low pay, but is unionizing residency programs the answer to these problems?

低工資，但建立住院醫師項目工會是解決這些問題的辦法嗎？

Or do the potential costs outweigh the benefits?

或者說，潛在的成本是否超過了收益？

Let’s find out.

讓我們拭目以待。

Dr. Jubbal, MedSchoolInsiders.com.

Jubbal博士，MedSchoolInsiders.com。

Residents joining unions is not a new phenomenon; however, it has been more prominent in the

居民加入工會並不是一個新的現象；然而，它在以下方面更為突出

media in the wake of COVID-19.

在COVID-19事件發生後，媒體的報道。

Throughout the pandemic, many residents were required to take on larger numbers of very

在整個大流行病期間，許多居民被要求承擔更多數量的非常

sick patients without additional compensation or social assistance.

患病的病人沒有額外的補償或社會援助。

In addition, the significant increases we’re seeing in inflation and housing costs as a

此外，我們所看到的通貨膨脹和住房成本的顯著增加，作為一個重要的因素。

result of the pandemic have further highlighted the issue of resident salaries.

大流行病的結果進一步突出了居民工資的問題。

These factors have led many residents to advocate more vocally for issues like increased compensation

這些因素導致許多居民更大聲地倡導增加賠償等問題。

and better work-life balance – and unionizing has the potential to help make these changes

和更好的工作與生活平衡--而工會有可能幫助實現這些變化。

a reality.

一個現實。

This is exactly what residents at Stanford hoped to achieve by unionizing.

這正是斯坦福大學的居民希望通過成立工會實現的目的。

For months, Stanford resident and fellow physicians negotiated with hospital leadership for increased

幾個月來，斯坦福大學的住院醫生和同事們與醫院領導層進行了談判，要求增加

compensation to help keep up with rising inflation and increased housing costs in California.

補償，以幫助跟上加州不斷上升的通貨膨脹和增加的住房成本。

In May 2022, however, they won a union election for representation by the Committee of Interns

然而，在2022年5月，他們在工會選舉中贏得了實習生委員會的代表。

and Residents, or CIR, which is the largest resident union in the United States.

和居民，即CIR，它是美國最大的居民聯盟。

By June 2, 2022, the union had given official notice to the hospital of plans for a two-day

到2022年6月2日，工會已向醫院發出正式通知，計劃舉行為期兩天的

strike starting on June 13, 2022.

從2022年6月13日開始罷工。

In response, hospital leadership met with the union the following day and the county

作為迴應，醫院上司在第二天與工會會面，縣裡

presented a tentative salary and benefits proposal in line with the residents’ demands.

提出了一個符合居民要求的暫定工資和福利建議。

As a result, the strike was effectively avoided and the residents achieved what they had hoped

結果，罷工被有效地避免了，而居民也實現了他們的願望

for.

為。

Although many see this as a win for residents and are calling for other residency programs

儘管許多人認為這是居民的勝利，並呼籲其他住院醫師項目

to follow suit, some are concerned that unionization may bring its own set of issues.

一些人擔心工會化可能會帶來自己的一系列問題。

Let’s explore both sides of the debate starting with concerns about the unionization of residencies.

讓我們從對住院醫師工會化的關注開始，探討辯論的雙方。

To start, many fear that if residents across the country begin joining unions and fighting

首先，許多人擔心，如果全國各地的居民開始加入工會並與之鬥爭

for increased compensation, it may negatively affect the cost of care for patients.

為增加賠償，它可能會對病人的護理費用產生負面影響。

Although federal funding helps pay for residents’ salaries, hospitals often still contribute

雖然聯邦資金幫助支付住院醫生的工資，但醫院通常仍會出資

to residency expenses.

對居住地的費用。

Although residents intrinsically contribute to educational costs through their labor contributions,

儘管居民通過他們的勞動貢獻對教育成本有內在的貢獻。

many argue that they are also receiving a tremendous amount of training “for free.”

許多人認為，他們也在 "免費 "接受大量的培訓。

In some fields, including many subspecialized fields of dentistry, trainees are required

在一些領域，包括許多口腔醫學的亞專業領域，要求受訓者

to pay tuition for their clinical training.

以支付其臨床培訓的學費。

In contrast, resident physicians are not required to pay tuition for their training and instead

相比之下，住院醫生不需要為其培訓支付學費，而是

receive a salary for their work.

他們的工作獲得了工資。

Some fear that if hospitals have to increase compensation for residents, these increased

一些人擔心，如果醫院不得不增加對住院醫生的補償，這些增加的

costs may end up being passed onto the patient.

費用最終可能被轉嫁給病人。

In addition, if hospitals are paying each resident a higher salary, they may be incentivized

此外，如果醫院向每位住院醫師支付較高的工資，他們可能會受到激勵

to offer fewer residency positions and spread their current residents even thinner.

