Inside the Buffalo Resident Strike with Lauren Lucente and Amanda Duggan

When does sacrifice become exploitation?  When they strip you of your health insurance because you asked to get paid an average wage. 

In this episode we go inside the University of Buffalo Resident's strike. Of the 830 residents in their union and 93% of them voted to allow a strike. In the interview we talk through the arguments, the negotiations, the intimidation, and the lawsuits (plural).

Our guests are Lauren Lucente, a 4th year psychiatry resident at the University of Buffalo, and Amanda Duggan, a second year medicine/pediatrics resident.  They were two of the many residents who are fighting a multi-billion-dollar healthcare system to give them average wages, the healthcare benefits they were promised, time off for chemotherapy, and even clean sheets in the call room 

To support their cause, visit https://ubhousestaff.org/

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If you have any feedback, show/interview recommendations, or want to collaborate on the show, please reach out!

Email: Tama.TheMDM@gmail.com

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Host: Tama Thé | Pediatric Emergency Medicine
Producer: Melissa Puffenbarger | Pediatric Emergency Medicine

Transcript

Untitled - September 20, 2024

00:00:00 Unknown: Hello and welcome to the MDM, a show about the ways medicine is adapting to the modern world. I'm Tom Tate. The residence at the University of Buffalo are on strike, or at least they were from September 3rd through the sixth. I didn't even know you could do that. You know what? I was a resident. Striking wasn't even a consideration. You know, in the medical law, the mythology that gets passed down through the generations of physicians, you know, the Hippocratic Oath is the ancient right that binds us to this fraternity of medicine. The emergency department is our battle arena, and the residents are like the goblins of a hospital. There are mischievously overworked, scrappy underclass tasked with carrying out all the thankless tasks that keep the entire machine of health care running. They are the epitome of sacrifice rate for 80 hours a week. They face immense workloads, sleep deprivation in the psychological burden of life and death decisions. And for most of us, that's just how it's always been. I mean, I did it. I remember fighting back tears while pulling on my scrubs to go in for a 30 hour ICU shift. And we did that every three days, but we did it. We did it because of the deeply ingrained narrative that medicine is a calling, that we're sacrificing our humanity to provide the best possible care for patients. When does that sacrifice go too far? Because we know it does. The physician suicide rate is twice the rate for non physicians in far too many of those occur during training. What if behind this veneer of dedication, behind the mythos of residency, there's a for profit hospital system that is taking advantage of a group of idealistic young doctors that instead of seeing them as future pediatricians and psychiatrists, they see them as cheap labor, just meat in the grinder. What if there are hospital CEOs in Buffalo getting paid $1.6 million a year to sit in their office and squeeze the life and humanity out of 830 residents because they know the residents aren't going to do anything about it. They know that the residents are only here for a few years. So of course they're not going to bother fighting for change from which they'll never benefit. These CEOs weaponized the inherent power dynamics in residency training, knowing that striking could jeopardize a resident's career, damage their reputation, and prevent them from getting competitive fellowships. But most importantly, these CEOs are counting on the fact that residents know that striking means leaving their patients to get substandard care. And that is a powerful moral and ethical dilemma. That's the uncomfortable truth that we're forced to confront, because this is beyond hard work for hard work sake. This is exploitation. We, the medical profession, has historically discourage unionization. Framing it as incompatible with the professional ethos of physicians. There's a long standing perception that unions and by extension strikes are for other sectors, not medicine, where the relationship between doctors and patients is viewed as sacred and non transactional. Because the difference is that in medicine the stakes are impossibly high. The Buffalo strike reveals a truth about our training system that many of us find surprising that residency is a job one where residents are underpaid and overworked and increasingly undervalued. And when the system that trains physicians begins to fail them, something has to give. And so on. The show today are two of the leaders of the University of Buffalo resident strike Lauren Lou Senti is a fourth year psychiatry resident and Amanda Duggan is a second year Med Pedes resident. They take us through the reasons that they're here in the process of organizing and then unionizing and then after a year of negotiations with the shell company that employs them in, despite threats of retaliation from faculty finally deciding to strike. So welcome to Season two Episode one of the MDM Inside the Buffalo Residents Strike. They we've got a packed house. And so I wanted to match names with voices and introduce each of us individually. And so first is Lauren Senti. She is a fourth