitals are run by people with business degrees who are employing more and more management positions who also have business degrees. They operate on the foundation of keeping costs low while driving the highest possible profit. The employees are paid a fraction of the profit made when seeing patients. Residents provide some much value to the healthcare system. While not fully licensed yet, have completed years of rigorous testing and training only to be paid minimum wage. Other than attendings, the knowledge, educational experience and duration of training exceeds any other position on team. Mid levels contribute a vital role in the team compensation for residents is nearly half?
Yes they need to be unionized.They obviously aren’t getting any help from physician groups or hospitals. I completely agree with the unionization of residencies.
So the main disadvantage of the union is disturbing your relationship with the hospital and attendings, who love you? So sayeth the AMA, who have always had the physicians best interests at heart? Um, …Kev?
In indonesia residents are not paid AT ALL 😄, because its still university based rather than hospital based , so yep
well, this makes me wonder, is medical school free in Indonesia? if not, how much is the yearly tuition? the main reason it would be unreasonable to not get paid (or to continue to get paid so little given the amount of work) in the US, is that graduates fresh out of medical school have an average debt of US$200K (not even including their undergraduate student debt), which by the time they finish residency may have greatly increased due to interest. I also think that residents in Indonesia and everywhere else should also get paid since they are providing work & revenue to the hospital (they are still getting trained but it is a job nonetheless)
@@mke_gal ofc its not free , the yearly tuition for medical school is around US$ 5k a year , and we do not have those student loan in here , so that's why not everyone can go to medical school even if they are smart , and then the residency will cost almost the same as the medical school. in total medical school + residency (+-14 Semester ) will take around $90.000 accumulated. Yes it is not as high as in the US.
The change should not just in unionization, but more importantly, how to train a doctor/nurse. More I see, more I feel this doctor industry is so shit.
I really appreciate your videos I’m applying to medical schools now and these have been very helpful thank you
The hospitals get paid from the US govt via medicare and medicaid almost twice as much as they pay the residents... The insurance companies and patients fo not oay their salaries.
Furthermore, they get paid per resident at their hospital so cutting the number of residents only hurts their own profits.
Great video as always, very important conversations are required on this topic.
Just because you're a resident, does not mean you bear the brunt of unfulfilled hours because the hospital and their bargaining side, sees residents as a means for exploitation...Disney does the same. In other words, a resident is not oblidged to work more than 20 hours nor 40 hours..that's the reality on the ground anyway in most clinics. So just because you think you're a hospital and create abuse tactics pretending that all conditions are urgent, that sooner means the hospital staff is paranoid. Just like a taxi company or spa has many people on a wait list to work, so must a hospital do the same. If the hospital doesn't have the courage and ignores these methods then they too risk the lives of patients so paranoia works both ways, but when it's the hospitals executive committee then they need to be diagnosed as a mental disorder and paranoid or PTSD etc. They are not above the law nor above unions nor above students nor above residents. I think its very interesting that hospital staff think that residents want to work in hospital off the bat. The hospital is not the only place residents nor doctors work...it's a great fantasy though. This story gets more interesting...A Resident by definition is a doctor!! A nurse, NPA and PA are not doctors..that they are not. A nurse, NPA and PA are also not medical doctors in training called residency...a specialty for doctors. So the pay scale too appears to be dumb down and paranoid..haha Sure many executive will be psychotic...in particular the diagnosis can fall through the act of omission, ignoring the rule of law and pay and labor laws and all the definition of what the term doctor means.
Abolish for profit medicine
*I used to be in a union. The union I was in, the president made more than the literal ceo and extracted way too much union dues from our paychecks for nothing in return. I think residency reform is needed but the "union" word pisses me off*
Why the hell does the Union president making more than a CEO matter? The size of the organization matters a heck of a lot more than their job title.
Not only that, but your union collectively bargained for a higher wage and better benefits than youd otherwise have, thats not nothing.
You sound irrational. The word union pissing you off sounds more like youre just a child.
you'll be surprised that residents in Indonesia are paying the hospital. 🤣
But the government is working on it to get a rid of this rotten residency system.
