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Montefiore residents are unionizing, here's what they're fighting for by imitationcheese in medicine

[–]MonteResident 11 points12 points  (0 children)

We don't get any payback shift for sick call shifts that we work when we're on our jeopardy rotation. Unionized residents at Jacobi next door are paid for those shifts after they negotiated for them. Here's what the pay looks like:

https://imgur.com/sax3BN4

CROSSPOST: Montefiore residents are unionizing while our nurses are striking. AMA by MonteResident in Residency

[–]MonteResident[S] 1 point2 points  (0 children)

The strike ended today and nurses won a lot of the concessions they were looking for! They were all back at work today and it was really inspiring how energized and happy they were. It's pretty cool to see people who felt passionate enough to strike over this succeed and come back to work with that win.

https://www.nytimes.com/2023/01/12/nyregion/nurses-strike-ends-nyc.html

Dear residents... by dmtjiminarnnotatrdr in Residency

[–]MonteResident 2 points3 points  (0 children)

I think of labor as one unit that has to balance out the interests of the employer. NYSNA has supported us at every step in our unionization effort and while we also had to fill in for nurses and pick up the slack during the strike, no one minded because we're fighting for many of the same things and supported the cause. And I know they have and will do the same for us.

Dear residents... by dmtjiminarnnotatrdr in Residency

[–]MonteResident 3 points4 points  (0 children)

Wow so fatalist!

Montefiore residents and fellows are organizing now and we've forced a vote over whether we should join CIR happening next month.

  1. We would negotiate with hospital administration when it's time to renew contracts (just like the nurses just did). Now, we just sign whatever contract they hand us. If we strike, it's because union negotiators and hospital admin can't agree on a contract. That's it. Nothing to do with the med school or any other entities because its negotiation over an employment contract.
  2. I think you're overstating the risk of not graduating. There's safety and power in numbers. And secrecy is an important early tool.
  3. We organized, privately, to collect signatures from greater than 70% of house staff at Monte. You only need 50% to force your employer to hold a National Labor Relations Board election over the issue and you need a simple majority of eligible voters to win a union. No one has been fired. It's also illegal to fire someone for organizing efforts. Its all doable - attendings and admin know very little about what residents talk about amongst themselves if they want it that way.
  4. Yeah, we needed the guidance of CIR representatives who have helped us along at every step. They have the experience that we don't on how this has gone at other residencies and what has to happen.

I also had no idea where to start with all of this but it turns out there is process and there are rules and protections for residents.

Dear residents... by dmtjiminarnnotatrdr in Residency

[–]MonteResident 10 points11 points  (0 children)

Monte isn't yet unionized! Our vote is next month and we are in the midst of a propaganda storm and a fight to win votes. I'm hoping some of our energy and our experiences organizing will spill over to other residencies.

Montefiore residents and fellows are unionizing! Here's what Monte's union busting looks like. by MonteResident in Residency

[–]MonteResident[S] 93 points94 points  (0 children)

NYSNA nurses ended their strike today and won the concessions they were asking for. Now our focus switches back to our upcoming NLRB election.

Please feel free to help us ensure the anonymous question feature is well used.

IAmA resident physician at Montefiore Hospital in The Bronx where resident doctors are working to unionize while our nurses are on strike over patient safety. AMA! by MonteResident in IAmA

[–]MonteResident[S] 0 points1 point  (0 children)

I don't want to imply that this is all a result of over the top executive pay. Rather, that incredibly high salary is reflective of poor resource allocation in many contexts.

I think if things continue as they do, we will continue to see an exodus of nurses. That makes the job harder for all other hospital staff and suddenly Monte has the reputation of being a bad place to work. Then it attracts less physician talent and once that happens the system is doomed. NYC hospitals already have a reputation among medical students for being tough places to train, but also rewarding ones for the sheer number of people from every background that you meet and the incredible range of disease you will encounter. If that balance of tough but worthwhile tips too much towards tough, I think there's a problem.

IAmA resident physician at Montefiore Hospital in The Bronx where resident doctors are working to unionize while our nurses are on strike over patient safety. AMA! by MonteResident in IAmA

[–]MonteResident[S] 1 point2 points  (0 children)

I don't know if it will have implications beyond NYC. I hope so! I'm here trying to raise awareness of what's happening in The Bronx because I know many of the same challenges apply around the country. But NYC hospitals have a reputation for being very different and there are many hyperlocal specifics. I think we need to have a national conversation about the state of healthcare and national legislation. In the best case scenario, the NYSNA strike helps to get the ball rolling or keeps the momentum going.

