We all know that, even before the horrific, world-changing event of Covid-19, society would fall apart without hospital workers and medical staff. But like so many other fields and sectors of work, the medical field is a very stratified one. Even though we as patients may not see it, many of the folks who make hospitals and medical facilities run are overworked, understaffed, under-protected, and paid way less than we’re led to believe. This was made painfully clear last month when frontline physicians at L.A. County hospitals voted overwhelmingly in favor of striking over unfair labor practices. After voting to authorize a strike, L.A. County members of the Committee of Interns and Residents (CIR/SEIU), a local of the Service Employees International Union, won historic contract gains, including major increases in salaries and housing stipends, the creation of a $125,000 fund for diverse recruitment efforts, and more. To talk about all of this and more, TRNN Editor-in-Chief Maximillian Alvarez chats with Dr. Frances Gill, a first-year resident physician at LAC/USC Medical Center who is training to be a psychiatrist.
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Featured Music (all songs sourced from the Free Music Archive: freemusicarchive.org)
- Jules Taylor, “Working People Theme Song
Pre-Production/Studio: Maximillian Alvarez
Post-Production: Jules Taylor
Maximillian Alvarez: All right. Welcome, everyone, to another episode of Working People, a podcast about the lives, jobs, dreams, and struggles of the working class today. Brought to you in partnership with In These Times magazine and The Real News Network, produced by Jules Taylor, and made possible by listeners and supporters like you. Working People is a proud member of the Labor Radio Podcast Network. So if you’re hungry for more worker and labor focused shows like ours, follow the link in the show notes and go check out the other great shows in our network. And of course, please, please, please support the work that we are doing here at Working People so that we can keep growing and keep bringing you all more important conversations every week. You can do that by leaving us a positive review on Apple Podcasts, and by sharing these episodes on your social media, and with your friends, coworkers, and family members. And the single best thing that you can do to support our work is become a paying monthly subscriber on Patreon for just five bucks a month.
And if you subscribe for 10 bucks a month, you’ll also get a print subscription to the amazing In These Times magazine, delivered right to your door every month. Just head on over to patreon.com/workingpeople, that’s P‑A-T-R-E-O‑N.com/workingpeople, hit the subscribe button and you will immediately get access to all of the awesome bonus episodes that we’ve recorded and published over the years. We’ve got some great bonus episodes to round out the month of June coming your way, including a special conversation with some fan favorites of the show, where we debrief on the Labor Notes Conference in Chicago, which I had just got back from after driving my ass like 11 hours from Chicago to Baltimore.
And like I said in the last episode, Jules and I really want to expand what we can do with this show. We want to get union-made merch for our amazing supporters.We want to host regular fundraising live streams for striking workers, workers who have been fired for organizing, and more. But we cannot do that unless we get more support on Patreon. So if you really want to support our work and help us grow, and if you want to listen to lots of great bonus episodes – And we’ve got lots – Then head on over to Patreon and become a subscriber today.
My name is Maximilian Alvarez, and like I said, I’m still recovering a bit from Labor Notes. It was truly an incredible gathering of rank and file workers from all over the US and around the world, really. I mean, union organizers, people who have been in the movement for decades, people who are just dipping their toes into labor organizing. I mean, we’re talking educators, longshore workers, railroad workers, hospital workers, hospitality workers, Amazon workers, Starbucks workers, John Deere workers, and Auto workers, gig workers, Teamsters, letter carriers, nonprofit workers, media workers, transport workers, and IATSE stage and film crew workers.
I mean, there were over 4,000 people in attendance. And I got to tell you, man, the Hyatt Regency was just buzzing with energy and solidarity the whole time. I mean, of course there were strategic disagreements and debates too. That’s what this space is for. It’s more productive to have those kinds of debates in person at this kind of event than to just be flinging shit at each other online. And that’s really, like I said, what this kind of space is for, for people to come together, to learn from one another, and to figure out how we can build the movement, to improve our lives and the lives of our coworkers, to empower and mobilize the working class.
I mean, that’s obviously not all going to happen in the span of three days, but I absolutely think it’s fair to say that the gathering at Labor Notes in Chicago was a vital opportunity for people to feel renewed, refreshed, and supported in their respective struggles, and for all of us to feel a little more connected and find a sense of common cause in our collective struggle. And my impression – You may hear differently – But my impression from the whole thing is that, by and large, that’s how people felt.
And that’s what we need now more than ever. Union density is at its lowest point since the ’30s in this country, and the planet is boiling. American society is eating itself while the rich are robbing all of us blind and politicians keep pushing for more of the same poisonous policies that create misery for the many and untold riches for the few. I mean, this was my first time at Labor Notes, so I don’t really have anything to compare it to. But what I gathered from other attendees is that everyone who was there understands the score. We all know how fucked things are right now. And they came to Chicago looking for ways to fight and looking to share lessons on how to win.
And that is a very special thing. And I’m grateful to everyone who made that a reality. And lastly, before we get to today’s episode – And spoiler, this intro is running a little long because I promised I would give some updates on Labor Notes, so just deal with it or fast forward if you want – But before we move on, I want to give a huge, enormous, magnum size thank you to the whole Labor Notes crew and all of the volunteers, the interpreters, and everyone who was a helper who made this important gathering possible. And I mean, if you’re listening to this, be sure to post a message of love and solidarity to our comrades Luis Feliz Leon, Jonah Furman, Al Bradbury, and everyone at Labor Notes who worked their butts off for countless hours, days, weeks putting together the kind of event that is normally put together by a team at least three times the size.
It’s really impressive what a small group of folks managed to pull off, and hats off to you all. You guys are the real MVP, and the movement is in your debt. Now, please, for the love of God, go get some rest.
All right. Well, we’ve got a great episode for you all today. Now, we all know that even before the horrific world changing event of COVID-19, society would fall apart without hospital workers and medical staff. I mean, we trust them with our very lives and the lives of our loved ones. And we saw during the past two and a half years how many hospital workers risked and lost their lives to care for us. But as we also know, especially if you listen to this show, like so many other fields and sectors of work, the medical field is a very stratified one.