year psychiatry resident at the University of Buffalo. Welcome, Lauren. Hi. Thanks for having me. Of course. And next is Amanda Dugan. She is a second year med Pedes resident who's also at the University of Buffalo. Welcome, Amanda. Hi, everyone. Also on the line is Melissa Puffin Barker. She's a pizza emergency medicine doc and a producer on the show. Hi, everyone. Thanks for inviting me to the conversation today. So the two of you headlined a press conference for the residents strike last week at the University of Buffalo. That's pretty insane. What brought you guys to this point? You know, like I understand that you've been negotiating for on the order of the past year. But can you just walk me through the events and frustrations that have led to the decision to strike? It's been a long time coming. I went to UAB Med School and now I'm here where you be residency. So I've been in the system for a while and we started to unionize over two years ago due to growing frustration about not feeling respected, not feeling valued. And to be honest, just being really underpaid compared to residencies and similar cost of living cities as well as not having benefits. You know, we're the only program, I think, in New York State without a retirement fund. We started to try to work with initially our GMI, our general medical education, and tried to set meetings with them try to talk before we even started this unionizing process. And it just led to no changes. We didn't get anywhere. So we started unionizing and officially unionized in May of 2023. Not a lot of residents support a lot of resident unity. And then we get to bargaining. And it's just felt like delay, delay, delay were paid by the Shell Corporation, which makes it really difficult to know who we're really bargaining with. The only person that's employed by this shell company is the lawyers were bargaining with. So they have no incentive to move this along. They get paid the longer this goes on. So after over a year of bargaining and with some pretty egregious actions from some residences here, we figured, you know, it's been long enough. There's power in numbers. We are realizing our own agency. And so they figure that we kind of had no choice but to strike. Can you tell me a little bit about the Shell company situation with you armrests? Because I don't know if I've ever heard of anything like that. You know, in my mind, the typical set up is like a hospital system that's paired with an academic system. But I've never heard of the shell company. What is that? It's honestly pretty confusing. Yeah, I've learned a lot about it this past year. I still don't feel like I know everything. And part of that's that maps the skating information and trying not to be so forthcoming. But basically there's only one medical school in Buffalo, one residency in Buffalo. It's under UAB University of Buffalo. And then we have several hospitals that we rotate because we rotate in almost every hospital in Buffalo. So basically how the hospitals decide they want to do it is they made the shell company to technically be our employer and then the hospitals would contract us to work there. They kind of backroom deals. How many spots would be at each hospital? I think it was the way to allow us to work at every hospital in Buffalo in different health care systems were at the Catholic Health Systems. We're at the VA, we're at the HMRC State Hospital where I Kaleido and Kaleido, as, as I'm sure we'll talk about is one of our main employers. So it fractured us and it made it really difficult to figure out who was really involved in all this decision making, because we're kind of employed by the shell company. We don't have direct access to any of our any of our places of work, the people that make decisions. There is this shell company in charge of program decisions. And what I mean by that is, like in my mind, your program director should be the one who is saying, all right, you need this many weeks on this institution or this many weeks on this service. But it sounds more like you're employed by the Shell company who could have a significant impact on residency curriculum. Correct. We are technically employed by UMass, which is University Medical Resident Services. That's the shell company that we work for that's on our paystubs. But university at Buffalo employs our program directors, etc. And they're the ones who decide on all programmatic things and ultimately, like they get to decide when we're allowed to go on vacation and when we're allowed to take days off and things like that. So it gets really messy and that's what's really made the bargaining really frustrating because for a lot of the egregious acts that we've alluded to, UMass is saying that they can't do anything about those things because they're only responsible essentially for our pay and you b and that must buttles are responsible for other things. But then because you and the hospitals are not our employer, they don't want to come and bargain with us. So it's really messy and I think that way on purpose. Tell me about those egregious things that you now alluded to twice. When I was a few months into my first year of residency, I ended up getting diagnosed with colon cancer. So I had like my routine lab work at my doctor's office and I was really, really anemic. And then in the meantime, I started having some weird, like, abdominal pain. So I actually thought I had developed a stomach