For most of America’s medical history, the idea of a doctors’ union has been an oxymoron. Doctors were management, rather than labor. But the consolidation of healthcare over the past several decades has taken power away from doctors while forcing them into inhumane situations. The pandemic brought those challenges to a rolling boil, particularly for residents–trainee physicians who are the lifeblood of hospitals. That’s prompting resident physicians around the country to unionize for fairer wages, more humane working hours, and more say over their workplaces. Abdul sits down with Dr. Lorenzo Gonzalez, a family medicine resident and the president for one of the most powerful unions on the front line of physician organizing.

TRANSCRIPT

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Dr. Abdul El-Sayed, narrating: The World Health Organization is planning to declare aspartame, a common artificial sweetener, a carcinogen. Homegrown malaria cases surface in Texas and Florida. The FDA approves a new Alzheimer’s medication. This is America Dissected. I’m your host, Dr. Abdul El-Sayed. [music break] Today we’re talking about physician organizing because last week, on July 1st, thousands of new residents, including my own little brother, began the residency training. For folks less acquainted with the gauntlet of medical education, let me explain. It’s a 3 to 7 year intensive training requirement based out of a hospital that doctors are required to do to be board eligible in a particular specialty. The shortest residencies last three years for things like family medicine or pediatrics. Neurosurgery is the longest requiring a seven year residency. Regardless, residency is a slog. The first year is called an internship. When your job is to do any and everything required of you. From there, you graduate upwards leading teams of interns and junior residents. Early long days, late nights, 24 to 36 hour call shifts. That’s what residency entails. Technically, residents can’t work more than 80 hours a week, but because that averages over the course of a month. Many routinely do 100 plus hour weeks. Some residencies are so malignant that they just tell the residents to misreport. After all, that 80 hour limit has been debated by older generations of doctors who worked far more. After all, the term resident itself comes from the technical term house officer, which harkens back to a time when residents actually well resided in the hospital. Every generation tells the generation right under them that they had it worse, and they probably did. Which gives residency the feel of an institutionalized hazing ritual. You’re taught to take pride in the pain, like somehow longer hours and more emotional whiplash make you a better doctor. All the while, though, the system itself gets in the way of doing the work you actually trained to do. Whether it’s trying to do an entire checkup in 10 minutes with a patient with a laundry list of ailments you know you’ll never get to, or it’s the financial hurdles that too many hospitals put in the way of getting care to the neediest and sickest patients. That moral injury, the result of being forced into behavior that doesn’t comport with your own deeply held values is the worst of all. And it’s why I personally didn’t pursue a residency when I finished medical school. I couldn’t imagine practicing in a system so broken by the pursuit of profit that the very people I had dedicated my career to serving couldn’t access the care I was training to provide. All of this came to a fever pitch during the pandemic when one in five health care workers left their profession entirely and one in three considered doing so. They watched as the profit motivated health care systems they worked in failed miserably to protect them, leaving them without basic PPE or necessities as they struggled to care for the sick and dying in a pandemic that was worse in America than most other high income countries in the world. Despite the fact that we spend more by far on health care than any of those countries. It became clear where all that money goes. Into the back pockets of the system’s corporate masters, rather than to the front lines of the fight for better health. But across the country, residents have had enough. Residents in hospitals, big and small, are organizing. The number of organizing campaigns spiked four fold between 2021 and 2022. They’re fighting for better conditions, more humane schedules, and more say in the decisions their hospitals are making. And they’re winning union rights. In an unprecedented move, residents at Elmhurst Hospital Center in Queens, New York, went on strike for pay equity with other counterparts at a sister hospital in Manhattan. Let me put my cards on the table here. I am a huge proponent of physician unions. When my wife was a resident, she was at one of the few programs that had a resident union back then. When she faced complications after the birth of our first child. It was the union that stepped in to make sure she got the time off she needed to heal. I know firsthand what a physicians union can mean for someone and their family. But on a broader level, as we’ve discussed so many times on the show, hospitals are consolidating. Corporations are becoming more powerful in health care, and they’re using their power to squeeze even more out of the doctors and nurses and health care workers who actually deliver our health care. In the past, physicians often worked in doctor owned practices. They weren’t labor, they were management, but no longer. In fact, in 2018, the median physician no longer worked for another physician and instead worked for a large health care system, a system that delivers less pay and less autonomy. Meanwhile, it’s the physicians who are left to advocate for patients who are getting less of them and bearing the brunt of those patient’s frustrations. That’s that moral injury we were talking about. And while nurses and other health care workers have always understood the power of a union, doctors have been slow on the uptake. But even in our current health care system, doctors remain one of the most important voices in health care, and they’re finally stepping up. Today, I wanted to talk to someone on the front line of that fight. Dr. Lorenzo Gonzalez is a family medicine resident and national president of the Committee of Interns and Residents and SEIU affiliate and the largest union representing trainee physicians in the country. He joined me to talk about residency training, physician organizing and taking the fight for patients and providers to the system. Here’s my conversation with Dr. Lorenzo Gonzalez. 