And even though we as patients may not see it, many of the folks who make hospitals and medical facilities run are overworked, understaffed, underprotected, and even paid way less than we’re led to believe. And this was made painfully clear last month when frontline physicians at LA County hospitals voted overwhelmingly in favor of striking over unfair labor practices. And this struggle really caught my attention when I saw a certain press release from the Committee of Interns and Residents, SEIU, which is a local of the Service Employees International Union, or the SEIU, that represents more than 20,000 interns, residents, and fellows in California, Florida, Massachusetts, New Jersey, New Mexico, New York, and Washington DC. And I wanted to read you guys a little bit of this press release, because I think it’s really fascinating. So here’s what it says, and we’ll link to this in the show notes:
“After concluding our vote to authorize a strike on Monday, the LA County members of the Committee of Interns and Residents or CIR/SEIU are planning to give our official notice today that we are planning to engage in an unfair labor practice strike, that will commence on June 13 and end on June 15. This will be the first time resident physician members of CIR have gone on strike since 1990 in New York City. CIR members overwhelmingly voted to authorize the bargaining committee to call for a ULP strike, with 99% of voting members voting in favor. From our first talks with the county almost a year ago, this fight has been about getting what we need to continue caring for our patients at the level they deserve and with our undivided attention, and ensuring that LA County can continue attracting talented and dedicated doctors to serve our communities.
We do not take the decision to strike lightly, and we have presented the county with more than sufficient notice of our strike plans in order to help ensure that they have time to safely staff our hospitals in our absence. While we would much prefer to continue doing these jobs we are passionate about without pause, the county’s conduct has left us with no choice. Furthermore we know it is better in the long run for our hospitals and the communities we serve to ensure that front line doctors can pay their rent and live in the city they work in. Amid ever rising costs of living in LA, and with some residents barely making minimum wage based on the number of hours they work, LA County must invest in its healthcare workers in order to support the people who need care the most. Already, incoming interns are calling us panicked about finding an apartment they can afford in LA. They deserve better, and the people of LA deserve better.”
Now, I don’t want to bury the lede of this episode, but the strike was ultimately averted in early June when the union bargaining team reached a tentative agreement with LA County. And it was a significant tentative agreement that included… Let’s see, average salary increases of 5.5% in the first year of the contract followed by 3.25% in the following two years; a $3,000 increase in annual housing stipends; a signing bonus for incoming interns; the creation of a $125,000 fund for diverse recruitment efforts; and more. First year residents will receive a historic 14.5% raise under the new contract. So shout out to the bargaining team, shout out to the union. We’ll keep you guys updated as there are any updates to give, but you can follow the union using the links that we’ve had in the show notes if you want to get updates.
And to talk about all of this and more, I had the honor of chatting with Dr. Frances Gill, who is a first year resident physician at LAC USC Medical Center in LA. Now, Dr. Gill is training to be a psychiatrist, and she is serving out her residency after completing medical school. And it was honestly through our conversation that I realized there was so much that people working on their residencies do and go through on a daily basis that I just, frankly, didn’t know about. But it’s really important that we know about it because, as we talk about in this episode, and as we talk about pretty much every week on this show, we need to keep expanding our movement to include workers like hospital residents. We need to share our stories and our struggles with one another. And we need to support and show solidarity with workers of all stripes, workers like Dr. Gill. This is her story.
Dr. Frances Gill: Hi. Yeah. My name is Frances Gill. I’m a first year resident physician at LAC USC, which is the county hospital in Los Angeles. And I’m a resident physician, which just means that we’re doctors in training. So this is the first part of our training after medical school. And I am training to be a psychiatrist, and I’m very excited to be on the show.
Maximillian Alvarez: Hell yeah. Well, Frances, it is so great to have you on the show, and yeah, really appreciate you making time for this. Not like residency has a lot of extra time for you to do such things, am I right?
Dr. Frances Gill: That’s right. They keep us very busy. It is definitely very demanding.
Maximillian Alvarez: Yeah. I was shocked when we hopped on the recording and we had the cameras on before we started, and I was like, oh, they do exist. Because normally when I’ve had friends or folks, when I was in grad school and folks would talk about being in residency, it was almost like you were disappearing for a few years.
Dr. Frances Gill: Yeah. No, it’s really all consuming. It’s a very totalizing effect on your schedule, and that can make it really hard to maintain the relationships in your life and stay in touch with friends, and all that kind of thing. So it’s real. Residency is definitely something that lives up to the hype in that regard.
Maximillian Alvarez: Yeah, man, I do not doubt it, and I think we’ll have plenty of time to dig into that and what your working life looks like right now. And we were originally going to do this interview, push it forward in the schedule for earlier in June, because you all have been doing some really incredible and important and undercovered organizing over there. And in fact, there was even the potential of a resident physician’s strike, which really caught my attention. And so I’d love to dig into all of that for listeners. But since developments in that struggle have gone the way that they have, we figured, hey, let’s take the opportunity and turn this into a full length episode. Because I’m sure listeners much like myself would be very, very interested to know more about you and how you got into this line of work, and what that work looks like, especially now in the world that we’re living in today, here in the year of our Lord 2022. So start small. Are you originally from Southern California?
Dr. Frances Gill: Great question. So, no, I am actually from Washington State originally. I grew up in a small town outside of Seattle called Fall City, Washington. A small town that has definitely since become a suburb of Seattle, but it’s actually the town where Twin Peaks was filmed. So most people know it from that.
Maximillian Alvarez: I was about to say, I was like, I know that from somewhere. And I was like, is it too hacky to say, wait, is that the Twin Peaks place?
Dr. Frances Gill: No, it’s the Twin Peaks town. Yeah. My mom used to work at, not the main diner in Twin Peaks, but another diner that was a location that they sometimes shot at. So they would sometimes bring the Twin Peaks tour bus around to my mom’s diner, which is funny. But yeah, I grew up [crosstalk].
