Rochester Regional’s selective pay hike

While Rochester Regional Health has said it cannot afford to meet recently striking Rochester General Hospital nurses’ salary demands, the health system is giving raises of up to $14,000 a year to medical residents.

In a July 28 letter addressed to the health system’s residents and physician fellows obtained by the Rochester Beacon, RRH chief medical officer Robert Mayo M.D. describes the salary bump as a partial response “to the concerns you’ve raised through the channels we’ve established at RRH, including through the Graduate Medical Education Committee, ongoing annual Resident Forums, and individual, face-to-face meetings with program leadership.”

Residents are recent medical school graduates who are not yet board certified. Fellows are board-certified doctors who rather than immediately starting regular practice sign up for further training in various specialties. Residencies can wrap up in three years, but can go as long as seven years.

The pay hikes—effective Aug. 13—started with a $4,300-a-year increase, bringing first-year residents’ annual pay from $65,700 to $70,000. Second- through seventh-year residents got similarly generous increases. Second years’ pay goes from $65,800 to $72,000. Fourth-year residents see a bump taking their pay from $69,000 to $79,000. The pay hikes top out at seventh years’ new $90,000 annual rate, up from $76,000.

Along with nurses and physician assistants, residents and fellows provide much of direct, front-line hospital care. Despite working sometimes punishingly long hours, residents are paid substantially less than full-fledged doctors.

Why RRH decided in what appears to be a unilateral gesture to offer significant pay increases to residents is not clear.  

System officials confirmed that RRH had sent Mayo’s letter but declined to comment on it. The system also did not respond to the Beacon’s request to say how many residents it employs.

The five-hospital system’s pay hike for residents comes as its flagship hospital, Rochester General, is in protracted first-contract negotiations with the newly formed Rochester Union of Nurses and Allied Professionals, which has roughly 900 members.

It also comes as dissatisfaction and interest in unionizing mounts among medical residents around the country.

The national picture

In a March 23 report, NPR chronicled long-simmering unrest that has led residents to unionize or seek to form unions at hospitals in New York City, Boston, Vermont, California, Washington, D.C., Pennsylvania and New Jersey.

According to the NPR report, the number of unionization drives by residents at U.S. hospitals jumped from two in 2021 to eight in 2022.

Common concerns cited by residents around the country included pay but also extended to working conditions such as subpar accommodations for residents who have to work back-to-back overnight shifts and inadequate child care for young parents.

“It’s easy to exploit physicians during this time in their career,” Sunyata Altenor, a spokesperson for the SEIU-affiliated Committee of Interns and Residents, told NPR. “They’re only going to be there for a few years. It’s sort of expected that you go through this hard, hazing culture, and then you come out at the other end an attending physician.”

In June, residents at the five-hospital Mass General Brigham system in Boston voted to join the Committee of Interns and Residents. The 1,215-412 vote brought some 2,500 residents and medical fellows into the SEIU affiliate’s fold.  

Speaking to the Boston public radio station WBUR, first-year resident Sarah Brown M.D. called the Mass General Brigham vote “a referendum on the structure of medical training and our compensation and our ability to negotiate what we want to see, not only with our employers, but in health care delivery.”

Last month, residents already represented by the Committee of Interns and Residents demonstrated at Boston Medical Center, decrying the Massachusetts hospital’s pay scale as lower than other area hospitals.

The union, which represents 750 residents at Boston Medical Center, cited wide pay disparities between BMC and other Boston-area hospitals including the five Mass General facilities as a main sticking point in contract talks. Other issues also play into the BMC residents’ unrest, however.

“Even those who are not exactly broke are broken in other ways,” Brett Lewis, a third-year family medicine and psychiatry resident at BMC told the Boston Herald. “Rates of burnout and moral injury are unprecedented.”

The hours demanded of residents has long been a concern. Twenty years ago, the governing body for U.S. resident programs—the Accreditation Council for Graduate Medical Education—established an 80-hour cap on resident hours averaged over four weeks. The move came in response to widespread complaints about hospitals requiring residents to work 100 hours a week or more.

Some question how much of a dent the two-decade-old cap has made.

“Many programs continue to require residents to work 28-hour shifts out of a belief that these long hours enhance continuity of care and resident learning,” noted Sathvik Namburar M.D., a second-year resident at Yale New Haven Hospital in Connecticut in a July 19 editorial broadcast on the Boston public broadcasting station WBUR.

By the end of such shifts, added Namburar, “residents are so sleep-deprived that they have the equivalent of blood alcohol contents of 0.1 percent, above the threshold for being legally drunk.”

A push to unionize

While medical staff grows more restive, hospitals have generally not welcomed unions. In a statement similar to Rochester Regional’s response to RUNAP’s formation, Mass General Brigham officials called their system’s recent resident-union vote “disappointing,” maintaining that collective bargaining is “naturally antagonistic.” 

RGH’s first contract negotiations with its fledgling nurse’s union have been ongoing for some 10 months. Earlier this month, hoping to move the needle on what RUNAP describes as virtually stalled talks, the union staged a two-day walkout.

While the union says improving patient care and getting more input into staffing are its main goals, salary remains a stubborn sticking point.

In a statement blaming union leadership for “tak(ing) their members out on strike,” RRH officials maintained that the health system has “sought to ensure our units are appropriately staffed, continue providing competitive pay and benefits and ensure we are able to provide our patients with the best possible care.”

Not so, union members have countered, complaining that RGH negotiators have not seriously discussed RUNAP’s proposal to adopt a nurse pay scale in line with what nurses at Buffalo’s Kaleida Health were paid last year. Buffalo, say the nurses, has a lower cost of living than Rochester, a disparity that shows their pay proposal to be reasonable.

“If RGH were to agree to everything RUNAP wanted around wages, staffing and benefits, it would cost Rochester Regional Health more than $111 million for just the first year of the contract,” the health system countered in its strike-response statement. “Given that RRH is already projecting a $150 million loss this year, and anticipates further losses into 2024, that would be irresponsible.

If it were to meet the union’s salary demands, RGH nurses would be “among the highest paid in the entire country,” the statement added.

A RUNAP spokesperson declined to comment on the resident pay hike.

According to an Aug. 15 Becker’s Hospital Review report, hospitals nationally this year upped physician signing bonuses by an average 21 percent to $37,473 while dropping nurse practitioner and physician assistant signing bonuses by an average 7 percent from $9,000 in 2022 to $8,355 in 2023.

Meanwhile, as physicians increasingly shift from private practice to employment by health systems and hospitals, not only residents but hospital’s regularly employed doctors are growing restive and seeking “seeking greater investments by hospitals in working conditions, staffing and pay,” Becker’s Hospital Revue noted in an Aug. 4 article.

As an example, Becker’s cited a vote in which 87 percent of 70-physican staff at Providence St. Vincent Hospital’s in Portland, Ore., favored unionizing in a recent physician-union drive sponsored by AFT Healthcare and serviced by the Oregon Nurses Association.

“We want to redefine our relationship with the hospital system which has increasingly put our concerns aside as it aims to meet corporate priorities,” said Shirley Fox, MD, an ob-gyn hospitalist at Providence St. Vincent in a statement put out by the Oregon physician’s union. 

Will Astor is Rochester Beacon senior writer. The Beacon welcomes comments and letters from readers who adhere to our comment policy including use of their full, real name. Submissions to the Letters page should be sent to [email protected].