Dr. Abdul El-Sayed: All right. Ready to go? 

Dr. Lorenzo Gonzalez: All right. I’m recording now. 

Dr. Abdul El-Sayed: Can you introduce yourself for the tape? 

Dr. Lorenzo Gonzalez: I’m Dr. Lorenzo Antonio Gonzalez. I am the president of CIR and a street medicine physician here in Los Angeles County. 

Dr. Abdul El-Sayed: So I want to step back, and I think I have a sense of this, given what you are training in. But why did you become a doctor? 

Dr. Lorenzo Gonzalez: This sounds cliche, but I wanted to be the vanguard of my community. I saw um what my parents lacked, the what my community lacked growing up, I come from a mixed status family. My parents are originally from central Mexico, Mexico, um Jalisco Michoacan areas, and they migrated here and they were able to get residency through the amnesty um during the Ronald Reagan era. Um and but I still saw the impacts of immigration and I saw what I like to say um disease being the manifestation of oppression. Um as I went to medical school and even undergraduate school, I wanted to be able to not only provide direct care, um but realized, especially in third, um third year medical school, that there was much more complexity to how diseases develop. Um. And I wanted to be that doctor that my parents deserved. That was really what drove me to move forward when I went into intern year um I was flabbergasted by the system of residency um and that’s when I started to turn towards organizing and making sure that we were able to be effective agents of change, um just not only for ourselves, but also for our communities and our patients we served. 

Dr. Abdul El-Sayed: And I really appreciate that and thank you for what you do and for your passion for the work of medicine. You know, I also went to medical school and for very similar reasons to you and ultimately wasn’t even uh able to get to the point where I completed a residency application. I just got so fed up, by the way that our health care system operates. And I want to get into a bit more about that. But a lot of folks don’t know what a resident does and don’t even appreciate that a resident, the word resident comes from to reside in the place we call residents house officers. And it comes from a time where residents actually lived in the house, meaning they lived in the hospital. Obviously they don’t anymore, but you might as well given the hours that you work. So walk me through what you do as a resident day to day. What is it like to be a resident? 

Dr. Lorenzo Gonzalez: Yeah, this is um what we try to do with CIR all the time is tell the world you know, what does it mean to be a resident physician because they all see us as physicians and there’s this like uh false narrative that all doctors have make a lot of money. Um. And I always told my mom, I’ll do the work and I’ll do the work for the community, but I’m not going to make that much. I’m not going to make the money you’re thinking that I’m going to be making as a physician and especially as a resident um that is not the case. I would say, um you know, it’s somewhere between training is going to be somewhere between 3 to 7 years, depending on your residency. Most folks most folks are going to do somewhere between 3 to 5 years. The you know surgery will go five um either, you know, uh primary care, family medicine, internal medicine will do three and some combination in between. Um. They all [?] of an internship and that internship I always tell folks, no matter who you are, what medical school you went to, um that intern year is going to be hard. Um. It’s very inpatient heavy. It’s very much so you’re going to spend a lot of times away from the folks that really allowed you to be where you’re at today. Right. That’s family. That’s loved ones, that those are those personal things. Those things are taken away from you. You’re constantly working. You’re working on average 80 hours. Um. And if you divide those 80 hours with the compensation that you’re given, you’re making less than minimum wage, which is mind blowing to some folks, right? Uh these physicians that have spent so much time and so much investment are making less than minimum wage um and that that has a lot of downstream effects right. Where you’re living, what you’re prioritizing, how you’re paying for your licensing fees, um that personal security. And ultimately it actually impacts where you want to practice. Um. Even as a person of myself that, you know, like I said earlier, I wanted to be that doctor for my community. I had to make a choice. Do I go to a place where I can actually practice on a patient population that looks like the people that I wanted to practice on? Or do I take myself to another area where I find more personal security? And that’s a decision that I felt like no one should have to make. It really felt like they were preying on our altruism. Um. And that’s where um you know a lot of this movement of you know establishing residents power was really being driven from. You know, on a day to day. I mean, you’re getting there really early, like before the sun rises, you’re leaving after the sun sets. Um. This is just a typical day. Um. You have no lunch, you have no breaks. Uh. These are you eat on the go um and you make sure that you go to the restroom when you can. There is definitely a um archaic sense that there is pride in being overworked, um and that’s something that we want to be able to remove from the medical training. It just doesn’t have to be like that. Um. One of the big things is you’re what they tell you is that you’re learning by experience that you need these amount of hours, that you need 80 hours, that you need to be able to be up 24 or 28 hours at a time in order to be able to be a proficient physician. Um. But that is just not the case. Um. There’s there’s no reason why I should be completely um sleep deprived in order to be able to go see a patient. It just makes no sense to be able to do that. Um. And this is what’s being asked of. And I think it’s incredibly important that in our current day, you know, with our current union and our current system, that we change that. And that is the responsibility that I think our union has taken upon. And not only today, I mean, historically this is something before we used to even work longer hours. It wasn’t until there was a there used to be folks who would say, I worked 120 hours, I did work 120 hours one week. And honestly, I would say it was only not breaking laws because the way it was averaged out over that month um and these type of like technicality, –ies is what we want to be pointing at and say yes, you know, I I I understand that you say I have to work you know 60 to 80 hours, but I think I should be compensated fairly for that. Why should we as resident physician, be the only exception when it comes to the labor force uh where we’re not compensated like any other worker? And I think these type of questions have never been asked from a point of influence. And that has been our goal for the last five years, is how do we develop our power to influence?