Maximillian Alvarez: Wait, what was that, sorry, I got to ask, what was that like? I can’t in good conscience let you continue without, do my Larry King, expand on that for us.
Dr. Frances Gill: Yeah. I mean, I didn’t watch Twin Peaks until I was about to graduate high school. So for most of my childhood, it didn’t really mean that much to me. I was just like, oh, this is weird. There’s these fans that come around to the restaurant that my mom works at. But it is, I mean, it’s a beautiful part of the country. It’s a beautiful part of Washington State, and I can see why David Lynch was enamored with it. So yeah, it’s a beautiful place. Definitely recommend visiting whether you’re a Twin Peaks fan or not, if you have the opportunity. It’s very much small town vibes, and does have a little bit of the creepy ominous Twin Peaks undertones.
Maximillian Alvarez: Yeah. That was going to be my question. I was like, okay, quaint, cute, small town. Is it also drenched in existential horror?
Dr. Frances Gill: I could see where it was coming from. Yeah, definitely there’s a certain amount of existential horror. Especially over the last 10 years. Like I said, when I was growing up, it felt like I was living in a small town, but now when I drive out there from Seattle, it’s just suburban sprawl. So I mean, now definitely the existential horror is palpable, but probably for different reasons than 30 years ago.
Maximillian Alvarez: Yeah. It would be interesting to see a reboot in our modern time. So what was it like for… I mean, when I was growing up, I feel like we were kind of… We’re around the same age. So yeah, that shit totally went over my head at the time. And even when I was old enough to have friends who were into it, it was like, I felt very much like an outsider. Like I just didn’t get it. So it took a long time for me to circle back and appreciate Lynch. But what was it like for you as a kid in that? So was grunge happening around this time? What did you do as a kid there growing up?
Dr. Frances Gill: Yeah. I mean, I would say not grunge so much. I feel like that’s a little bit before my time. But definitely it was a kind of shitty small town. So I feel like I had a lot of friends whose parents had grown up in that small town and were going to live in that small town for the rest of their lives. And there was a little bit of a dead end feeling, but a little bit of like everybody knows everybody, and that’s fun and okay.
It would liven up a little bit in the summer because there’s a river that goes through the town. And so in the summer people would come out and float the river. That was a big thing. And that’d be quite a party scene. And my mom worked, she worked at the diner that I mentioned, and then she also worked at this bar in town. And every summer when the floaters would come down the river, she would get just so pissed off at everybody because it was just such a… Like people would just litter, and party, and drink. And I don’t know. So it had this grimy party scene in the summer, and then this really dead end empty vibe in the winter.
But that was the town itself. And then surrounding the town is all this new development and stuff that was encroaching more and more as I got older, and has now pretty much taken over the whole town. So what felt to me like a pretty grimy small town place to grow up is now a bougie suburb of Seattle and Bellevue. And actually, a fun detail is that the bar that my mom worked at was called the Last Frontier Saloon, and it was named that because the town doesn’t have a sewage system, everyone was on septic tanks still. And it was in the flood plain of this river. So it was felt that this was the last frontier area in Western Washington that wasn’t overdeveloped, because it was in the floodplain, so they couldn’t really do it. But change comes for us all.
Maximillian Alvarez: Yeah. And I mean, as I understand it, it came really fast to, as you said, where you live. I have a book of interviews with 10 workers that I did at what was then the height of the COVID pandemic. So that was like December 2020, January and February of 2021, so that’s when we recorded them. And one of them is with a burlesque performer and producer in Seattle, and they just talked about the whiplash that they had from growing, being a native of Seattle from the early ’90s to now with the tech boom, and from grunge to tech to everything else. It feels like even if it was the last frontier, it made up for lost time in a very, very short span of time.
Dr. Frances Gill: Totally, totally. Yeah. No, I think that’s so true. It did seem like it happened so fast. It was like, I mean, it was happening when I was growing up and when I was in high school, and then I went away to college and then came back, and it felt like a whole different place. And so people ask me if I will move back. and I mean, my family’s there, so eventually I probably have to go home at some point, but it doesn’t feel that appealing to me. It doesn’t feel like a place that I could really put roots down in again, unfortunately. But it’s still, it’s a really beautiful part of the country. It’s gorgeous. I mean, the scenery is really great. So I don’t know. It’s got its pluses and minuses, I guess.
Maximillian Alvarez: Yeah. I feel the same way about… So I grew up in Orange County. I grew up kind of over by where you are now. And it’s weird how the things that you miss so much about home end up becoming oppressive when you go back. You still miss them so much when you’re away, then you’re there, and just, you feel suffocated. It’s a tough thing to grapple with. Because then you start to wonder, you’re like, man, how did I ever just live day after day in this without feeling this way.
Has the place changed or have I? And the answer, I guess as always, is both. But let me ask you this. So as a little nerdy kid in Southern California, I knew from a very early age that I wanted to be a medical doctor.
Dr. Frances Gill: Okay.
Maximillian Alvarez: Spoiler alert, I am not. But for most of my young life, that was one thing I never had to think about. I was like, oh yeah, I’m going to be an MD. And I remember asking my mom, I was like, what’s a good medical school? She’s like, well, Harvard’s pretty good. And I was like, okay, I’m going to be a doctor. I’m going to go to Harvard. So that’s just what I told people for the first 17 years of my life. So was going into the medical profession, was that something that you had wanted to do from an early age? Or did you fall into that later?
Dr. Frances Gill: I fell into it a little bit later. I thought I was going to be like, I mean, I didn’t really know what I was going to be, but I thought I was going to go to college and be an English major and do something with books and literature. And I was on that train. But then I took an intro, like a general bio 101, biology 101. And I had never thought of myself as a science person, I didn’t take any advanced science classes in high school or anything. I didn’t think of myself as someone who was good at science and math. And I’m not that good at science and math, but I did take this biology class and I just really liked it. And I found it really interesting. And I was like, whoa, I wasn’t expecting to enjoy that. It was really hard. It was really challenging, and I liked that aspect of it.