ulcer from the stress of being an intern. So I eventually I do get through to my primary doctor and he actually told me to go to the emergency room. And that's where they did an upper scope. They didn't find any ulcers or anything in there. And then they ended up doing the colonoscopy. And that was the shock of my life. So I needed surgery to have the tumor removed. So I needed six weeks to recover from that. I ended up using all four weeks of my sick time, which was my entire year's worth of sick time. And then two out of my four weeks of vacation time. I'm Canadian so is pretty near to the US. So I didn't really understand about FMLA and things like that. That's just what I was told to do. And because I had so much going on, I really didn't question it. I later did ask about FMLA and I was told that I would have had to use up all my vacation time before I would have been able to do that. I also could have potentially taken like an unpaid leave, like a short term disability or something. But I was really worried about my visa status in the U.S. because I moved my entire life and I was worried about my health insurance. You know, like I've had a lot of people comment, Well, why wouldn't you just go back to Canada like it's free health care there? Well, yes, but there's also long wait times. And I'd already established with an oncologist and I had a great surgeon and I just wanted to stay put, so I just wanted to make it work. So I had my surgery. But after those six weeks were up, I went back to work and I was on chemotherapy as well. I really wasn't sure how it was going to go. You know, like the oncologist said that I'd probably tolerate it pretty well and wouldn't have to miss too much work, but we couldn't really be sure. So I discussed all of that with my program director, the pediatrics program director. Everyone was on board telling me they were going to support me no matter what, and whatever I needed was going to be just fine. So I said, All right, I guess we're going to I don't know how I'm going to do this, but I guess we're going to do this. So I went back to work, very busy pediatric hospital here in Buffalo called okay Children's Hospital. And I got surprised that despite being promised that they were going to work with me, how much I really didn't feel supported after that I needed every month or so to leave work early, to go to my oncologist as another couple of appointments for iron transfusions as well. Apart from that, surprisingly difficult. I ended up rescheduling my transfusions because I was initially told that, you know, like I could go, but I'd have to come back to work after. Yeah. And that really didn't work for me. So I rescheduled them to a time that was better for the hospital. And then, you know, just every month sending these emails, hey, this is when my appointment is and just feeling stressed every time, not knowing, you know, like how it was going to be received, especially at that first experience and that all cumulated until one of the very last months I was on chemo, I was getting pretty sick. By that time was was side effects and things the toxicity builds the longer you're taking it. And I was on my month of PDR actually. It's a busy place. It's a busy place. So I was mostly night shifts and I needed this appointment. So every week, despite being on nights, pediatric residents are expected to go to a lecture on Thursday afternoon. And I thought, okay, well, if I schedule it during Thursday afternoon lecture, that's perfect. Nobody has to cover for me. It'll be fine. So I emailed everybody well ahead of time and did all of the things, and then I got it kind of a surprise afterwards where I found in my schedule they had put me as using personal time. So I emailed her like I this was a mistake. Like, remember, I had this appointment with the oncologist and the responses that I got from the program director were that, no, everybody who misses lecture has to use personal time. And this is the same for all resident, including you just didn't seem right. Yeah. And I later learned that Ub's own graduate medical education. It's against their rules, and it's against Acme rules as well, which governs all residency programs in the country. So they didn't end up being able to take my personal time because I'd used all my sick time by then. So the only paid time off I had left was my vacation. So it's kind of at that point that I got really. Be involved with the union? Yeah. I reached out to them just to see. Like, I just. I felt like I needed help. At that point, I was almost on my chemo, but I really wasn't sure what was going to happen. I wasn't sure if I was going to have to continue on it or what. So I just felt like I really needed support. And that was how I ended up at the bargaining table across from our employers lawyer who essentially told me that this was a program issue and he couldn't do anything about it. Wow. There's a lot there that I want to just kind of rage at for a second. First and foremost, the answer should have be moved to Canada, you know what I mean? Like we have to be able to be humans and recognize that we can be flexible in whether it's because you missed a lecture or you missed clinic day. That's insane that a reasonable person would consider, yeah, just move away. Just moved to another country is insanity. It sounds like it's not just humorous. It sounds like this is from a programmatic perspective as well. This is your