Dr. Abdul El-Sayed: And this is this is a really important point that you’re making, which is, you are overworked and underpaid. And one of the things a lot of folks don’t appreciate is that if you’ve ever been a patient in a large hospital, you have been taken care of by overworked, underpaid clinicians who are making the majority of the day to day decisions of your care. And so it’s it’s a patient safety issue as well. And then you talked about the personal aspect of it. Can I ask you, you know, this might be a personal question you don’t have to answer if you don’t want to, but how much debt did you take on to go to medical school? 

Dr. Lorenzo Gonzalez: Easy. Um. You know, I think I’m on pretty much the average. I’m pushing to 250-260,000. And a lot of it was very daunting. 

Dr. Abdul El-Sayed: Yeah. 

Dr. Lorenzo Gonzalez: As a person coming out of no generational wealth. Right. This was uh me trying to say this is how we move up on the social economic ladder is by going through education and becoming a physician. And this will make our our future generations better. It was it was very many sleepless nights where I was like, how am I going to pay this back? 

Dr. Abdul El-Sayed: Yeah. 

Dr. Lorenzo Gonzalez: Can I ever pay this back? 

Dr. Abdul El-Sayed: Do you have a, how long do you think you’re gonna be paying it back– 

Dr. Lorenzo Gonzalez: Oh you know. 

Dr. Abdul El-Sayed: –after you finish residency? 

Dr. Lorenzo Gonzalez: Honestly, I’m looking at the service loan forgiveness. Um. So ten years is definitely in my future um trying to make sure if that pans out. And why I say that pans out because it all comes down to what happens at the Capitol Hill. Uh. This is currently being uh negotiated in the courts and there is going to be a new president if there is a new president, right, these things matter to our our day to day life. Um. So the certainty is not there. The plans might be there. Um. But as we saw in the last administration um previous to Biden, um those type of promises were hard to actually come through. Um. So it’s what we think might happen, ten years. But honestly, who knows? And– 

Dr. Abdul El-Sayed: Yeah. 

Dr. Lorenzo Gonzalez: –one of the things we try to advocate is, you know, especially with the pandemic, there has to be some sort of either forgiveness cancellation relief uh in the in the making, because um this this process that that saved America, uh that saved so many lives. Right? Like the resident physicians were the ones that were saving the lives that were coming into the hospitals. Those individuals um need to be fairly and adequately compensated. And one way of looking at that is through student debt. 

Dr. Abdul El-Sayed: So I want to I want to talk a bit about the culture that you touched on, because one of the aspects of being a resident is it’s not just like any other job. You can’t just opt out of it. You can’t be like, Oh, well, you know what? This is too difficult. Because at the end of the day, in order to be a practicing physician, you have to have completed a residency. And so the hospital has this profound power over you that can force you into this kind of work where you are the lifeblood of the hospital. And so in some respects, all hospitals in America run on this, the form of, in effect, indentured servitude for people who are carrying hundreds of thousands of dollars in debt, working 80 hours a week, getting compensated less than less than a basic uh minimum wage. And all of it is sold to you as this is what doctors do. This is this is what it means to to do the work of becoming a doctor. Never mind the four ought years before that you spent memorizing PowerPoint slides. Never mind the fact that you know you’re in this this this situation where you’ve been skimmed off the top of the top of the top of the top to get to medical school in the first place. Uh. Never mind the fact that, you know, you’re doing the work of of of healing every single day. You know, all of this is sort of inculcated by this culture. And part of that culture is intended to shut you up. You know, I I I and one of the reasons I didn’t do a residency is because I don’t shut up. It’s kind of one of my worst characteristics. I just can’t do it. And um and I realized that I’d be spending years of my life just screaming at the void about exactly the incoherence of this situation. You know, I happened to be lucky enough to to do an M.D., Ph.D. So, you know, my education was paid. I didn’t even have to worry about that whole uh debt thing. Like, I if had I taken this much debt, I actually don’t know what I would have done. Um. I want to ask you, you know, as you think about this work, so much of what you’re trying to penetrate when you’re organizing is that culture that young physicians are taught to respect, that they think they benefit from. How does it how does it work trying to have that conversation with that culture? It’s really tough to penetrate. 