And I just started thinking, well, what am I doing here? What should I be doing? And I was also doing a volunteer thing at the time that gave me some exposure to the healthcare system. I don’t know how 20 year old me decided, I’m going to be a premed student, but at some point I did. And once you’re on the path, it’s a little bit hard to get off the path. Definitely, the farther along you get, it’s hard to get off the path.
But I also enjoyed it. I liked the coursework. I liked the challenge of it. I liked my opportunities when I got them to do clinical, have clinical experiences. And I like working with people, and it seemed like this great field where you get to… I also worked in restaurants all through college and after college. I was always waiting tables somewhere.
And so I think I knew that I liked talking to people and I liked busy, fast-paced work. And I also liked intellectually challenging work where you have to solve problems and figure stuff out. And medicine seemed like a perfect field for that. There’s always some new thing to learn. There’s always some new problem that you’ve never faced before. And even as you start to get better at solving some of the more everyday problems, then you start getting to think about bigger and more challenging and more complex problems, and systemic problems within the healthcare system, too. So it seemed like a field where I would be continually challenged and continually learning, which was very appealing to me. And the opportunity to work with people from all walks of life and have that busy, fast pace, and to feel… I mean, it does feel good to be of service to people. Not to overstate the… What’s the word I’m looking for? But –
Maximillian Alvarez: I mean, I totally get that.
Dr. Frances Gill: The myth of doctors as utterly selfless and generous folks. Obviously some days we do more good than other days. But a lot of the time you get to help people, which is cool.
Maximillian Alvarez: Yeah. No, I mean, I totally get that. And not to make light of the horror that we’ve been living through for two plus years now, but in terms of big systemic problems to solve, you got what you were looking for. Jesus. Oh, man. Well, you know what’s funny is that you and I kind of did a double helix in terms of our directions. Because I, like I said, was just totally gung-ho about going into college, being premed from the jump, and going to med school, all that good stuff. And those OCHEM classes that they’re like, oh, this is a weed out class and only 30% of you are going to be here by the end of the year. So I got weeded out. I was so determined not to, but by the end of it, I was like, man, fuck this, I hate this. And I took a hard left turn and I ended up changing my major to Russian literature and –
Dr. Frances Gill: Oh, wow.
Maximillian Alvarez: Yeah. And so my BA, masters, and PhD are all in literature, and history in the PhD as well. But yeah, it was funny, because something you said made me think about that position of coming from a family where, and not to be presumptuous, but you were saying in reference to your mom. And so I thought of my mom. And so, we didn’t have doctors in the family. And so for our family, it was all just like, yeah, that sounds great. Let us know how it goes.
Dr. Frances Gill: Yeah. Same. My family’s like, great. Godspeed.
Maximillian Alvarez: Godspeed. Yeah. I hear it’s hard. And the funny thing was, looking back on it, it’s so sweet and God bless her heart, but my mom would always find these… Because I think when I told my parents that I was like, hey, would you guys basically murder and disown me if I switched from pre-med bio major to Russian literature? And to their credit, they took it about as well as any parent could. And I think it’s because they already knew that I was always more of that humanities person, but they were trying to be supportive. And so then looking back on it, I started to realize like, oh, yeah. My mom would do things like say, oh you’re going to be such a good doctor because of this and this.
None of it had anything to do with my knowledge of medicine or my abilities at science. She would say things like, oh, Max can fall asleep anywhere, and doctors need to be able to do that when they’re doing their residency. Or Max can talk to people, and you got to talk to patients. So it was very sweet and encouraging, but when it came down to it, I did not have the other requisite skills needed to do what you do. Did your folks do that at all?
Dr. Frances Gill: Yeah. I could totally, they definitely did a little bit of that. Yeah. I think my dad’s theory is that I wound up going to medical school because I like school. And he was like, you just picked the longest path. Although, a PhD in Russian literature, that sounds like a pretty long path too.
Maximillian Alvarez: Yeah. I guess we’re gluttons for punishment in our own way. But yeah, even just hearing you talk about it though, I could feel that same excitement that I once felt. Because for me it was the same, biology really got me. I hated chemistry because chemistry’s basically just math, and fuck math, math sucks. Biology is cool. That’s the official Working People stance. So given what your dad said about you, I meant to ask this before we moved on from your upbringing in Washington State. Were you always more of a studious child? Were there many ways to get into trouble growing up over there?
Dr. Frances Gill: Definitely. There were ways to get into trouble. But yeah, I think I was a pretty nerdy kid. I did Knowledge Bowl in high school. I think I was pretty much a nerd from the jump.
Maximillian Alvarez: Wait, when you say Knowledge Bowl, is that like a Super Bowl for –
Dr. Frances Gill: Yeah. Quiz Bowl, I think they call it in some, it’s like you have to do math really fast, and it’s like trivia, but you’re competing against other high schoolers.
Maximillian Alvarez: Outstanding. Outstanding. I’ve heard of the mathletes and –
Dr. Frances Gill: Yeah. Kind of like that.
Maximillian Alvarez: Okay. All right. I respect that. I do. Yeah, it wasn’t always easy for us growing up being openly nerdy, but at least now we’re a little more comfortable in our own skin. So, what was the path from there to your residency in LA?
Dr. Frances Gill: Yeah. So after undergrad, I took about three years between undergrad and med school, and was living in New York working in restaurants. And then I applied to med school and wound up getting into Tulane in New Orleans. And I’d never lived in the South. Didn’t really know much about the South. I’d visited New Orleans once for vacation, that was my only exposure to the city. But I got in. With med school, you gotta just go wherever you get in. And I was sad to leave New York, but I made the leap. Oh yeah, and I didn’t say that I went to undergrad in New York at NYU. Maybe I did say that. But anyway, so then I went to Tulane, and moved to New Orleans and did med school there.