program directors, which when I think about going to residency and we had the same situation when we went through, we couldn't participate in retirement because we had a stipend or whatever and they wouldn't sign forms and there was like a whole bunch of stuff. But at all times we felt like we had the backing of our program directors, you know, like if we went to them with anything, it felt like they would step up And that doesn't sound like what's happening here. And that, I think is probably the most concerning thing that I've heard so far. Yeah, I mean, it really depends on the program. And if I'd been in a different program, I'm sure things would have been different and I probably wouldn't be sitting here with you today. Lauren, you had mentioned that you took a couple of years before you got to the point of unionizing. Walk me through, how did that process go? How were you able to get enough people to say, no, we need to do something about this? Yeah, I had been fairly involved in like the push to unionize. So part of it was, was like Amanda saying there's some really great programs, really sort of program directors and some are not. And there's no there was no other way to find support. So even simple things like call rooms, you know, I remember I can't tell you how many shifts I had to call room. There was no sheets where like I'm trying to find a towel to put over the pillow or something you would hope would be we would find a way to get that message to the hospital or whoever. Our program directors typically wouldn't do anything about it. No one bring it up. We had no way to contact the hospital. We brought it up to the graduate medical education to go anywhere. Hey, was another big one just being pretty underpaid and feeling the squeeze of health inflation and then buffalo. As a city, the cost of rent has gone up quite exponentially as it has a lot of cities across the country and so are one and a half percent raise a year. Really didn't keep up with any of that. So I mean, Pay Subway was a big galvanizing factor because we were just getting priced out of the city and, you know, you're working 80 hours a week. It's tough to to live, especially if you're not being paid enough to barely you can barely afford rent. So just a lot of program directing issues, kind of like Amanda saying, I think up an anesthesia. Why a resident went off on maternity leave and her health insurance got cut off while she was on maternity leave. She took eight weeks cut off after six weeks. So she's there with a newborn and by appointment that she was kind of told, well, that's the way it is. Or program director didn't step up to the bat. Graduate medical education. h.R. And our shell company were not helpful. So thankfully, with the help of the union, two years later she got reimbursed some of the fees. So there was we were finding ourselves kind of with these just not being protected, you know, as well as not being able to make money to life. In preparation for this conversation, i just did a quick look at some programs and I would say as probably a medical student searching around for residency or residence looking for fellowship, it can be somewhat easy to find some benefit information. But I actually found salary information missing on several programs I looked into. So I kind of wonder your thoughts on transparency for those that are applying. So when I was applying, I had this whole spreadsheet and it was pretty low priority for me. But I did have the salary comparisons for all the different places that I was applying, and I knew that the salary here in Buffalo was basically the lowest of any of the programs I applied to. At the time, though, I was told that the health insurance was free here, but I was told that my interview is that I should take that number and add an extra $5,000 per year to it because I wouldn't have to pay for health care premiums. So as a little bit reassured, you know, and I really wanted to come to an academic center. Buffalo seemed like a good location. I liked the size of the city, so I ended up ranking it high. And then I matched here and shortly after I matched was when the residents voted to unionize, which I personally was actually very happy about. And then shortly after that news came out, I'm out the news that all of the health insurance stuff was changing and that we were. We're going to have to pay premiums now. So that was, you know, just not very nice news to someone who's newly matched to residency and in the process of moving to a new city Were those things linked? Like, did your residents unionize? And then as repercussion of that is that they were changing the health insurance or was it. Health insurance is changing. And you guys were like, whoa, hang on, we can't do that. We currently have unfair labor practice. We were lawsuit going because it does seem like it was retaliation. Wow. For for unionizing that is in the court system, which takes a while. But I do want to highlight, though, with Amanda that you really were promised like a low deductible health care plan. Now for a family of a 30 $200 deductible before any costs get mad. So I mean, I can only imagine what that was like for you, Amanda, like going through cancer, being unsupported by your program and having to pay all these ridiculous fees. It seems like everything is just so fraught with tension, and I understand that this is a massive corporation. One of Katrina's friends had