提供更少的住院醫師職位，使他們現有的住院醫師人數更少。

This would put further strain on the already limited number of residency positions leading

這將給已經很有限的住院醫師職位帶來進一步的壓力。

to more unmatched medical students each year.

每年向更多未被匹配的醫學生提供服務。

I talk about this topic in depth in my Surprising Facts About the 2022 Match video over on the

我在《關於2022年比賽的令人驚訝的事實》視頻中深入討論了這個話題。

Kevin Jubbal, M.D.

Kevin Jubbal, M.D.

channel - link in the description.

頻道--描述中的鏈接。

Another concern is that the collective contractual agreements that unions fight for may limit

另一個擔憂是，工會所爭取的集體合同協議可能會限制

flexibility.

靈活性。

As it stands right now, resident requests are handled on a case-by-case basis.

就目前的情況而言，居民的請求是按個案處理的。

Programs look at each request one at a time and try to come up with an individualized

方案逐一查看每個請求，並試圖提出一個個性化的

solution tailored to that resident’s situation.

為該居民的情況量身定做的解決方案。

In contrast, unions often fight for collective contracts which apply to everyone.

相比之下，工會往往為適用於所有人的集體合同而奮鬥。

The problem with this is that residents in different specialties often have different

這方面的問題是，不同專業的居民往往有不同的

needs.

需要。

Surgical residents, for instance, are required to perform a certain number of procedures

例如，外科住院醫師被要求執行一定數量的手術

in order to qualify for board certification.

以便有資格獲得委員會的認證。

As a result, they may not be able to take advantage of benefits such as additional time

是以，他們可能無法享受到額外時間等福利。

off as they need to work a certain amount to fulfill their case number requirements.

因為他們需要工作一定的數量來滿足他們的案號要求。

On the other hand, these same surgical residents may benefit from improvements to hospital

另一方面，這些外科住院醫生可能會從醫院的改進中受益。

on-call rooms that other specialties don’t utilize.

其他科室不使用的待命室。

During negotiations between unions and hospitals, compromise is often required on both sides.

在工會和醫院之間的談判中，往往需要雙方做出妥協。

If a union negotiates to increase time off and improve on-call rooms, it’s possible

如果工會為增加休息時間和改善待命室進行談判，就有可能

that the hospital only agrees to one of these terms.

醫院只同意這些條款中的一個。

In this scenario, only some residents would benefit from collective agreements whereas

在這種情況下，只有部分居民會從集體協議中受益，而

others would not – despite having to shoulder the other cons that come with unionization.

其他人則不會這樣做--儘管他們必須承擔工會化所帶來的其他弊端。

Threats of resident strikes, such as the one that occurred at Stanford, also have the potential

居民罷工的威脅，如發生在斯坦福大學的罷工，也有可能是

to fray relationships between residents and hospital staff leading to animosity between

破壞了居民和醫院工作人員之間的關係，導致他們之間產生敵意。

the two parties.

兩黨之間的關係。

This, in turn, could have a significant impact on the dynamic between residents and hospital

這反過來又會對居民和醫院之間的關係產生重大影響。

leadership.

領導力。

Resident strikes may also undermine the trust that patients and communities have in resident

居民罷工也可能破壞患者和社區對居民的信任。

physicians resulting in strain on the relationships that resident physicians form with their patients.

導致住院醫生與病人的關係緊張。

Lastly, there is some research that suggests unionizing residencies doesn’t dramatically

最後，有一些研究表明，建立住院醫師工會並不明顯。

improve the residency experience.

改善住院醫師的經驗。

In a 2021 article posted in JAMA, the authors evaluated the association of resident unions

在2021年發表在《美國醫學會雜誌》上的一篇文章中，作者評估了居民聯盟的關係

with working conditions and well-being.

與工作條件和福祉。

They found that although vacation time and housing stipend benefits were improved at

他們發現，儘管休假時間和住房津貼福利在以下方面得到了改善

unionized programs, unions don’t appear to improve burnout, suicidality, job satisfaction,

工會項目，工會似乎並沒有改善職業倦怠、自殺、工作滿意度。

duty hour violations, mistreatment, or program educational environment.

違反值班時間，虐待，或計劃教育環境。

The authors conclude that these factors should be taken into account as residents and residency

作者的結論是，在居民和居住地應考慮到這些因素。

programs discuss well-being and contemplate unionization.

節目中討論了福利問題，並考慮成立工會。

In short, if the goal of unionizing is to improve resident well-being through addressing

簡而言之，如果組建工會的目標是通過解決以下問題來改善居民的福祉

issues like burnout, depression, and suicide, the data suggests that it may not yield the

諸如職業倦怠、抑鬱症和自殺等問題，數據表明，它可能不會產生。

result that residents and programs are looking for.