Dr. Lorenzo Gonzalez: I found it very interesting um because I don’t come from labor. I’m not I don’t have a labor background. My family wasn’t union members. Um. Like I said, I come from a mixed status family. But what I did come from was uh community organizing, um coming from organizations like Latino Health Access, who uh really pushed the idea of the community health worker, what they call the promotoro and promotora model, which is like seminal when it comes to developing community health. Um. I saw what they did by organizing folks um and being able to do that collective power. When I moved into residency as an intern and I was thrown into the bargaining table, I saw something I haven’t seen probably ever prior to that. And that was power. That was influence. That was something where you know I saw um our health system administrators have to take not only our words as a consultation, um but they were actually delegated, there was delegated power. There was a partnership. If we didn’t like what we were hearing, we had the ability to walk out of the table and if they didn’t like what they were hearing, they can walk out of the table. I’ve never seen an institution that, as you said, we were all convinced that these are the all powerful individuals being able to actually have to sit down across the table and negotiate. That was powerful. So I started to look at this as an opportunity to really mobilize folks. And luckily for me that there has been CIR as an organization since the 1950s who have been doing this, um you know, throughout New York, moving out to the West Coast and throughout other states. And one of the things that I think was really important and why I think really allowed our growth to accelerate so fast is that we were able to show the power of the union at a national level when it came to COVID. It wasn’t that COVID was necessarily accelerating our growth, it was that COVID was showing cases of how we can utilize labor to be able to not only get control over our schedules to impact what the hospitals were doing, to be able to help um by creating PPE, obtaining PPE to utilizing levers that were not necessarily available to our our hospital systems. There was a level of partnership there. And I think what what really struck this is this trifecta. Right? We were not only able to say we’re doctors and we care about our patients, but we’re also incredibly intelligent. And we were leaders before we came to this situation. Right. In order to become, go into medical school, you had to really show that you were an exceptional individual that had characteristics of a leader, of a researcher. All these things that make you that, like you said, that cream of the cream of the cream of the top. And then we’re able to be in the situation where we’re exploited so extremely. So it was natural to be able to get folks that A.) um Were natural organizers, natural leaders, natural people that have been doing this to get to this point, successful individuals in their own right and be able to say, hey, see this level of exploitation? There is a mechanism to be able to utilize to make this better. And this is what I call true participation. This is what I think what a union it truly is, is that we’re able to be able to give folks the ability to truly participate in the outcomes of the decisions that are being made over their day to day lives. And for many folks, this was very appetizing because now they could really impact if it’s either, you know, be able to do quality improvement projects, if it’s being able to bring resources for their patients either through equipment or community projects, whatever was driving them. We made that a union issue um and that really brought forth a lot more of this idea that I am a union person. I am part of CIR. We made CIR go to them. So that was like a really key moment in being able to say this autonomy, this regional autonomy of what is happening at UCSF, what is happening at MGB, what is happening at Stanford um utilized labor laws to be able to then make a true participation and impact that change. And the best thing is that we had a great population, although overworked, committed to making health care better. Um. And that’s something that you find throughout you know physicians. 

Dr. Abdul El-Sayed: We’ll be back with more with Dr. Lorenzo Gonzalez after this break. 

[AD BREAK] 

Dr. Abdul El-Sayed: And I want to ask you, because you guys have had and you mentioned some some really big wins in terms of unionizing interns and residents. And I think COVID was a really important catalyst because I think it showed physicians, particularly trainee physicians, just how low health care systems were willing to go to exploit them and their bodies in the midst of the pandemic. But I also think that we’re in a moment where there are two other really important trends. The first is that health care itself is changing, and the power of large health care corporations is becoming more and more profound. And I think young uh physicians are looking out into the horizon and saying the payoff on the back end of this ain’t all that appetizing anymore. We’re losing out in terms of the value created by our work. And we’re going to be working for these large health care systems, presumably into the end of our career. And if we don’t do something about it now, we may never get the opportunity to. And I think the other part of it is that there is a growing union movement among sector were, among uh service sector workers, and you’re starting to see everybody from Starbucks workers to doctors decide that the institutions that control the value creation in their industry cannot continue to exploit. I want to ask how those two trends have shaped the attitudes among uh your members and uh driven the kind of successes that you’ve seen. 