pulled up the balance sheet for one of the hospitals and looks like they have $1.25 billion of liabilities. But at the same time, it doesn't seem very human. We talk about in medicine, there's a certain amount of medicine is a calling. And so you are going to sacrifice your twenties to study in your thirties, all of your earning potential, because eventually what you're going to do is you're going to save the world. You know, you are going to be there for all the little children and whatever, whatever. It just seems like everything that you're describing, any time you all ask for things like pillows and sheets, you're getting friction and pushback and it just feels poisonous almost. You do you get the feeling that is this is this is something that is just buffalo. Buffalo. There's something wrong. We need to get to the to the bottom of this and cut it out. Or is do you feel like this is a broader trend in the health care industry in general, where labor is often so stretched thin and were overworked and were undervalued and underpaid? But because it's health care, we're all going to suck it up and do it like. Do you feel like is this a broader fight for resident rights or is this a no, no, no? Buffalo is poisonous. We need to fix this. I was pretty vocal on my social media during the strike and following, and so I've gotten a lot of comments from people in Buffalo, from people outside of Buffalo. And I can tell you it is not just a Buffalo problem. It's a problem in residency programs all over the country. So what I've kind of been telling people is that I'm going to be very vocal about change in Buffalo. And then after that, I plan to advocate for changes in residency programs all across the country. And just to add to to that, you know, not being just a buffalo problem, I mean, look how many residences are unionizing across the country. Right? I think Stanford kicked it off in this motor racing cluster back and COVID era, UPN just unionized. Georgetown does unionized. There's programs organizing across the country, which I think is also gives evidence to this not being a buffalo problem. And then other thing I did want to point out, because we've been hearing it from our our numerous and what they've been saying in the media that, you know, we don't care about our patients, we're not willing to sacrifice. And I just need to make very clear that we have never asked to work less. Let us never even been on the table for bargaining. That's never been any words out of our mouths. We are not asking to work any less. We're not asking to be less dedicated to our patients in any way. I think this strike was really difficult for all of us personally to take that choice to step away from patient care. And we still feel very dedicated to to patient care. We're willing to sacrifice a lot. I think we can still sacrifice and have respect. And that's what this is about. We are all very dedicated to our patients, and we came here knowing their residency was going to be hard and we were going to miss time with our families and we were going to sacrifice having holidays off and all of those things. But it doesn't have to be this hard. It doesn't have to be like a cancer diagnosis and not feeling supported. That just shouldn't happen. And part of the reason I think it's so important to advocate for ourselves is because we're going to have a hard time recruiting really great doctors to come here And the people in Buffalo deserve to have great doctors coming here. The people in Buffalo are wonderful. They just deserve to have great doctors here. Absolutely. I'd love to hear about the planning for the strike experience, because I have read that health care workers are required to provide about ten days notice exactly what you guys are referring to. The need to still provide patient care and U.S. health care workers not wanting to affect that, but wanting to advocate for your own rights as an employee. What what was your experience of informing your program directors, your administration that this was coming their way? And how did you see the hospital respond to staffing the hospital while you were gone? Because it's interesting to see how hospitals can adapt when pressure is put on them. First the process goes, you have to hold a vote to all the union members, which is every single resident as part of the union. You can't opt to be out of it. So we all the member wide anonymous vote about whether the union members would give the bargaining team ability to call a strike should the bargaining team think that's necessary. So the bargaining team, which Amanda and I been part of, the bargaining team, we're starting to feel that we're really not make any progress. We should see what our members think about the strike. And so then we held this anonymous vote to see what people support a strike being called by the bargaining team, should they feel it was necessary. And we had 92.8%, I think, of our members gave us a yes vote like that. You could call a strike if you thought it was necessary, which was you know, that number obviously shows how much residents felt dissatisfied and frustrated with things, how they are. So, you know, we ended up scheduling a press release to talk about the results of that vote and call a strike because we figured, you know, we got this overwhelming resident support. We might as well strike while the iron is hot, put some pressure on the hospitals. We we announced it, I think, over 