How do we care for those who care for us? It’s an important question — especially after the COVID-19 pandemic pushed every doctor, nurse, and medical staffer to the brink. The debate has now reached doctors in training — also known as residents and fellows — who are in the process of deciding whether they want a union at Mass General Brigham.
I’ve stood in their shoes, training to become a neurosurgeon at Massachusetts General Hospital. Now, as a faculty member, I have the great privilege of training this next generation of great physicians.
Mass General Brigham’s training programs are among the country’s top-ranked — and will be the highest-paid come this summer. However, as the economy has changed, so have the needs of our workforce — inside the hospital and out. That’s why Mass General Brigham began a multiyear process to assess and raise salaries across the organization two years ago. Mass General Brigham increased pay for trainees in July and this year trainees will receive a 10 percent pay increase; better benefits, such as no-cost health insurance and employer contribution to a retirement savings plan; and a $10,000 stipend for such needs as housing or child care.
But as doctors, we are lifelong learners, committed to finding ways to continually make improvements. That’s why residents are also part of decision-making on matters critical to their programs through Mass General Brigham’s newly created Education Operations Coordinating Committee, bringing fast and direct changes in response to their needs, including new teams to manage patient overflow and more administrative support on inpatient floors.
Mass General Brigham is investing in our residents in so many ways because it’s the right thing to do and it’s what they deserve. But I worry about the impact collective bargaining could have on how Mass General Brigham trains doctors for the future and the lasting impact it could have on their careers by limiting access to educational resources and the flexibility residents need to chart their own paths.
I think of one former student who came to my neurosurgery department for training. He was already brilliant and trained in immunology, and we knew that he could bring those skills to the operating table to become an equally brilliant neurosurgeon. We worked with him to create an individualized plan that would enable him to train in neurosurgery with us and to further his research at the same time. This collaborative effort has led to the development of a promising new therapy for brain tumors and new hope to patients. Based on this work, he recently enrolled the first patient in a clinical trial to receive cutting-edge CAR T-cell therapy, all while mentoring trainees as a faculty member at the hospital.
Another resident, already an expert in neuroscience, realized she wanted to shift gears to study cancer and become a skull base surgeon. Change like this is not easy when you are training in a medical specialty, but we worked with her to give her access to experts in both fields and offered the flexibility she needed to focus on skull base surgery while also conducting cancer research. This helped her get the experience she needed to land one of the most sought-after skull base surgery fellowships in the world.
These are only two of my stories. Every resident, and every mentor and teacher, has similar stories. For me, my proudest moment was when my own mentor, someone who many years later I still consult with on my cases, called me to consult on a case of his own.
When I am in the operating room, my resident and I are assisted by an exceptional team of technicians, anesthesiologists, and nurses. But when it comes down to making that split-second decision on how to save or better a life — it is just me and my resident. In that moment, the resident is my only partner. It is hands-on and emotional. We rely on each other. We are a team.
How much of this experience can be collectively bargained? Honestly, I don’t know. A union, almost by definition, creates a disconnected and adversarial relationship. And a 2021 Journal of the American Medical Association study found that resident unions did not lead to improved satisfaction on things like burnout, job satisfaction, or salary.
There is always more that Mass General Brigham can and will do, together with our residents, to ensure we deliver on our promise of an outstanding educational environment. But I fear a union could derail those efforts, limiting our ability for flexibility and putting at risk the real-time team experience our doctors-in-training need to be successful — in their careers and for the patients they care for.
Dr. William Curry is chief medical officer at Massachusetts General Hospital and a practicing neurosurgical oncologist, pediatric neurosurgeon, and neurosurgeon.