Penn Medicine Station

Doctors in the Class Struggle: An Interview with a Marxist Physician

Resident doctors and fellows at Penn Medicine, the health system affiliated with the University of Pennsylvania in Philadelphia, announced their union drive on February 17. At the time of this announcement, more than two-thirds of the residents at Penn Medicine had signed cards in support of the union. These workers are organizing with the Committee of Interns and Residents (CIR), which is affiliated with the Service Employees Union (SEIU).

A resident doctor is a physician who holds a medical degree and is completing a period of on-the-job training and specialization known as a residency, which can occupy them for several years. During their residencies, doctors are responsible for providing all of the hands-on care expected of medical doctors, but do so under the supervision of fully-credentialed physicians.

Capitalist health systems take advantage of this period of training to exploit these medical professionals to the maximum, squeezing them for as much profit as they can. Resident doctors work grueling hours for a fraction of the pay of their colleagues, even though they shoulder most of the same responsibilities.

Penn Medicine
According to ProPublica, the University of Pennsylvania Medical System’s CEO collected a salary of $5,971,412 in 2020. / Image: Wikimedia Commons

While Penn Medicine is legally a “non-profit,” in practice, it operates like any other capitalist business—competing on the marketplace, accumulating and investing capital with the expectation of a return, and lavishly compensating its executives. According to ProPublica, the University of Pennsylvania Medical System’s CEO collected a salary of $5,971,412 in 2020.

Maximum unity not only between the residents, but all health workers—doctors, nurses, support and administrative staff, EMTs, and so on—is necessary to beat the capitalist “healthcare” giants. This unity needs to extend not only between the various categories of health workers, but between workers at competing health systems as well. The unions must fight not only to organize the unorganized, but also to demand the nationalization of the entire healthcare sector under democratic workers’ control. Only in this way can the working class guarantee access to quality healthcare for all—free at the point of service—while securing proper compensation and quality conditions for our health workers.

Shortly before the union’s announcement, Socialist Revolution sat down with a Penn Medicine resident to talk about the working conditions, changing consciousness, and union campaign in their workplace. We congratulate the residents on their bold decision to organize, and offer our full solidarity in the struggle ahead!

Doctors are often seen as highly-trained, relatively privileged professionals who have lucrative careers. Can you talk to us about why resident doctors are organizing at Penn Medicine?

I think there are a couple different reasons. I was actually thinking before this conversation that in the first chapter of the Communist Manifesto, there is a quote about how the bourgeois have taken the halo off of highly-respected careers like doctors, lawyers, poets, and scientists and made them into proletarians. I think probably in the particular instance of physicians, this is somewhat delayed from when the Communist Manifesto was written. For most of the twentieth century, physicians were truly small businessmen. But there’s been a move towards a proletarianization of physicians. You’re either a hospital employee, or you work for a finance company that has bought up all of the small physicians’ groups and now they treat you like a paid employee of a health system. So there’s that aspect of your relationship to the employer that’s part of this process of proletarianization.

From a wage perspective, on one hand, it is true that doctors make a lot more money than many workers. But also think about the amount of crystalized labor in what a physician has done and how many years they train, with no pay, to be a doctor. I also think my labor is highly valuable, and I think that’s manifested in the way that hospitals employ us. From a practical perspective, it is hard to put a value on how much it is worth to save someone’s life. But our labor creates value for the capitalists and I think that even though our wages are high, we only see a part of what we produce. It’s funny that now as a resident I am paid essentially $20 per hour to do a job that [when I graduate] I’ll be paid $200 an hour for. In both instances, the hospital still makes a profit, but there’s not much difference in what I’m actually producing.

Nurses on strike
“We want to feel like we’re taking care of our patients in a safe way. In New York, recent nurses strikes happened around the issues of patient ratios and safe working conditions.” / Image: PASNAP

What are the main demands coming from workers who are supporting the union at Penn Medicine?

I think resident unions are in a lot of ways similar to nurses’ unions. There are demands for wages and benefits that affect our lifestyle, but there are also demands that affect the quality of work we do. We want to feel like we’re taking care of our patients in a safe way. In New York, recent nurses strikes happened around the issues of patient ratios and safe working conditions. It’s not like we don’t want to do the job we’re doing and we’re not slackers about working hard. I think it’s a matter of, at the end of a 28-hour shift, I want to be able to afford an apartment close to the hospital so I don’t have to drive half-way across the city while I’m sleep deprived. I think that’s a pretty simple demand. I don’t want to have to pay for parking at work while also making exorbitant student loan payments. I think these are reasonable demands. In the case of resident physicians, probably most people aren’t demanding a reduction of hours even though we work notoriously harsh hours. Most people recognize that you need to put in time to gain the skill and the excellence to take good care of patients, and every resident wants to be a good doctor and get that training. But I think it’s a matter of “How do you do that in a humane way? How do you do it in a safe way? How do you do it in a way that makes you feel like you’re being adequately compensated for the work you’re doing?”

What was it like working through the early months and years of the COVID-19 pandemic as a resident?