Dr. Lorenzo Gonzalez: Yeah, I think a lot of folks um come into this not really knowing what to expect. Um you know. I think one of the things that I always tell folks um becoming a resident physician is likely your first job. For folks like that first true job, you go you went through undergrad, you went to medical directly, and now you’re part of this labor movement um and the expectation is to continue to work. And then you hear now you’re starting to hear, especially um from the other side, right, which is now the attending world, that it doesn’t really change much um and that although even though you might work less, um you don’t have that control that you thought you were going to be able to have. I remember doing uh so one of the things I ommitted was um I have a master’s in urban planning um and that I got between medical school as a dual degree program. And one of the things the opportunity that granted me was to be able to work alongside developers um and not just any developers, but developers of um of hospitals. And and I remember having this conversation with one of the developers and at the end of the conversation, he said, doctors don’t deserve offices. Plain and simple. Um. Every square foot has a dollar sign. And you know one of these things is now that you start looking at us as being just revenue producers, um really removes us from why we came into this like profession to begin with. I’m a deep believer that everyone who joined medical school and took the Hippocratic Oath has altruism within them, and they’re doing this to try to be able to um provide excellent care. Uh. But that is being removed. Um. And because the ROI might not necessarily be in there, I think what when you start looking at us aligning with other like service industries, especially as we’re part of SEIU, which is our bigger um union, uh which is roughly getting close to 3 million members, you know, that level of like lack of say, right, that that level of like lack of participation in that decision making um is something that we crave. It’s something that we want to be able to say, you know, we see X and Y happening in our clinic, we see X and Y happening in our profession. Uh. We need to make a change about this, and we get stuck into this idea of consultation, which is you write this email, you do this business proposal, you submit it to the decision makers and they give you a big thumbs up. They’re like, thank you for this. We’ll take it into consideration. Um. We’ll get back to you if we want to move forward with you. That is what I think the union is really changing and being able to showcase that you have control over your own life, that you have control over your workspace and your environment, and from a from a basic part of safety to something as much as education, right? Like propelling yourself to that next level. All these opportunities, I think, is what is enticing all of our members, because not one answer is going to fit everyone. Not everyone’s going to be into the contract, not everyone’s going to be into developing, you know, the the benefits plan of of what we win. But there is going to be something for everyone. And I think that unity is what’s really driving our wins, is that we’re able to offer uh expand what labor feels like. Um. And even for the folks that are into community health, we talk about bargaining for the common good, for the folks that are talking about research, and that’s what drove them into medicine. We want them to feel a part of labor. So we focus on quality improvement. Being able to bring these folks together has allowed us to be like really good at unity and we’ll be able to see like a strike authorization, something around 95%, people saying, yes, we will go on strike. So those are the type of things that I think are really driving this generation is that we’re not necessarily just harking on one aspect of the movement. We’re trying to bring the movement throughout all aspects of medical education and medical training because we understand that level of impact. All we have is collective power. We don’t have the power thats anointed by an institution, a board, a charter. We don’t have that. That is the part that has been taken away from us. So the only power we can really wield is collective power. In order to have that collective power, we need to make sure that people feel, like I say, feel the purple. And that might take different forms. Um. And if we’ve been successful, and I think you know our recent wins have shown that. 

Dr. Abdul El-Sayed: One of the things that I really find compelling about your approach is that you understand that it’s not enough simply to win a set of uh bargaining outcomes at the table with your particular employer. It’s also a recognition that a lot of health care needs to change. Can you talk a little bit about some of those broader aspirations as the union movement takes hold among physicians? What does the health care system with that kind of collective physician power end up looking like? 

Dr. Lorenzo Gonzalez: Uh. This is um I think this is where true change happens. Um. One thing is if we change medical training, then by merely changing medical training, we change medical education. And by changing medical education, then we really change how doctors are going to are going to practice in general. Uh. And that is that is something that we don’t take lightly, that what we’re doing is really going to alter the shape of not only what we’re doing today in the 72 shots, but it’s going to force medical schools to really adapt to how we’re we’re changing that landscape. So that’s one thing. Um. The other aspect is we don’t live in a vacuum. Like I said earlier, um disease is a manifestation of oppression. I’m a strong believer that you don’t wake up with diabetes, it is diabetes after 40 years of working two jobs, having cortisol just running through your body. Um. You know, heart attacks, CVDs. These things happen because of what people are experiencing. So coming from a physician aspect, making sure that we’re the best doctors that we can be. There has to be a component of advocacy, and I think this is where we really push this idea for you know things like Medicare for All. We’re going to make sure that reproductive justice is not taken away, but it is a right for everyone on the country. And we want to be able to codify that, making sure that LGBTQ rights are front and center. And we’re huge advocates of it, making sure that medicine gets diversified. These are things that we care about. And the only reason that we’re able to speak about these as a national platform is because of our now new influence. And I think that the big point when folks might necessarily say is your union becoming too political is I would take them to Virchow’s quote saying that, you know, medicine is politics um just at a different level. Um. And we have to be able to advocate for our values as physicians, as a unified voice. Um. And if we continue to focus on why how this translates to better patient care, then we can really discuss on why we need a just compensation, why we shouldn’t be preyed on our altruism, why we need more of a diverse uh workforce, and how this is something that really goes to the root of a lot of the issues. And let’s have those critical um conversations. And if we’re going to have those critical conversations, I don’t want it to be a therapy session. I want to be able to have an actual impact on the decision making. Uh. And all of this takes time. Right? I say that when we talk about true participation. What we’re really saying is that we’re going to have to really decrease efficiency. We need to make sure that people have the ability to feel that this space belongs to them and they’re able to make informed decisions. Uh. And that’s from all levels, from a resident to a patient. Um. And that it really comes from this national level that we need to impact health care right now. First of all, everyone needs health care. So we’re a strong supporter of Medicare for All, but at the same time, we need to be able to then use utilize our systems that we have today, and which is how we improve our hospital system through these better contracts. One example is now we have a diversity, inclusion and anti-racism article in a contract for Los Angeles County that specifies two things. One, every resident is going to go through a curriculum that talks about diversity, inclusion and anti-racism, and there is a fund attached to it that is controlled by residents. This is now legally binding in a contract that was won by residents, that is impacting on how we’re looking at diversity in medicine. These are the types of the wins that we want to be able to bring across the nation, and we do it through either legislation or we’re doing it as a contract at individual hospitals. But we’re having that template for everyone to be able to copy. 