14 business days before the strike actually happened and then put in the final tweaks to the strike schedule with a ten days notice that we're supposed to give. You're not required by law to give your program directors notice or your attendings notice. You technically can just walk off. So I you know, we talked to a lot of residents. I think people did what they felt comfortable with. I know that I reached out to my program director and then my director tending supervisor that day. It's pretty awkward. But, you know, I felt that I know I'd wanted to let you know, my program director has been very skittish to talk about anything union wise and kind of avoids talking to me a little bit nowadays. But anyway, so she she didn't respond. I don't know how it was for you, Amanda, but in psychiatry at least they were all just expecting that we were going to strike. And so they prepared for everyone to strike and made appropriate plans. I did hear some stories about like attendings trying to probe residents to see if they were planning to strike. So what I did was I just asked the union if they could like re reach out to those programs to just remind them that they should be asking us and that they should just be assuming that all residents are going to strike because a lot of residents aren't comfortable with those conversations. For me personally, it was pretty well known that I would participate in the strike because in my day to day work, I wear a union button. I sent out a pretty comprehensive sign out on all the patients on the team to the attending the night before, just to, you know, make sure that there was some continuity. You know, I know for my program, thankfully, I didn't receive any intimidation. And but several residents, especially in like ob gyn and surgical specialties, were threatened that certain attendings one write the letters of recommendation if they chose to strike, that the attendings would not try to teach them because they clearly didn't care about their patients anyway. And just a lot of intimidation tactics used to threaten these residents. And we're in a pretty precarious spot in residency or saddled with an average $250,000 of debt. And we need to graduate to make a living to pay off the debt. So it did lead to some residents fairly fearing the termination at striking or fearing retaliation. I mean, it strikes me that there is so much psychological trauma that went into the decision alone of going into the strike, not just what brought you to the table, but the friction with your program directors, the friction with other residents. And then you're talking about retaliatory actions from supervisors and attendings. I imagine if I was in that position, I would have wilted like a flower. If you even think a little bit negatively about me, I'm going to be like, Oh, I'm so sorry. You're no, you're right. I'm going to suck this up. I'm super impressed with the dedication to the cause. I'm super impressed, guys, that I can't even describe it in words. But can you describe a little bit more about your own psychological experience of taking on this decision on behalf of 800 other residents? It must keep you up at night. You know, is this the right choice? Are we doing the right things? Is this going to blow up in my face? Am I not going to get a job? Can I not get a fellowship after this? Tell me about what that was like. It's been really hard. Going on strike in the first place took a lot of guts. I'm so proud of every single person who first decided to participate in the strike and then even more so for actually having the guts to show up on the picket line and risk being in photos on the picket line and just being afraid of their program director and their attending, seeing them out there. I do have a lot of anxiety around it, and especially since I've been such a public voice during the strike and I continue to be a public voice after the strike. Yeah, I'm nervous. I think that my relationship with some attendings will be changed, which isn't surprising. Like I've been critical of what you be is doing and that's perhaps damaged their reputations, whether or not. They were involved in the injustices that I faced. And I have a lot of anxiety around that. I have some guilt around that. At the end of the day, though, a year of bargaining and we got we basically went backwards with our negotiations. So I just I felt so strongly that if we wanted to see a change, we had to really stand up and fight for it. You know, at the end of the day, despite all the anxiety, that's what kept me going. So your team was on strike for four days and now you're back at work in negotiations are ongoing. And from what I can tell, watching the the local news at Buffalo is that you've got a significant amount of media coverage and social media coverage, and it looks like people are really talking about this. And so I have to imagine that grandma and you be is really wanting to just put this to rest and figure out a way to move on. But where are you expecting this is is going to go? How do you all see the next couple of weeks, couple of months, even the next couple of years playing out? You know, it's a weird limbo we're in right now where the dust is settling. And also the momentum is growing, too. You know, Amanda's video keeps getting more comments, more views, more people. You know, we're talking to you today. And I think having more talks with politicians and local politicians