Yeah. I took an extra year to do public health stuff, and eventually landed on my specialty, psychiatry, and wound up applying to residency all over the place. But I wanted to be back on the West Coast, but I liked living somewhere warm. I had gotten really accustomed to that in New Orleans. And so I wanted a big city on the West Coast that was going to be warm all year, and LA fit the bill. And I had a lot of friends that had wound up in LA. So I figured I’d have community here. And I liked the idea of working at a big public hospital, which, I’m in my residency at USC, which, like I said, the residents work at the county hospital mostly. So one thing led to another, and now here I am.
Maximillian Alvarez: So I definitely get that rationale, because again, having grown up there, it was always so weird to people when you were saying you were going to leave. I think I was one of like… Legitimately I think I was one of five people from my graduating class who went out of state. It was not something that you did. And it was like, okay, what Cal State or UC are you applying to? And when you said, oh, I’m going to Chicago. They were like, what’s that? And having lived now almost as many years away from California as I’ve lived in California, I certainly get it. I spent a number of years in Chicago, then Michigan freezing my ass off. My beautiful Mexican pigment is all gone and my family makes fun of me. I miss the Mexican food. So I get the allure, I do.
Dr. Frances Gill: Yeah.
Maximillian Alvarez: How are you doing with the rest of the city? The traffic and all that good stuff, and the insane gas prices?
Dr. Frances Gill: Yeah. Gas is crazy expensive. The traffic, you get used to it a little bit. When I lived in New Orleans, a 20 minute drive, a 25 minute drive was like, it felt so far. It’s like, you’re going all the way, you’re leaving town. You’re going all the way across town and you’re literally leaving the town. And now it’s like, okay, 45 minutes, whatever. It’s going to take me 50 minutes to get somewhere. I’m just going to deal with it. I listen to a lot more podcasts, and I get more road rage. I guess you just get used to it. But gas is really insanely expensive, that I cannot get used to. But then, also I’m lucky because I live fairly close to the hospital. So half the time to two thirds of the time, I just wind up riding my bike to the hospital, which is like a 20 minute bike ride and then I’m not spending money on gas. So –
Maximillian Alvarez: Nice.
Dr. Frances Gill: So that’s a nice setup. Yeah.
Maximillian Alvarez: Yeah. I can’t blame it entirely on this, because the Alvarezs are famously unpunctual people. And that has very much carried over to me. And that does not mean that I was late to our recording because of my family lineage. I actually did have a work emergency, but normally –
Dr. Frances Gill: No judgment.
Maximillian Alvarez: Yeah, normally I’m still very bad with it. And I feel like that, when you were talking about it, I was like, man, that probably has something to do with it. Your sense of time and distance, it gets really warped living in Southern California because you’re like, oh, yeah. That’s two miles away. I’ll be there in 45 minutes. But yeah, it’s another world and I do miss it, but also don’t necessarily want to be back living there.
So let me ask you this, though. Like we were saying up top, I think that there’s so much mystique around the residency. And I think if anyone knows about it, the main thing that they know is that you guys just work nonstop and are sleeping for an hour in a supply closet. That’s the cultural depiction that we have in our head. But actually, I get the sense that most of us don’t really know what that looks like on a day-to-day basis. And so I was wondering if you could give us a behind the scenes look. What was it like for you beginning that residential appointment? And what has your “typical” week looked like doing that work? And what kind of work do you do?
Dr. Frances Gill: Yeah. It is very mysterious. And so from the outside it’s definitely confusing. But yeah, your residency is like… So you finish medical school, and medical school basically consists of two years of book learning, textbook stuff, and then two years of clinical learning where you’re actually in a hospital or a clinic and you’re participating as part of the medical team, but you’re still a student. So you don’t have any real responsibilities. You can’t put in orders or really take responsibility for the full care of the patient. And then you graduate medical school and you begin residency. And the residency is where you get sorted into whatever specialty you want to do.
So I picked psychiatry, but if you want to do general internal medicine, you do a medicine residency. If you want to do a surgical field, you would do a surgical residency. So you’re divided between your different specialties. And so your experience of residency varies a lot depending on which specialty you go into. But basically what it means is that you got the MD after your name. So then you’re a medical doctor. You’re able to order medicine, prescribe medicine or… What else? You take a little bit more responsibility for the care of the patient. It’s still a process. So you’re, as a first year resident, medicine is very hierarchical. So as you proceed through residency, you get more and more responsibility. But it is a big learning curve and a big jump from being a student to having that MD after your name and having the responsibility that comes with it.
In a practical sense, what are residents doing? Like I said, it varies a lot depending on the specialty that you’re in. But as a psychiatry resident, for example, my first year of residency is actually half divided between psychiatry and other specialties. So we actually do like four months of internal medicine and two months of neurology while we’re training to be psychiatrists. So the idea being that a psychiatrist still needs to know some general internal medicine stuff, they still need to know a little bit of neurology. So as a psychiatry intern, you spend about half the year on off-service non-psychiatric rotations.
And then you do about four months of inpatient psychiatry and two months in the psychiatric emergency room. And that varies depending on the program that you’re in, but generally speaking that’s about what you’re going to do. And on the day to day, when I’m on a medicine rotation, I’m working in what we call medicine wards. So you’re the intern, the first year resident. So there’s so much jargon in residency, but you’re the first year resident on a medical team that takes care of all the… You’re the primary team for patients that get admitted to the hospital that have medical problems. So not surgical problems, not psychiatric problems, but your regular general medicine problems. It’s like primary care for the hospital. So primary care, but they’re sick enough to be in the hospital. So this is like patients who have heart failure exacerbations, or patients who have lung disease exacerbations, or pneumonias, or all kinds of different medical problems.
And when you’re in that setting, you usually work six days a week. So you have one day off, and you work 12 to 14 hours a day. At 6:30, well, at 6:00 AM you come into the hospital and you chart check your patients. So you look at your patients on the computer, see really quickly like, did you get new patients overnight? How are folks’ vital signs looking? So you do some chart check, then you go downstairs and you get a sign out from the night team. So you meet up with the doctor that was covering overnight, and you hear about how your patients did overnight. You hear any information about new patients that came in.
