Name: 住院醫生的工會化 (The Unionization of Doctors in Residency)
Uploaded: 2022-07-25T17:40:38.000Z
Duration: 9 min 52 s

It’s common knowledge that residents work long and challenging hours for relatively

眾所周知，居民的工作時間長且具有挑戰性，但相對而言，他們的工作時間較短。

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？

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

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。

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

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

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

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.

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

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.

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。

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

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

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.

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。

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。

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。

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

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.

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

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

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。

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。

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。