are starting to talk about our cause more so. A while the the dramatic climax of the strike is now settling. I think we're we're slowly building more pressure and so we're hoping that that is going to convince numerous to do their jobs and bargain with us in good faith. We know we're not going to get everything we initially wanted in this contract. It's a first contract. We're only asking for average pay in the area. We're hoping for us that which we thought was a pretty reasonable ask, but on hours that we did not. We have a couple of structures in place that will hopefully help us kind of tackle these issues, like call dirty call rooms and some programmatic things, and then really teach residents to advocate for themselves, to really think about how they fit into the system and the health care system. So that when we sit on the table again at the table in three years for a new contract, we can really iron out something we're all happy with. The hope is that we get improvements. But I kind I anticipate we're not going to be 100% happy with our first contract. And part of the reason that, you know, we're going to accept that is with the hope that we can continue to make positive changes for the future. It's probably not going to be Lauren or I that see those, you know, I have three years left, so I'll be gone by the time we're negotiating again and Lauren will be gone after this year. So, you know, a lot of what we're doing is also for the people that come after us. Just to add, because I know we touched on the health care and this kind of bait and switch, what we've been calling I mean, effectively it is. But I know that I've talked to several first and second tier residents who even, you know, a year and a half after they're still advertising this no deductible, no cost health insurance on the website and in residency interviews. But that was not the case they came in with. So I know several residents with chronic conditions or spouses with chronic conditions chose this residency for our good health care and then were found that that was not the case. And so that was another big unionizing, like why people were really intent on unionizing and trying to get this fixed because it's pretty unaffordable. You know, people are not going to the doctor when you can't even schedule it because you can't get time off or just that it makes all this stuff about residency. It makes it difficult to schedule doctor's appointments. So I just want to point out that even as of this, until this upcoming recruitment cycle, so even as last year, they were still advertising the the no deductible health insurance, which was pretty unethical. Yes, it really was. I know that affected a lot of our first year. Residents this year have been reaching out to me with just these terrible stories about how they were they ranked Buffalo first because they thought we had this incredible health insurance that they weren't even going to have to pay premiums on. And then they came here and that was completely untrue and not the case. And that was untrue and not the case for me when I came here as a second year. So it's just pretty unbelievable that that was allowed to happen. Yeah. Is that part of your lawsuit as well as that? There is a part we actually have because there's one about the retaliation piece and then actually have a class action lawsuit that some of the residents have signed on about this bait and switch part of it. Holy smokes. Yeah, a lot of lawsuits. Erica Yeah. One of the things that we talked about is that this is becoming a trend around the country that, you know, COVID highlighted the dangerous working conditions, the inadequate staffing, the low pay for residents. I was a fellow when it first started, and luckily I was in a place which was very, very cognizant of the fact that we were all in danger being in the emergency department. But that was not true. Around the country. You hear stories about like not just residents and medical students, but even attendings, you know, like the Lorna Breen story also in New York, which is just devastating and really highlights the idea that I think something needs to change. So having now spent two and four years fighting for change at your own institute. Options. What is your recommendation for either someone who wants to help you in your strike or if they want to advocate at their own institution? What would you recommend? Somebody who is wanting to help but like me, has just no idea how to even start? Yeah, I think there's a couple of things that we would appreciate. First, you can go to our website. You'll be house staff dot org. There's a couple steps there like call to action things on the website. We have a petition that anybody can sign right now to ask for our hospital system and numerous to be more clear about their funding sources because the government pays about $150,000 per resident. So part of it is trying to figure out where this money is going, if it's not going to us. If anybody feels really inclined, I love I think that we really need to be talking to our local politicians and trying to get our council members, our state officials. Chuck Schumer's office recently, like we had a conversation with them. So trying to hit different levels of the political sphere and that I think as far as advice to other residents are struggling with similar things that the medical system we're so used to. This is a track you're just following this conveyor