A recent survey of 91 residency programs in New York City showed that at least 340 residents had become infected with COVID, with anesthesia and emergency medicine residents having the highest probability of contracting the disease. Approximately 50 percent of residents had suboptimal personal protective equipment (PPE) and around 75 percent of programs had resident redeployment.1 Anecdotal reports are even more striking, with one physician stating that 80 percent of their internal medicine residents missed time from work because of COVID-19 symptoms.2
Explore This IssueACEP Now: Vol 39 – No 07 – July 2020
With all this stress weighing on the young doctors of our country, you would think offering hazard pay would be a no-brainer. Residents are underpaid and carry high debt burdens. Meanwhile, many of our physician assistant (PAs) colleagues are receiving hazard pay, and hospitals are recruiting extra staff with free lodging and meals on top of exorbitant amounts of money, upwards of $10,000 per week, in order to address COVID-19 needs.3
Is Hazard Pay Realistic?
A common reason for refusing residents hazard pay is the current financial strain on hospitals due to the pandemic. However, few details are offered after this initial point is conveyed.
A typical New York City hospital CEO earns more than $1 million a year. A normal hazard pay stipend averages about $1,250 per resident. Therefore, a one-time pay reduction of 12.5 percent for the average New York City hospital CEO could easily fund about 100 house staff with hazard pay.4
The CARES Act Provider Relief Fund has begun to distribute an unprecedented $175 billion to hospitals, with some New York hospitals already receiving more than $250 million in aid. Some of this money is undoubtedly going to medical supplies and other critical infrastructure.5 In light of these infusions of financial aid, hazard pay would not seem to be an overly burdensome ask.
Is Hazard Pay Ethical?
Articles in the press have quoted leaders and other physicians arguing that residents should not be focusing on “making a few extra dollars” and that doing so is not becoming of a caring doctor. This unfairly asserts that a resident cannot have an opinion on more than one matter at a time. It promotes a culture that prioritizes suffering as the driving force that makes a great physician. Negotiating a middle point and expressing concerns are actually skills that residents should be encouraged to learn before independent practice and should not be actively suppressed by leadership.6
Some argue that residents should be considered students, which makes them unable to negotiate pay. It is true that residents are in training, but this argument fails to recognize that residents are integral to an academic hospital infrastructure. It is improper to posit that residents are simply students when they are demanding hazard pay yet classify them as essential staff who need to be redeployed to provide valuable patient care during a pandemic. In fact, the United States Supreme Court has already ruled on this: residents are not students.7
Major medical bodies support hazard pay. In April 2020, the American Medical Association officially recognized resident hazard pay in their guiding principles, stating “residents should be candidates for hazard pay in a way that is equitable to other health care workers.”