It’s weird to say, but it had its ups and downs. For one, in Philadelphia it was never quite as bad as it was in say, New York City, during the early part of the pandemic. But I think that we all want a sense of meaning in our work, and in some ways it was the defining thing that gave a lot of meaning in our work. You know, there’s a crisis, and you’re the ones responding to it. Maybe this speaks to the way residents are treated but it felt like a time where we got a lot of respect, so there was something rewarding about being the ones “to rush into the burning building to put out a fire.”

There’s that aspect to it. But there’s also the aspect of not having enough PPE and [feeling like] you’re putting your life on the line for a system that doesn’t have your back and is treating you like cannon fodder. So there were certainly really hard aspects to it, and at times it was super scary and stressful. We thought about bringing infections home to our families and loved ones. There were challenging parts of working through that. We all want human connection in our lives. During that period I was socializing more with my coworkers than anyone else, everyone was holed up in their apartments. There were moments when we really felt like “wow we’re really going down there and making a difference by helping people and doing this thing.” But there were other periods when I was super stressed out about it.

In your experience, how have other residents at Penn Medicine received news of the union drive there?

I think it’s been very positive. This is something that, given my political leanings, I’ve been thinking about for years even before the pandemic. We heard whispers about it here and there and it would kind of die out on its own. But people are now fed up with the way things are going, fed up that our wages aren’t increasing proportionally to the crazy inflation that’s going on, and that our cost of living is going up while our quality of life is going down. So I think the time is ripe for it and people are recognizing that they can have this power through a union.

How has the administration reacted to the union drive?

As of this conversation, there hasn’t been an official public announcement, though that is imminent. The administration almost certainly knows—this is a bargaining unit that would potentially be 1,000 people—so it’s hard to be completely quiet about it. They’ve tried to offer some concessions, like offering wage increases, this or that. But the administration doesn’t understand what the workers want. They’ll increase our wages, but then they took away our parking benefit. Which is so stupid because they’re probably going to spend more money on an anti-union lawyer than they would providing our parking benefit. They have their outreach, claiming that they want to listen to our concerns and claim that they want to help, but obviously they can’t address our problems in such a heavy-handed and bureaucratic way.

COVID-19 Front-Line Workers
“We were all promised that we were heroes as front-line workers, but… it’s crushing to feel like you can’t afford some pretty simple stuff when you’re working 80 hours a week.” / Image: U.S. Pacific Fleet, Flickr

There are several union organizing campaigns among residents in hospitals around the US today. Why do you think we’re seeing so much activity on this front at this point in time?

I think the pandemic had a lot to do with it. We were all promised that we were heroes as front-line workers, but seeing how we’re treated on the other end of it is illuminating. The fact is that we are all workers, and we have high student debt, and it’s crushing to feel like you can’t afford some pretty simple stuff when you’re working 80 hours a week. You want to live a decent life, but sometimes it feels like the way inflation is going and the way our wages aren’t increasing, it’s hard.

I should also add that what’s particular about resident labor is that some of it is compensated by Medicare and the Federal Government. Not all residents are funded through Medicare, but the vast majority are. So the government gives money to hospitals to pay for resident labor. You work extraordinary hours to make extra money for the hospital, so it feels a little back-handed to hear, “oh we don’t have enough money for this, we don’t have enough money for that,” when you’re providing essentially subsidized labor.

You have a socialist analysis of the kind of work that you do and the role that your labor plays in the hospital, so you’re able to take a systemic look at things. Do you think that many of your co-workers are drawing more radical conclusions about healthcare and the way the system works in the US based on their experience or involvement in the union campaign?

I think so. It’s hard not to talk about the cost of healthcare in this country and to think about your labor power and how you’re being reimbursed. It calls up some Marxist principles about how to analyze society. With resident labor, you’re probably being compensated between $15 and $30 an hour while some of your patient care probably generates thousands or tens of thousands of dollars for the hospital, so of course you wonder where that money’s going. I think some healthcare systems are very brazen about how they spend their money, building c-suites and new buildings. There are several healthcare systems across the country that are notorious for being “nonprofits” but don’t act that way. Their CEOs make a ton of money. You know, doctors are smart and can do some simple math and figure out where all of the surplus value they generate is going.

You mentioned that your union campaign will be “going public” imminently. When that happens, how do you think other workers at Penn, workers at other health systems, or the broader working class in Philadelphia can support your struggle best?

There have been some other high-profile residents union campaigns, like the one at Stanford. When they went public, Stanford took out full-page advertisements in the New York Times to criticize the union. And you wonder, “what is this healthcare system in California doing taking out adverts in the New York Times”? It’s because they want to poison people against unions. They want to claim that we’re hurting people and being selfish. So I think the way that other working-class people can support residents unions would be to fight back against that ideological push. The same rhetoric is used against teachers too; you know, “they’re being leeches,” “they’re being greedy.” I feel like in healthcare they try to pull at your heart-strings. They say “oh there’s some sick person who’s dying because these residents are trying to form a union,” some ridiculous stuff like that.

Healthcare is a struggle for all working-class people. It’s an issue that all kinds of unions go on strike over. We need to understand that what is going to improve our healthcare system is giving workers more of a voice instead of handing the system over to corporations and corporate greed. We need to make political arguments for these sorts of things—even minor issues like parking benefits, meal benefits, childcare options, and maternity benefits are a political question.

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