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

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.” 

Is Student Loan Forgiveness Better Than Hazard Pay?

Congress currently has multiple student loan forgiveness proposals in front of them for front-line workers, including Student Loan Forgiveness for Frontline Health Workers Act, Opportunities for Heroes Act, and Student Debt Emergency Relief Act.⁸

While student loan forgiveness would be appreciated, it would not help residents with current day-to-day struggles as hazard pay would. A normal salary for a first-year resident in New York City is around $60,000 a year, a large portion of which immediately disappears due to New York’s high living costs. While a small stipend may seem like a drop in the bucket for most, it is actually quite substantial for a resident that doesn’t have significant funds at baseline.

Medical students and residents have advocated for student loan forgiveness for decades without success. Despite current circumstances, it would be rare to see an issue with so much history and precedent pass through Congress with ease. To rely on student loan forgiveness in place of hazard pay is unwise.

Ultimately, the onus is on hospitals to take on this initiative. Residents were redeployed and willingly took on extra hours all to help with the workload. Residents exemplified all the admirable qualities you would want in your employees during a crisis. For hospitals to not recognize that is demoralizing. 

Next Steps

Some hospitals have offered hazard pay to their house staff. New York-Presbyterian is offering $1,250 to all staff who worked the COVID-19 front line. Mount Sinai not only offered their residents hazard pay but also announced that their executive leadership team would take a significant pay cut during the coronavirus crisis.^9,10

Many hospitals have not been so generous. Residents need strong advocacy from physician organization groups to suggest a fair starting hazard pay rate and suggest making payments retroactive to when cases first appeared at their hospital. Such policy statements would give hospitals a framework for negotiation and potentially move talk into action.

Residents have tried petitions that received many thousands of signatures, they’ve tried organizing letters and emails to leadership, and some have even resorted to talking to the media in an attempt to be heard.^6,11,12 All of this has spurred little change. We need physicians, nurses, other staff, and the industry as a whole to recognize the unfairness of our situation and to stand with us in order to create this greatly needed change. 

Dr. Clifford is a PGY-2 emergency medicine resident at Icahn School of Medicine at Mount Sinai in New York City.

References

1. Breazzano MP, Shen J, Abdelhakim AH, et al. Resident physician exposure to novel coronavirus (2019-nCoV, SARS-CoV-2) within New York City during exponential phase of COVID-19 pandemic: Report of the New York City Residency Program Directors COVID-19 Research Group. Preprint. medRxiv. 2020;2020.04.23.20074310.
2. Maier T. Study: 340 NYC resident physicians had confirmed or suspected coronavirus. Newsday. Updated May 11, 2020. Accessed June 30, 2020.
3. Hong N. Volunteers rushed to Help New York hospitals. They found a bottleneck. New York Times. Apr 8, 2020. Accessed June 30, 2020.
4. LaMantia J, Schifman G. Typical NYC hospital CEO earns more than $1 million a year. Modern Healthcare. Jan 16, 2020. Accessed June 30, 2020.
5. Provider relief fund COVID-19 high-impact payments. Centers for Disease Control and Prevention website. Accessed June 30, 2020.
6. Hlavinka E. NYU leadership gaslights residents over hazard pay. Medpage Today website. Apr 23,2020. Accessed June 30, 2020.
7. Denniston L. Court: medical residents not students. SCOTUSblog website. Jan. 11, 2011. Accessed June 30, 2020.
8. Minsky A. There are now five plans to forgive student loans—how do they compare? Forbes. May 7, 2020. Accessed June 30, 2020.
9. Smith C. COVID-19 Update from Dr. Smith 4/2/20. Columbia Surgery website. Accessed June 30, 2020.
10. Klein M. Mount Sinai exes take massive pay cut amid coronavirus crisis. New York Post. Apr. 11, 2020. Accessed June 30, 2020.
11. Kim E. Doctors-in-training at COVID-ravaged public hospitals demand hazard pay from city. Gothamist. Apr. 22, 2020. Accessed June 30, 2020.
12. Naranjo S. Amidst pandemic, CIR hosts Zoom press conference call on NY Hospitals to address the working conditions of resident physicians. SEIU/CIR Committee of Interns and Residents website. Mar. 31, 2020. Accessed June 30, 2020.