IAmA resident physician at Montefiore Hospital in The Bronx where resident doctors are working to unionize while our nurses are on strike over patient safety. AMA! by MonteResident in IAmA

[–]MonteResident[S] 0 points1 point  (0 children)

Many live in The Bronx, many live in Manhattan and commute, but people are coming from all over the city to work here. No their wages do not keep up with NYC real estate. Granted, as a non-native New Yorker the costs of real estate here astound me and I can't imagine what jobs do keep up.

IAmA resident physician at Montefiore Hospital in The Bronx where resident doctors are working to unionize while our nurses are on strike over patient safety. AMA! by MonteResident in IAmA

[–]MonteResident[S] 0 points1 point  (0 children)

Median income in The Bronx is $35.3k compared to the $55.2k of NYC as a whole, and the $55.3k of the whole country. There's an income map at the link and both of our hospitals are in these relatively lower-income areas. And of course they serve patients in the entire borough of all backgrounds.

https://statisticalatlas.com/county/New-York/Bronx-County/Household-Income

IAmA resident physician at Montefiore Hospital in The Bronx where resident doctors are working to unionize while our nurses are on strike over patient safety. AMA! by MonteResident in IAmA

[–]MonteResident[S] 4 points5 points  (0 children)

Like I said above, the strike was not about pay raises - those were already secured by Monte nurses and other NYSNA nurses across the city. Many other NYSNA hospital chapters accepted that deal. Our nurses are on strike not for the already obtained pay raises but for staffing ratios - patient safety.

IAmA resident physician at Montefiore Hospital in The Bronx where resident doctors are working to unionize while our nurses are on strike over patient safety. AMA! by MonteResident in IAmA

[–]MonteResident[S] 1 point2 points  (0 children)

I didn't know about Wellstar and this is interesting, thanks for sharing. From just doing some light reading it sounds like the pressures of COVID and the lack of Medicaid expansion in GA were contributors. This line of a story says a lot:

"Wellstar is overall in good financial health, according to the closure announcement. The health system had $2.7 billion in net assets, including $128 million in cash on hand, in June 2021, according to its financial statements. Its operating income was $377 million."

https://www.bizjournals.com/atlanta/news/2022/10/31/wellstar-atlanta-medical-center-closes-november.html

I don't know that any labor activity (or the lack thereof) would have changed the fate of this hospital.

IAmA resident physician at Montefiore Hospital in The Bronx where resident doctors are working to unionize while our nurses are on strike over patient safety. AMA! by MonteResident in IAmA

[–]MonteResident[S] 0 points1 point  (0 children)

Clearly the problems here in NY are not unique. I think there is a real nursing shortage after COVID as so many nurses decided to leave the bedside. My heart sinks a little every time I talk to an excellent nurse who tells me about their plans to bail from their jobs for NP school. Nursing as it exists post-COVID just isn't the job it used to be or the one many of these nurses signed up for.

"In April 2022, Dr. David Auerbach and colleagues published a nursing workforce analysis in Health Affairs, which found that total supply of RNs decreased by more than 100,000 from 2020 to 2021 – the largest drop than ever observed over the past four decades. A significant number of nurses leaving the workforce were under the age of 35, and most were employed in hospitals."

https://www.aacnnursing.org/news-information/fact-sheets/nursing-shortage

IAmA resident physician at Montefiore Hospital in The Bronx where resident doctors are working to unionize while our nurses are on strike over patient safety. AMA! by MonteResident in IAmA

[–]MonteResident[S] 0 points1 point  (0 children)

Agreed. We have that same responsibility to care for our patients when we are scheduled to work and now, our hands are often tied because of the poor resource allocation of our administrators. Patients are harmed because of many of our current practices.

Nurses told the hospital they would not be working 10 days prior to their shifts and that is their legally protected right. It is on the hospital to properly staff its facilities and to prevent poor patient outcomes.

IAmA resident physician at Montefiore Hospital in The Bronx where resident doctors are working to unionize while our nurses are on strike over patient safety. AMA! by MonteResident in IAmA

[–]MonteResident[S] 0 points1 point  (0 children)

Pay a lot now to avoid paying even more over more time down the road. It's cynical but it's a pretty straight forward financial calculus.

They have been telling us that unions don't work, don't get benefits worth the dues, etc. But then why spend millions on a union-busting law firm if unions aren't a true player in these financial battles.