居民和項目正在尋找的結果。

Instead of focusing our efforts on these issues, many argue that our focus would be better

許多人認為，與其將我們的努力集中在這些問題上，不如將我們的重點放在

placed on other factors that are more effective in improving resident well-being.

放在其他對改善居民福祉更有效的因素上。

Now let’s explore the other side of the argument and talk about the benefits of residents

現在我們來探討一下論點的另一面，談談居民的好處

joining unions.

加入工會。

Perhaps the most obvious benefit is that by unionizing, residents are able to participate

也許最明顯的好處是，通過成立工會，居民能夠參與到

in collective bargaining.

在集體談判中。

When everyone is on the same page and fighting for the same cause, they have more leverage

當每個人都在同一起跑線上併為同一事業奮鬥時，他們就有了更多的籌碼。

to get what they want.

以獲得他們想要的東西。

We can see this in the case of Stanford.

我們可以在斯坦福大學的案例中看到這一點。

If it was only a handful of residents threatening not to show up for their shift, it wouldn’t

如果只是少數居民威脅說不來上班，那就不會

have been nearly as concerning for the hospital compared to a significant portion of their

與他們中的很大一部分人相比，醫院的情況幾乎同樣令人擔憂。

residents refusing to show up.

居民拒絕露面。

The value of this cannot be understated as residents, even relative to most employees

這方面的價值是不能低估的，因為居民，甚至相對於大多數僱員而言

in the U.S., are often in a position of powerlessness.

在美國，他們往往處於無能為力的地位。

After medical school, you need to complete residency training in order to practice as

醫學院畢業後，你需要完成住院醫師培訓，以便作為一名醫生執業。

an attending physician – and residency spots aren’t necessarily easy to come by.

一個主治醫生--而住院醫師的位置不一定容易得到。

If you’re unhappy with your program, it’s not easy to leave and find another spot at

如果你對你的項目不滿意，要離開並找到另一個位置並不容易，在

a different program.

一個不同的程序。

Leaving residency is often perceived negatively and makes it incredibly difficult to find

離開居住地往往被認為是負面的，並使其難以置信地難以找到。

another position.

另一個位置。

As such, many residents are forced to endure much more than they would otherwise because

是以，許多居民被迫忍受比其他方式多得多的東西，因為

the only other alternative puts their entire career as a physician in jeopardy.

唯一的其他選擇使他們作為醫生的整個職業生涯處於危險之中。

By coming together and unionizing, these residents are on a more equal footing with hospital

通過聯合起來成立工會，這些居民與醫院的關係更加平等。

leadership and have a much better chance of achieving their goals without risking their

領導人，並有更好的機會實現他們的目標，而不冒他們的風險。

careers.

職業。

According to Medscape’s 2021 Resident Salary & Debt Report, approximately 57% of residents

根據Medscape的2021年居民工資和債務報告，大約57%的居民

are dissatisfied with their compensation and 87% don’t feel that it reflects the number

對他們的報酬不滿意，87%的人認為報酬沒有反映出他們的人數。

of hours worked.

的工作時間。

In addition, 81% report dissatisfaction regarding their compensation relative to other members

此外，81%的人表示對他們的報酬相對於其他成員不滿意。

of the medical staff such as physician assistants, nurse practitioners, and nurses.

醫務人員，如醫生助理、執業護士和護士。

Despite still being in training, resident physicians and fellows are second only to

儘管仍在培訓中，住院醫師和研究員的地位僅次於

attending physicians in terms of their level of knowledge and expertise, yet their salaries

在知識和專業水準方面與主治醫生相差無幾，但他們的工資卻很高。

don’t reflect this.

並不反映這一點。

Newly graduated nurses, NPs, and PAs are still training when they begin employment and have

新畢業的護士、非執業醫師和執業助理醫師在開始就業時仍在接受培訓，並有

far lower levels of expertise but they earn substantially higher salaries per hour than

他們的專業知識水準要低得多，但他們每小時的工資卻大大高於普通人。

the average resident.

普通居民。

According to the American Medical Association and Medscape, the average first-year resident

根據美國醫學會和Medscape的數據，平均第一年的居民

physician makes around $60,000 per year and works greater than 50 hours per week.

醫生每年賺取約60,000美元，每週工作超過50小時。

It is not uncommon, however, to hear of residents working upwards of 70 to 80 hours per week

然而，聽說居民每週工作時間超過70至80小時的情況並不少見。

in many specialties.

在許多專業領域。

If we use a modest estimate of around 60 hours per week on average, that comes out to an

如果我們採用平均每週60小時左右的適度估計，那就意味著

hourly rate of just $19 per hour.