So you get signed out, and then you pick up the phone, which is like the phone that nursing staff or other medical teams are going to use to call you. And basically once you pick up that phone, it doesn’t stop ringing pretty much all day. And so it can be really stressful, because as soon as you get that phone, you could have three or four new patients who came in overnight, plus you have the 10 or so patients that you had yesterday that are still there today. And then you got to run around and you see all those patients, you go and check on all those patients. They’re scattered all over the hospital, so you’re running around from floor to floor, checking on all these patients. And then you come back and you meet up with the attending physician, that’s the supervising doctor that oversees the whole medical team, and you round on the patients together. So you go over the whole list, and here’s the plan for this patient.
The attending says, oh, let’s actually do this. Or what did you guys think of that? And then you spend the rest of the afternoon after you finish rounds putting in orders, writing notes, calling family members, checking on patients again in the afternoon. Just doing different kinds of patient care things. So your day is really, really busy, and it’s usually jam-packed, and it’s long. And then you get to 5:30 or so, and that’s when you sign out to the night team. And so you go back to the night doctor and you say, here’s what happened during the day. Here are the things that I need you to do at night. And then the night doctor takes over. And then if you’re lucky, you’re done for the day. Or, more likely, you didn’t finish writing all your notes, so then you go back to the workroom and you type up all your notes.
And then when you’re done, you go home. And especially as a new first year resident, you’re not very fast, and you’re not very good at what you’re doing yet. So it takes time. And so sometimes you can be there till 8:00 PM or 9:00 PM or later just finishing the work for the day. And then you have to be back at 6:00 the next morning. And like I said, you do that six days a week. And I would do it, as psychiatry residents, we do it in four week blocks. So we’ll do four weeks of medicine wards.
Yeah, it’s pretty grueling. My other rotations are similar, though not quite as intense, but that’s the general schedule for an internal medicine intern, that’s what they’re doing. A lot of other specialties also rotate on medicine. And then for surgical residents, it’s basically a million times worse. They work even harder and they have, well, not even harder, all residents work very hard. But they do have, I think, worse hours on average than the medicine interns, the medicine residents. And it’s just really grueling, and they have long residencies. Five years, sometimes more. Anyway, that was a long ramble, but it’s –
Maximillian Alvarez: Oh, no, that’s why we love hearing about this. I mean, because, again, for those of us who’ve only ever seen it from the patient side, it’s hard to make those distinctions. And there are just so many people flitting around doing so many different things, and [it’s a] very, very complex ecosystem inside those hospital walls. And yeah, you can’t really quite tell like, oh, who’s a first year resident, who is a nursing assistant, who is a lab technician.
And then the more that you learn about these things, the more you learn about all of the tasks that go into that workday. And that’s something that I’ve been hearing I think since I interviewed the first hospital worker ever on this show, which was maybe in season two. Because we talked to a bunch of different folks in different types of medical facilities at different positions doing different kinds of work. And we actually, now that I think about it, we kicked off season four of the show with Dr. Amir Atabeygi who was striking. This was, when was this? This was like in November 2020. And he was a physician at the MultiCare Indigo Urgent Care in Washington State. These kinds of –
Dr. Frances Gill: Oh wow.
Maximillian Alvarez: Yeah. And so he was unionized with the Union of American Physicians and Dentists, and he talked all about those urgent care facilities, and I think what he calls like the… How did he put it? It was like the retail model for healthcare. The way that things had been running there. So anyway, the point being is like, it’s so important for me and for listeners to learn about these things from people like yourself who are actually doing this work day to day. But I swear to God, the thing that everyone has mentioned is that data entry. It seems to be the thing that everyone in the medical profession hates the most is like, after your shift you gotta sit there and log everything, and you can’t leave until you’re done.
Dr. Frances Gill: Yeah. It’s brutal.
Maximillian Alvarez: Yeah. Well, I deeply, as someone who hates having to sit in front of a computer all day but does it anyway, solidarity with you guys, because that sounds awful.
Dr. Frances Gill: Thank you.
Maximillian Alvarez: I mean, the rest of it sounds great. I mean, interesting and exciting, but also exhausting and anxiety producing. So yeah, that’s the whole ball of wax. And I was wondering, so you said that this is, when did you, pardon me, when did you officially start at LA County hospitals?
Dr. Frances Gill: I started almost exactly a year ago, last June, I think 24. So almost exactly a year.
Maximillian Alvarez: Okay. So what was it like doing that in the middle of COVID? Because I think we’ve been working on putting together more interviews with medical workers of late. But some of them have taken, understandably, a long time to put together, because folks are exhausted and just the… Like there’s one interview that I’ve been trying to do with medical workers and teachers together. We’ve been trying to put it together for like four months, and a lot of that is my fault, but a lot of it was also the Omicron spike. And people obviously, understandably, everyone wants to just “go back to normal” and “live the lives that we once had.” And every time I talk to someone working in the medical field, they’re just like, you have no idea how burnt out everyone is, and how much we are bleeding staff, and how much faith everyone has lost in this entire system. So I don’t want to put all that on you, but I just wanted to ask, what was it like walking into that in the middle of a pandemic?
Dr. Frances Gill: I mean, the burnout is real. The burnout is definitely real. My timing of entering residency was not as bad as the folks the year before me who started residency June 2020 and were really just walking right into the fire. We would definitely have times when I was on my medicine services where a third of your list is of a patient who has COVID. Although I think the healthcare system had gotten a lot better at managing the flow of COVID patients in and out of the hospital, I think the staffing shortages as a result of people being overworked and burnt out and just feeling like they’d really put their lives on the line and not seeing the appropriate response from bosses, that was definitely palpable and always a struggle.