Dr. Abdul El-Sayed: Now. I love that. And I think, you know, I love the the the vision you shared of a collective of doctors coming together to build a health care system built around people. And I think for some listeners who hear you talk about efficiency, they said, don’t we want a more efficient health care system? And I could argue that our health care system is actually profoundly inefficient at the thing that we think our health care system is supposed to do, which is to take care of people. Our health care system is efficient at the level of a corporation making a lot of money off the bodies of sick people. And so when we talk about that inefficiency, we need to redefine what we think of as efficient. A truly efficient health care system would be really good at identifying patients who actually need care, be really good at providing them the care they need, it’d be really good at making sure that patients felt cared for not just medicalized and um and our system doesn’t do that. We’ve actually we’ve actually tried to scrub our system out of those things so that it’s entirely oriented to a billable good. Right? You are a revenue value unit creator. That’s how the health care system thinks of you. And of course, they wouldn’t want to give you an office because you wouldn’t be producing revenue value units at the same level. One of the challenges I worry about and I’ve had this hypothesis for some time, is that physicians have been pretty resistant to unionizing over time for for a couple of reasons. The first is physicians used to be management. Uh. In the past, you used to graduate residency. You would put up your shingle, you might join a practice, you’d become a partner, and you are now an employer of other physicians. The median physician is is no longer employed by another physician as of 2019. And the challenge, though, is that once you get out of residency, your salary does increase really quite substantially. Right. The the the lowest um full time physician salary is in the six figures. And the challenge is that I think that kind of money mollifies um a lot of physicians at the top. And so the question I guess I’m asking right is, is this. Will we continue to be able to sustain the kind of unionizing as this crop of union member residents becomes attendings? And it’s an important question for a couple of reasons. Even though physicians are no longer um part of management, I think there is something enticing about being a highly trained professional that makes you think that somehow you don’t need other highly trained professionals to be a part of your union, especially if you’re making six figures and you’re now an attending and you have a team that that you run. And then the second is that a lot of the hospitals, I think, are implicitly trying to mollify residents unions and thinking through how to make sure that you go from being a union member resident to a nonunion member attending as fast as possible. So I’d love to get your take on that and how we take that on. 

Dr. Lorenzo Gonzalez: Yeah, I think it’s um this is what we call wicked problems. Um. Not necessarily have clear answers, um but this is this is how I’ll respond. Um. We have 30,000 members right now. We have organized in our existence close to 100,000 members. And that’s something that is very unique to our union, is that there is a short time that we can have folks in right? Like I said, at the most, it’s seven years, um but most oftenly it’s three years. So there’s always every year we lose somewhere between a third of our membership. That means we lose about a third of our great leaders um that came in and, you know, really spent and dedicated some time here with our union. Those folks move forward and their trajectories are going to be incredibly high. Right? These are the folks that are going to sit at boards. These are folks that are going to sit at committees. These are folks that are going to be running hospitals. Um. And that is probably one of the like the most substantial opportunity that we have in really making a deep impact in health care delivery and health care systems as a whole is that the next generation of physician leaders are going to be formed, their ideas of what a union was through what they’re experiencing at this moment in time. And what we want to be able to offer is that they remember and let’s be clear, most of the physicians that are coming through come from a generational wealth background. They’re some of the most privileged individuals. It takes a lot of investment to become a physician that not everyone has the ability to do. Now, if we are able to take this group of individuals that are some of the folks with the highest trajectories um in our nation and be able to get them when they’re at their most exploited and be able to say in this space where you felt that intern year, when you felt how you were struggling to pay for your rent, when you felt that you had no control and you contemplated leaving medicine, the only thing you ever wanted to do since you were you know in elementary school and you had this new mechanism, these new tools, which is labor laws, which is collective action and collective bargaining. And we made a substantial difference in your life at this moment in time. We feel that we’re really embedding this idea of collective action, of collective collectivities within who they become and move forward towards. So it’s not that they might always be a union member. We want them to. I think my life moving forward will always be in labor. I found a home in labor. I was able to you know bring my background in to what I do today and how I advocate for my patients. But at the very least, I want folks to remember this time as not only as fun but actually productive that they found a way to really get things done. Now, as you know, we need physicians to continue to be in the labor movement, as you said, that now you know folks are becoming employees. They’re no longer becoming the managerial aspect that we was once in the past. And we need those folks to be able to come together. And I think that this development of a new idea of what a union is and how we work and how we work together and our impact and what we can actually accomplish, we want that to continue either if it’s going to be, you know, being the next, in the next CBO. We want community organizing. If you want to be in the next labor uh organization, such as UAPD and Doctors Council and the ones that are out there, we want to be able to bring our greatest leaders to those spaces to grow them. And I think the connection is we can not just have wins for ourselves. We have to tie our wins to our patients um and we’re going to be able to attract more folks because this is not just a mechanism of how to increase our wages. This is how we make sure that our clinics and our hospitals are providing the right resources and the right medical knowledge and professionals and staffing to make sure that we are able to do what we set out to do, which is care for patients. That doesn’t change, right? We went through this process. We want to be able to utilize that to move the markers in the future. 