I lost a lot of respect for you in this video. You spent the first half of the video repeating anti-union propaganda with barely any challenge.
"Hospitals might stretch residents more thinly?" Are you kidding? The entire point of a union is to resist that.
"Patients might lose trust?" No patient wants a tired resident taking care of them. They want someone who is fresh and ready for them.
Your anti-union tone is unacceptable. You also cited one piece of research and then said "the evidence." Yeah, that was one study. You didn't say a damn word about the authors or the rest of the research.
I am completely disappointed.
You may as well post a video called "Pros and Cons of Studying for the MCAT."
The real cons of joining a union are getting retaliated against by admin if you have to start a new one. That's all you had to say.
I'm hoping that you are not a doctor because a doctor isn't supposed to be this biased
@@mustang8206 Biased about future working conditions lol, how could you not be? get real dude
@@mustang8206 The entire point of extensive education and experience is to be able to form expert opinions about things. It's arguably OBLIGATORY for physicians to take stances on issues like this that impact literally every facet of public health.
I hear you, but I don’t believe the author held a negative tone, but rather presented existing arguments against unionization of residents. I think it’s important to discern what the author actually believes - which is stated at the end of the video when he states “I believe [unionizing] is a step in the right direction”.
How do we unionionize as physicians?
Your next video should be " so you want to be a dentist."
Wait until u hear pay and working hours in India for residents lol
So you want to be an oncologist please
Collective contracts dont limit the ability of management to improve conditions further. A union contract sets a minimum standard. I genuinely love your videos but for me, this one was a miss.
I think unions are more beneficial
Could we saw some info about what it takes to be biomedical engineer and what with that education I could do? Like perfusiologist? What options I have in private and public sector of medicine?
So you want to be a chiropractor please
Laughs in junior doctor UK (NHS)
omg is it that bad?
@@abcdefghi_lmnopqrstuvwxyz2961 work fewer hours in total but the pay is atrocious - for juniors and for consultants (attendings)
Great
I know this is unrelated, but I was wondering if I got suspended in middle school would that affect my med school application
Well for one thing colleges only care about what happened in high school and med schools only care about what happened in college so no it wouldn't have an affect as long as you stay out of trouble in high school and beyond
Hospitals aren't going to eat this themselves. They are going to pass this onto the patents
Why do you suppose they would do that? They certainly wouldn't have to, but you're correct, they will choose to do so. Ask why they will do that, and then ask why should we allow them to.
Patients and non-medical staff unfortunately. Pay and hospital sponsored benefits will decrease. Then the staff will be forced to also fight for unions.
you wont catch me worrying about the salary of a resident when, in a few years, they will be making a salary well within the top 2%
not to mention you completely omit the amount of money residents cost hospitals. the amount of medical errors they cause is staggering
my brother in Christ they are basically used as free labor
@@SoggyBagelz A third of all mistakes residents make is from fatigue; improving working conditions and hours would decrease the amount of errors made and the amount hospitals would have to pay out
@@memcore1312 reread, you wont catch me worrying etc etc.
@@strangething7379 maybe!
My new concern is that hospital executives and their bargaining committees dont speak enough English to even barter any type of negotiation nor create discourse for the negotiation in a unionized bargaining process nor unionized process. Faking English speaking skills and faking proficiency both fail. Passive Agressive demeanor and temper is bipolar and diagnosable easily. Have you heard, I'm laughing inside or dancing inside or smiling inside..versus outwardly displaying a smile or dance. Not saying dance, that could go against someones religion like money goes against communism's slavery.
Airplanes 🛬 overbook to throw out the remaining balance of people.
Hospitals 🏥 run their business / fill 📂 their gap wirh residents students.
Like the plane ✈ companies does but it is the other way around.
I understand that a Dr have to be the best of the most best but I also think 🤔 that the recidency system should be reformed in such a way that "the social work" [of recidency] should be a good and more human "👐 on patient care/work ⚒. 😊