And I think the other thing I’d say is like, I remember talking to residents who were working as residents in March of 2020, when things first started getting bad. And multiple people expressed to me, I didn’t know if I was going to live or die. I thought every day I walked into work I was going to get this disease, I was going to get sick, and I was going to die. And that was just the mentality that those residents and all healthcare workers at the time, I think, were dealing with. No one knew what was going on and no one knew how to protect themselves from it, and it was all just so new and so scary. And I think folks were just like, this could just be the end.
And they still went into work and took care of patients. And I think now you’re seeing the long term sequelae of that, which is people don’t want to stand for that. They don’t want to stand for that. I think for so long, healthcare workers, it’s assumed that at the end of the day, you won’t abandon patient care in order to fight for better working conditions. And I think that myth is just, we’ve got to just totally knock down the door and just say that is not the case. And that was certainly something I heard when our residents were preparing for a strike. And when we were negotiating our contract, I heard multiple attending physicians say, oh, residents will never strike. They’re bleeding hearts.
They’ll never set aside patient care and walk off the job. But we were ready. We were 100% ready. We had, of our 1400 members of our bargaining unit, we had 1000 who voted in the election, and 99% of them voted to strike. Even aside from just the numbers on paper, the conversations that I was having with people, people were 100% ready to do what they had to do. And they understood that the stakes were not just about their contract or about their salary, that it was about respect, and it was about being treated like a human. And I think the thing that drives me crazy about how residents get mistreated is there’s this assumption that, okay, you put your time in, you work really hard, you make really shitty money. And then when you become an attending, life is so good. Life is just so chill.
And first off, that’s not even really true anymore. Obviously doctors make good money. There’s no doubt about that. But even once you’re an attending, your schedule is not great, and you’re still working a lot, and you still have a ton of responsibility. And you’re still getting pressure in a million directions by the hospital administration to churn, churn, churn, and move patients in and out. And so first off, that part isn’t true. And then second off, the first part is just fucked up. Residents are usually, you’re 27, you’re late 20s to mid 30s, it’s this time where a lot of people want to get married and have a family and be moving forward with their lives.
And you have to put all that on hold because you’re making minimum wage and you’re working 80 hours a week. And I just think that’s really unfair, and it’s just really messed up. It’s not a good deal. And I think a lot of residents really are internalizing that and realizing that, and especially coming out of the COVID pandemic where it was so abundantly clear that healthcare workers’ lives were disposable, basically, to hospital administration.
And yeah, I think people are just fed up, and they recognize the power that they have as residents. And I think everyone was just so sick of the bullshit. And I think everybody knew that the only way that we were really going to get the boss to take us seriously was if we put up that strike threat. And I think, at the end of the day, we didn’t have to do it, but there’s just no doubt in my mind that if we had to, that folks would’ve walked off the job. No doubt in my mind that we were ready to do it.
Maximillian Alvarez: Well, and again, it’s a sign of the times. I mean, what was it? We are in June, early June right now, and this episode will come out a little later in June. It was in the fall of last year, 2021, when the largest healthcare worker strike in recent memory occurred. We were on the verge of it with Kaiser Permanente workers, I think over 50,000 ready to walk off the job. Again, that many people working in this field aren’t ready to walk off the job in unison unless there’s something really wrong here. And that strike was also narrowly averted, although not all of them. I think there were some locals where you had certain departments that did go on strike and didn’t get the attention that they deserved, but the major strike was averted.
And yeah, I mean, we’re going to link to this in the show notes. But when I was looking through the press release from SEIU healthcare, the Committee of Interns and Residents, the press release said, and I quote, “Frontline physicians at LA County hospitals to vote on authorizing a strike citing unfair labor practices. Over 1300 resident physicians and fellows at LAC USC Medical Center, Harbor-UCLA Medical Center, and Martin Luther King Jr. Outpatient Center could join more than 55,000 county workers in striking for a fair contract.” And that really jumped out at me because I was like, damn, I don’t think I’ve heard of residents getting ready to strike before. That seems like a pretty big goddamn deal. So could you give, I know I can’t keep you for much longer, but could you talk about that question of respect, like you were saying? Because it seems like a lot of this was focused on the administration just basically not giving you the respect at the bargaining table or taking you all seriously.
Dr. Frances Gill: Yeah, exactly. Exactly. I think their attitude was very much that residents will never strike. One, there’s, oh, they’re bleeding hearts, they’d never set aside patient care. Obviously patient care is our top priority. But in the long run, this is not good for patient care. Overworked, under-slept, stressed out residents are going to make poor decisions. And so in the long run, having a better working environment for residents is better for patient care. Everybody knows that. And so the whole like, oh, they would never set aside patient care just to win a higher salary, that’s bullshit and everybody knows it. And then second of all, they weren’t coming to the bargaining table. They were canceling bargaining sessions, and not bringing real proposals, and refusing to move on all of our economic proposals.
They weren’t taking us seriously. And I think they just didn’t realize one, I don’t know if they realized the extent to which resident labor keeps these hospitals running. There’s a lot of misconceptions about how residents’ work is allocated and how residents, what our role is on the medical team. And so I think, I honestly think that a lot of times they just didn’t realize how much power we really have, because we genuinely do run these hospitals.
And then two, I don’t think they realized how organized we were. CIR, we’ve grown a lot in the last five years, both nationally and in Los Angeles, we’ve grown and we’ve strengthened, and we’ve organized a lot. And I don’t think that they realized until we took that strike vote. I don’t think that they realized that it was possible for us to get 1000 of our residents to do something. And now they saw that it is, and that changed their tune really fast. But it does come down to respect. Because I think, like I said, medicine is so hierarchical and there’s such a clear delineation of authority, and residents are at the bottom of that hierarchy in a lot of ways.
Working People is a podcast about working-class lives in the 21st century. In every episode, you’ll hear interviews with workers from all walks of life. Working People aims to share and celebrate the diverse stories of working-class people, to remind ourselves that our stories matter, and to build a sense of shared struggle and solidarity between workers around the world.