Dr. Abdul El-Sayed: I want to ask you, um because I’m rather certain that the hospitals aren’t taking this lying down. What are some of the ways that they’ve tried to push back? 

Dr. Lorenzo Gonzalez: Oh, the investment that they do in anti-union campaigns uh is incredible, right? The fear mongering is is huge. This idea, well, it’s always this carrot and the stick. Right. So this idea that first they’re going to come at you with the line that anyone says this to you, you should really take as a red flag is, you know, we’re family here. We’ll be able to take care of each other, that we know you the best. Um. But never forget that medicine is a business. Health care system is a business. Um. There is a return of investment and there is a hierarchy to this. Um. And we need to understand how we engage in that. Um. They will utilize you know most recently, if we look at the Massachusetts general. Um. Very um they were they were definitely giving a lot of what we were asking for initially to kind of avoid this unionization effort. So they’re willing to say, hey, we need to stop this now, which is quite interesting because this type of, you know, interplay between residents and management. Where was this a year ago, two years ago, when this movement was really starting to take off? Right. There was a reason why folks felt disgruntled enough to say we need to unionize. But it wasn’t until there was an actual credible threat where they felt like there was actual movement. Once they see that the movement is not happening, uh this is where it becomes divisive, where folks are being put into what they call captured audience meetings, where they say this is a mandatory meeting and you have to be there um and they won’t let you go out and they will talk to you about why it’s so bad to join a union. Um. And, you know, our talking points are the reasons why we say this is, you know, let hear what they got to say. But at the end of the day, what we’re trying to do to you is make your voice matter, to give you a forum where you can advocate for yourself um and to actually have an impact. Those are very core things and very democratic things and I think very American things, um and which we can all rally around um and being able to stay in a system where your your your behold to middle management, which is what, you know, program residences are, these are folks that wield power over folks. But they also have, you know, people they have to report to. Those are the folks that are going to try to take care of you, but not all the time can. So what we’re really trying to offer and it’s never adversarial, it’s just partnerships with these hospitals. Let us be able to advocate for what you need and utilize our um, you know, our tools as a labor um to be able to get them. And I think that’s the conversation we need to be having. This is not something that we want to take away from the hospital. We actually want to be additive. We want to be able to provide better care for our patients. We know that’s going to happen with the hospital system, not without the hospital system. And therefore, we need to figure out how to have this partnership. Look, we’re all incredibly intelligent individuals. We have something to say and we want to be able to, you know, credibly be able to participate in that process. 

Dr. Abdul El-Sayed: I want to ask for folks out there hearing you speak and learning about this movement, how can they get involved? How can they how can they support? 

Dr. Lorenzo Gonzalez: Yeah, so I think um let’s say you’re already finished your training and you’re an attending um support, support when you hear you know, wear the purple wear the color. Let the residents, you know, take a lunch to to be able to sign a petition, let the residents be able to go and do a unity break where they come together to show their strength as a collective. Now, these are these are ways that you can actively be able to support folks, right. Don’t schedule uh these frivolous or, you know, things that can be done through an email during the times where the union is organizing an event. When you go into medical school, you know, you have you have the ability to at least have a say on where you want to go. You don’t have the concrete decision because there’s a whole match system and we can talk about that another time. But if you are going to be ranking, if you’re going to be selecting, select the ones that are unionized and be able to support those. And when you go there, you know be not only an active member, but participate in that union. And then, as you know, just society as a whole understand that these doctors are the doctors that are caring for you as soon as you get there and when you leave and they’re the ones that are taking care of you um throughout COVID, and most of the time they’re the only doctors you’re going to see. And they’re currently situation is not anything anybody would want to work in and that level of public support when a lot of these um type of um contracts are going public. We need the public to support the doctors that are fighting for better patient care, that are making sure that you all receive the best care that you all deserve. All these aspects, I think, are incredibly important, and I think the media as well being able to cover and being able to differentiate, you know, what is a resident, what does a resident do? How does this training happen? I think that’s incredibly important because that education is going to give insight on why this is such a hot topic and why this is such a pivotal and historic time when it comes to physician training and development of the next generation of physicians. 