belt trying to make it through. But your life now matters too, and your experience still matters as well. There's power in numbers, even if you really feel like you need to graduate to make a living. But there's power in numbers, meeting, connecting with your fellow residents and, you know, helping each other through things. But also finding ways to put your collective strength together has been really impactful. And it has helped us in certain ways, even already, even without a contract. I know that resident that got her health insurance cut off to get that reimbursement, partly because of our collective action and collective power. So being in a together can help in a lot of ways. Definitely you be how Steph dawg the petition reaching out to the politicians even you know if you're not into that you can have a look on social media to try to support us in that way with getting the word out. I have a very tiny little tick tock channel that I just started during the strike and then ended up going somewhat viral. But my handle is Amanda Victoria Joy So if you reach out to me on there, you can, you know, share the videos, you can look for other videos and then just tag other influencers who have a lot of followers on those things with the hopes that they can continue helping us spread the word so that we can just keep getting eyes on the problem, not just for Buffalo, but for residents around the country, too. This is wonderful, wonderful work. And I want to commend you for and your colleagues for everything you're doing, because as you guys have been talking about, advocating for a very practical thing, salary and sheets on a bed when you have call, I think that those are reasonable things. I've been reflecting on how a resident's only recourse for providing feedback to their program is the yearly evaluations that get filled out that are part of the whole maintaining accreditation process. And I know that there are duty hours violations routinely all over the country that go unreported because residents are coached on how to answer those questions and what each type of answer means for the program. And as somebody observing and I just think that that is unacceptable. So I could see how the pathway you have taken to unionization and striking may likely feel like the only pathway. Because I can't I can't see another way that you guys get to have effective feedback and change to your programs and please comment if you think differently. But I just I just think you guys are doing very important work for yourselves and your colleagues. I agree. You know, I was pretty late into, you know, my issues around getting my time off that I needed before I reached out to the union. You know, I had tried multiple avenues before that and I was having a lot of difficulty. And then coming to the union was really the last kind of resort. But I think that it's a good thing for residents going forward that there is this community of us that are involved in the union as well as the union itself, where you can turn to to ask for help. What is something that you would do if you were a fourth year medical student today and you were applying for a residency, knowing everything that you've just learned over the past 2 to 4 years in your own experience go through the benefits of the program. But I mean, asking residents, I think it's tough because it's virtual, too, right? You're not like going and seeing, you know, the by the program. But, you know, ask the residents, do they feel heard? Do they feel see? And I feel like most residents are going to try to be honest, especially in those virtual social hours that theoretically the program directors are not supposed to be at or anything. I think that that can be helpful. But realizing that you like your your individual program is important, but also the greater residency structure. Is that supportive or not? Yeah, I would definitely say, you know, to. The fourth year medical students. Make sure you're asking the right questions at those little pre-interview night before get togethers. You know, ask if they're happy with their health care, ask if they're happy with their salary. Ask them if they feel their program director is supportive. Ask them if they have seen any positive changes in their program in the past year to get a gauge for how willing and flexible the program is. And also just researching on the Internet, a lot of the programs do post their salaries and benefits on their and you know, like as we saw with our our intern year this year, probably verify with the resident you know, to make sure that that information is actually accurate, you really shouldn't have to recommend that you do that. But I wish I had recommended it this time last year to people. Thank you both so much for coming on the show. I can't imagine what your lives must be like. You know, it's busy enough to be a resident. It's busy enough to try to have a personal life. Then on top of this, you're taking on the juggernaut that is one of these giant health care chains. So good for you. I hope you all get honored with some kind of J.D. down the road for all the the amount of legal work that you're doing. Keep us posted on things, if you don't mind. We'll check in maybe in a couple of weeks and see how things have been going. Otherwise, keep up the good fight. Stay strong. Good luck in New York. We'll do what we can out here in Kentucky. Thank you so much. Yeah, thanks for having us.