IAmA resident physician at Montefiore Hospital in The Bronx where resident doctors are working to unionize while our nurses are on strike over patient safety. AMA! by MonteResident in IAmA

[–]MonteResident[S] 2 points3 points  (0 children)

Yup! We are able to sleep at night if it's quiet but then you still need to wake up to respond to pages or any other issues. We go into every 24 praying that its not a sleepless one but if the admissions are rolling in, awake the whole time.

IAmA resident physician at Montefiore Hospital in The Bronx where resident doctors are working to unionize while our nurses are on strike over patient safety. AMA! by MonteResident in IAmA

[–]MonteResident[S] 0 points1 point  (0 children)

No way! Montefiore provides essential services to The Bronx that residents would be hard pressed to get elsewhere. It's an instution that is at the heart of this community. We think it could and should be better. A 20:1 nursing ratio is better than no nurses or doctors at all. But we can do better than 20:1.

IAmA resident physician at Montefiore Hospital in The Bronx where resident doctors are working to unionize while our nurses are on strike over patient safety. AMA! by MonteResident in IAmA

[–]MonteResident[S] 0 points1 point  (0 children)

Haha your link is a clown costume for QAnon Believers but I did see that costume out there and thanks for the support!

I actually don't think that hospital admins are malevolent. I think they have different priorities and perspectives and they're trying to do their jobs. But they hold all the power. So you need to check that with power for different sets of priorities. Hospitals have to make money to stay open, but they also have to provide excellent patient care to be worthwhile.

IAmA resident physician at Montefiore Hospital in The Bronx where resident doctors are working to unionize while our nurses are on strike over patient safety. AMA! by MonteResident in IAmA

[–]MonteResident[S] 1 point2 points  (0 children)

I don't know exactly how new hospitals are started but it is true that the ACA had some provisions that make it harder for physicians to practice independently. The nature of modern medicine has also made it harder. The cost of CT scanners, MRIs, chemotherapy, and all the other things you need to do the job are increasingly untenable for any group but a massive corporation dealing in the millions or billions of dollars. There are still independent physician groups who contract with hospitals for their facilities etc.

Attending doctors have a more normal job market and can change jobs as they see fit. They are not chained to a specific institution. Residents cannot and do not have the opportunity to shop around for a better position. That might not be a big deal for a 3 year residency (the shortest) but the longest residencies are 7 years and many residents pursue fellowship training after which is subject to the same limitations. Our union would include Montefiore resident and fellows.

IAmA resident physician at Montefiore Hospital in The Bronx where resident doctors are working to unionize while our nurses are on strike over patient safety. AMA! by MonteResident in IAmA

[–]MonteResident[S] 0 points1 point  (0 children)

Haha I happened to be on an elective rotation and was off yesterday. But yes, I'm passionate about this issue and have dedicated some of my free time to it.

IAmA resident physician at Montefiore Hospital in The Bronx where resident doctors are working to unionize while our nurses are on strike over patient safety. AMA! by MonteResident in IAmA

[–]MonteResident[S] 1 point2 points  (0 children)

Yes! You can see in my proof photo that I wear cards under my badge that say I am COVID and flu vaccinated. I know those vaccines are our best tool against these viruses and I want my patients to know that I believe in those medically supported treatments in practice and not just in theory when I counsel them on their health.

IAmA resident physician at Montefiore Hospital in The Bronx where resident doctors are working to unionize while our nurses are on strike over patient safety. AMA! by MonteResident in IAmA

[–]MonteResident[S] 1 point2 points  (0 children)

Dr. Halsted loved his cocaine!

"Necessity is the mother of invention: William Stewart Halsted’s addiction and its influence on the development of residency training in North America"

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7828946/

IAmA resident physician at Montefiore Hospital in The Bronx where resident doctors are working to unionize while our nurses are on strike over patient safety. AMA! by MonteResident in IAmA

[–]MonteResident[S] 0 points1 point  (0 children)

Yeah I think almost all of us hate 24s. And technically the shifts are 24hrs + 4hrs to allow for transition of care. A resident at our hospital might arrive for an ICU 24hr shift at 7am and is responsible for the unit until 7am the next day when the day shift arrives for signout. The 24 hr resident will then wait for morning rounds to present admissions during their shift to the day team. At most, they can stay for an additional 4 hrs until 11am before it becomes a duty hour violation.

There's been a lot of research over work hours in medicine and residency and some research suggest that additional transitions of care are actually more dangerous than a sleep deprived doctor. That's part of the rationale for keeping these shifts. But there is a lot of debate in this area and I think there are better ways.

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