Dr. Abdul El-Sayed: Well, uh that’s why Dr. Lorenzo Gonzalez, national president of the Committee of Interns and Residents, we were really excited to have you. We appreciate you taking the time out of what I know is a really busy schedule to share your perspective with us. We wish you all the luck in the world as you continue to to build a more equitable um physician forward health care system. And uh we’re really, really grateful uh to you for the time. 

Dr. Lorenzo Gonzalez: Thank you so much. It was a pleasure being here. 

Dr. Abdul El-Sayed: As usual. Here’s what I’m watching right now. Had a Diet Coke lately? I did. Chances are we both probably had some aspartame, a ubiquitous artificial sweetener that just made a bunch of headlines. The International Agency for Research on Cancer, a branch of the World Health Organization, is reportedly going to slap a, quote, “carcinogen label on it.” Let me clarify what this means. There are several classes of carcinogens. Aspartame is about to get a 2B classification, which means it, quote, “possibly causes cancer.” I get health questions from friends all the time, but I’ve got more questions about this than just about anything else in the past few days. So let me clear this up. Before you flip out and throw out all your Diet Coke. Here’s what’s important to understand. The IARC doesn’t consider magnitude in its decisions. For example, Bacon is a class one carcinogen, meaning it definitely causes cancer. So is plutonium. Wait, what? While plutonium at even a very small dose will definitely cause cancer in virtually everyone exposed to it, Bacon decidedly does not. So why is Bacon a class one carcinogen? Well, because there’s enough population level evidence definitively linking consumption of processed meats to a lifetime cancer risk. Here are a few other substances in the 2B category which aspartame is about to join. Aloe vera, pickled vegetables and nickel, you know the stuff we make five cent coins out of. So what does that mean? There are some well-designed and executed studies that have shown a link between aspartame consumption and cancer risk, but not enough to definitively link the two. Now, look, if you’re someone who looks at this and says, you know what? I’m done with pop entirely, which is, by the way, what we call soda in the Midwest. Good for you. But I’ve heard enough folks say that they’re going to replace their Diet Coke with OG Coke. You know, the stuff that’s full of high fructose corn syrup. Please don’t, because consider the fact that sugar sweetened beverages like Coke are definitively linked with diabetes. And given the evidence, I’d recommend a Diet Coke over a Coke every single day. In the past two months, five cases of malaria were reported in Texas and Florida. That’s not news on its own. There are literally thousands of cases of malaria reported in the U.S. every single year. But here’s what is news. Unlike all those other cases, these weren’t linked to travel, meaning they seem to have been contracted in the United States. Malaria is one of the biggest single killers in history. It’s a parasitic disease contracted from the bite of a specific species of mosquito. That mosquito is and has been endemic in the U.S.. In fact, homegrown malaria was commonplace here until the late 1940s. That’s when we began spraying like crazy. Men all but eradicated endemic malaria. But a couple of things are changing now. First, and I shouldn’t have to tell you this, but, well, it goes back to climate change. That mosquito that carries malaria, it’s migrating in ways that make it more likely for malaria carrying mosquitoes to infect folks here in the United States. And there’s a specific temperature required for malaria to spread, which is becoming more commonplace. Does this mean that malaria is going to make a resurgence in the U.S.? Probably not. We still can spray like crazy, but it does mean that we may be having more outbreaks to contend with in summer months in the South. Now to end on some good news. 

[clip of unspecified news reporter] It’s the first time a drug meant to slow the progression of Alzheimer’s disease has ever been granted full regulatory approval in a clinical trial involving about 1800 patients in the early stages of Alzheimer’s, the drug Leqembi slowed cognitive decline by 27% over an 18 month period. 

Dr. Abdul El-Sayed: As Americans age, more older adults are living with Alzheimer’s disease, for which treatments have been extremely limited. This new FDA approved medication is the first to receive full approval in over two decades. While it can’t fully prevent or reverse Alzheimer’s, it slows cognitive decline by upwards of five months over an 18 month period. Leqembi works by neutralizing certain protein clusters that form in the brain of folks with the disease. Critically, the drug has been approved for coverage of most of its high costs by Medicare, meaning it could create a sea change in Alzheimer’s treatment nationwide. And that, my friends, is good news. That’s it for today. On your way out. Don’t forget to rate and review the show. It really does go a long way. Also, if you love the show and want to rep us, please drop by the Crooked store for some America Dissected merch. America Dissected is a product of Crooked Media. Our producer is Austin Fisher. Our associate producers are Tara Terpstra and Emma Illick-Frank. Vasilis Fotopoulos mixes and masters the show. Production support from Ari Schwartz. Our theme song is by Taka Yasuzawa and Alex Sugiura. Our executive producers are Leo Duran, Sarah Geismer, Michael Martinez and me. Dr. Abdul El-Sayed, your host. Thanks for listening. [music break] This show is for general information and entertainment purposes only. It’s not intended to provide specific health care or medical advice and should not be construed as providing health care or medical advice. Please consult your physician with any questions related to your own health. The views expressed in this podcast reflect those of the host and his guests and do not necessarily represent the views and opinions of Wayne County, Michigan, or its Department of Health, Human and Veterans Services.