每小時費率僅為19美元。

It is important to keep in mind that by this point in their training, resident physicians

重要的是要記住，到了培訓的這一階段，住院醫生

have over 8 years of post-secondary education and over $200,000 of student loan debt on

有超過8年的中學後教育和超過20萬美元的學生貸款債務。

average.

平均值。

In addition, resident physicians perform many of the same duties as their attending physicians

此外，住院醫生履行許多與主治醫生相同的職責

despite making only a fraction of the salary.

儘管掙的錢只是工資的一小部分。

Although resident salaries vary by state and program and increase by a few percentage points

儘管居民工資因州和項目而異，並以幾個百分點的速度增長

with each additional year of training, they are still several times less than the $260,000

每增加一年的培訓，他們仍然比26萬美元少幾倍。

per year that the average primary care physician earns and the $360,000 per year that the average

平均而言，初級保健醫生的年收入為36萬美元，而平均而言，醫生的年收入為30萬美元。

specialist earns.

專家的收入。

As such, many resident physicians feel that their compensation does not come close to

是以，許多住院醫生認為他們的報酬並不接近於

reflecting their level of knowledge and training or the work that they are doing.

反映了他們的知識和培訓水準或他們所做的工作。

By joining unions, residents may also be able to improve their working conditions.

通過加入工會，居民也可以改善他們的工作條件。

The majority of residents work more than 50 hours per week with nearly a quarter reporting

大多數居民每週工作時間超過50小時，近四分之一的人報告說

working more than 70 hours per week.

每週工作超過70小時。

Although duty hour regulations exist that limit residents to 80 hours per week and require

雖然有值班時間的規定，限制居民每週80個小時，並要求

them to have at least one day off, this is averaged over 4 weeks.

他們至少有一天的休息時間，這是4周的平均數。

And even then, many programs violate these restrictions.

而即使如此，許多項目也違反了這些限制。

As such, there are many residents working in excess of 80 hours per week, which translates

是以，有許多居民每週工作時間超過80小時，這就意味著

to an average of 13 hours a day, 6 days per week.

到平均每天13小時，每週6天。

Many residents argue that these long hours take a toll on them emotionally, physically,

許多居民認為，這些長時間的工作對他們的情感和身體造成了傷害。

and psychologically and negatively impact their ability to provide care for their patients.

和心理上，並對他們為病人提供護理的能力產生負面影響。

As such, unionizing and improving resident work-life balance has the potential to improve

是以，成立工會和改善居民工作與生活的平衡有可能改善

patient care as well.

也是對病人的照顧。

Residents need to be able to put their own oxygen masks on first and take care of themselves

居民需要能夠首先戴上自己的氧氣罩，並照顧好自己

before they can effectively take care of their patients.

在他們能夠有效地照顧他們的病人之前。

Lastly, unionization can be beneficial for hospitals as well.

最後，工會化對醫院也有好處。

By having a contract that applies to all residents, hospitals don’t need to spend time debating

通過制定適用於所有居民的合同，醫院不需要花時間爭論

a broad range of requests from each individual resident.

每個居民都有廣泛的要求。

Instead, they can say that “this is the rule for everyone, and we can’t deviate

相反，他們可以說，"這是對所有人的規則，我們不能偏離。

from it.“ For too long, residents have been hazed, overworked,

從中"。長期以來，居民們一直被欺負，過度勞累。

and poorly treated.

而且待遇很差。

As a consequence of this, we have concerning levels of burnout, depression, and suicide

是以，我們有令人擔憂的倦怠、抑鬱和自殺水準。

among resident physicians.

在住院醫生中。

Although unionizing residency programs is likely not going to be the end-all, be-all

雖然住院醫師項目的工會化很可能不會是萬能的，萬能的。

solution to these issues, I believe that it is a step in the right direction.

我相信這是朝正確方向邁出的一步。

That being said, even as resident unions fight to improve pay and work-life balance, we still

也就是說，即使在居民工會為改善薪酬和工作與生活的平衡而鬥爭時，我們仍然

need to take a critical look at the system as a whole to address these other deeply-rooted

需要對整個系統進行嚴格審查，以解決這些其他根深蒂固的問題。

issues.

問題。

Only then will we be able to produce a generation of happier, healthier, and more effective

只有這樣，我們才能培養出更快樂、更健康、更有效的一代人。

future doctors.

未來的醫生。

Thank you all so much for watching.

非常感謝大家的觀看。

If you enjoyed this video, be sure to check out Why Are Doctors Miserable?

如果你喜歡這段視頻，請務必查看《醫生為何痛苦？

| The Burnout Epidemic or this other video.

| 倦怠流行病或這個其他視頻。

Much love and I’ll see you guys there.

非常感謝，我們會在那裡見到你們。