And I think, I really think people are just sick of that, and they know, residents, we know how important the work that we do is. We know what it means to connect with the patient and to make a difference in a patient’s care, and to make a difference in that person’s day and their life. And we’re all really dedicated to that and we’ve devoted our lives to it. We’ve chosen this career path not because we’re bleeding hearts, but because we do really, really care. And I think to have that mindset and to be so devoted to this field, and then also side by side to have such disrespect from the boss, just such disregard for the things that we were asking, which weren’t crazy, by the way, they weren’t out of line.
We were asking for salaries that were commensurate with other residency programs and housing stipends that made it possible to live in Los Angeles. The new incoming residency class, the folks that are going to be starting in just under a month, they were already emailing and calling and saying like, I can’t find anywhere to live in LA. Because the salary that we had as of last year was not enough to be able to say to a landlord, here’s my security deposit and my first two months of rent. People just couldn’t do it. And also when you’re coming from medical school, you don’t have income in medical school, you’re taking out loans.
And I think that’s the other thing about this is that the system as it’s set up is basically designed so that unless you come from a rich family, it’s really hard to become a doctor. You have to pay for admissions applications, and all these tests, and med school you have to take out all these loans. And then there’s so many times during this process where you don’t have any income, but you have to move across the country.
And so, I know when I started residency, I wound up with $4,000 in credit card debt between the move and paying rent on a new place, and blah, blah, blah, and that’s not unique. A lot of my co-residents have that situation. And it’s so messed up because we want a healthcare workforce that reflects our patient population. And that’s why also a big part of what we were bargaining for was a fund dedicated from the county that was run by residents to recruit and retain new residents of color. So we had this diversity fund that we were arguing that needed to be stipulated in our contract. And of course at first county was like, no, we’re going to do $0, $0 for that. And we bargained them up to a $125,000 fund that residents control, which I just think was a really big win.
Maximillian Alvarez: Yeah, no. I mean, I think that’s huge. And so much of this, and by way of wrapping up because I know I got to let you go in a minute. But I know that, like you said, the medical field is so hierarchical. And one of the things we really try to do on this show is to give space to workers of all kinds, and to really let listeners know, it’s like everyone that you hear on this show is a worker. Everyone has something to give to the movement, and everyone deserves space in that movement. And I feel like so much of our task is breaking that crust that has been put over our eyes that has taught us that like, oh, well, workers look like this. Residents at hospitals are not workers.
You’re right down the street from a strip club in North Hollywood where strippers have been on strike for like two months. They are workers. And they’ve been struggling mightily to get the attention that they need and deserve. And again, it’s just like you look around, and you look, union density is at its lowest point. Inequality is through the fucking roof. The planet is boiling. We don’t have time to be sitting around arguing about who is and isn’t a part of this movement. I think there can be very clear lines in the sand when we’re talking about bosses and fucking, I don’t know, cops. But apart from that, what are we doing flinging mud at each other and not working to actually build our numbers, build that solidarity, and listen to one another? Because even just hearing you talk, there’s so much in what you were describing that is of course unique to the work that you do, but there’s also so much of it that resonates with stuff that workers from all across the country have talked to us about on this show.
And so I think that’s all by way of saying that part of the issue is that we need to stop gatekeeping the movement in that way, but also internally, right where you are. I know that like academia it can be very hard to get people to see themselves as workers in the first place and to feel that sense of camaraderie and rank and file solidarity. And so I just wanted to ask by way of rounding out is, how have you all come together out of this struggle? And do you see hope in moving forward with residents where you are and beyond taking more of that sense of ownership of their place in the movement? And what can people listening to this do to show support for you guys?
Dr. Frances Gill: Yeah. I love those questions. I absolutely think that this fight has made our union stronger. There’s no doubt about that in my mind. And I’ll say that people absolutely saw how powerful we were and how we won what we won because we made the threat to withhold our labor. People saw that. Yeah, so the fight absolutely made our union stronger. People saw the power of what we were doing. They saw how powerful we were as workers. And there was this intuitive understanding that if we withhold our labor, we can win what we want. And I think that was a really beautiful thing. And I also think it was a newer experience, because like you were saying, a lot of people, you have to bridge this gap so that folks conceive of themselves as workers and understand what’s at stake and what they can win.
And I think we really saw people make that leap. And we saw also our bargaining team really cohered and came together as this united force. We had residents from these three different hospitals and fighting for this contract for all three of our hospitals, and I think that was a really powerful thing too. I know I learned so much. I’ve been a member of the Democratic Socialists of America for five years, and I’ve thought of myself as a socialist. And I’ve had this ideological framework for understanding struggles within the labor movement. But I had never been a union member, and I had never been on a bargaining team, and I’d never participated in contract negotiations. And I had never put all that ideology to the test in this way.
And it was just such a profound, incredible, illuminating experience for me personally, and I know for other folks on the bargaining team and for residents who were paying attention to this. We would do our bargaining calls and have 200 residents on the Zoom. People were paying attention, they were listening, and they saw how much we won. And we’re getting folks from other residencies who are reaching out saying like, how can I start a union at my residency? People understand the urgency of the fight and they’re motivated and inspired by the work that was done here. And I know that this will have ripple effects for residents, for the situation that residents have been dealing with for decades. And I know that that’ll also have ripple effects beyond just residency programs and beyond healthcare. I was just thinking today, if every CIR member threatened to strike, we would win Medicare for all in two weeks. Residents run the hospitals, and our labor is really irreplaceable, we’re very uniquely positioned in the hospital hierarchy.
You can’t easily hire the number of attending physicians that you would need to replace resident labor. You can’t hire as many nurse practitioners or advanced providers as you would need. You can’t do it in a month. You can’t do it in, I mean, I know at the county hospital, it takes three months to hire an RN, hire and onboard. So we are irreplaceable. We have a tremendous amount of power. We just have to get organized enough that we can leverage that power to win the things that we want. And when we do, we will win big.