Medicine and society have changed—but not conditions for residents

When Ruth Potee’s father started his medical residency at Boston City Hospital in 1949, the system was pretty simple: young medical school graduates received room, board and a lab coat in return for patient care and the training that went along with it. At the time, only residents at Bellevue Hospital in New York City received a stipend.

That changed when Gale Potee and his colleagues formed the first house staff association in the country and won stipends from the city of Boston. “It started a movement where residents were recognized as not just students, but doctors who deserve some compensation,” says Ruth Potee, M.D. ’99. But change is slow. Half a century later, when Potee was deciding where to train, she could safely expect a paycheck, but she also wanted an institution where the house staff had a say in how the hospital runs. “I didn’t want to be at a place where I was a voiceless peon in the system,” she says. She joined Boston Medical Center, where in 1972 the house staff association became a union with bargaining rights, and became an active member of the organization her father had helped found.

In 2002, in the final year of her residency in family medicine, Potee became national president of the union, the Committee of Interns and Residents (CIR). (Union rules allow members to remain on the executive committee for two years after completing a residency.) Now the largest house staff union in the country, CIR still represents only about 12 percent of the nation’s 100,000 residents. “It’s hard to organize residents,” Potee says. “They have no time to organize themselves. They are so tired and broken and depressed, they can’t imagine things ever getting better.”

But Potee firmly believes residents need to be organized, especially since medicine and medical students have changed so much since the system was devised. For much of the 20th century, residents were usually young, male and single. Today’s resident is far more likely to be older, female, married and a parent. Potee was a member of the first majority female medical school class in Yale history, entering medical school at age 26 after working in politics in Texas and New York. She married and had her first child while at Yale, and gave birth to her second child during residency. (Half of women in medicine give birth during medical school, residency or fellowship, says Potee, who wrote her thesis on medicine and motherhood.)

Through her position at CIR, Potee works to make residency better for today’s graduates. Founded in New York City’s public hospitals in 1957, cir won a collective bargaining agreement and established a benefit plan for house staff early on, and in 1975 negotiated a contract provision limiting call to one night in three. In a landmark 1999 case brought by CIR, the National Labor Relations Board ruled that residents are employees, not students. CIR helped shape New York state’s Bell Regulations on duty hour limits for house staff, a model for the new duty hours guidelines from the Accreditation Council for Graduate Medical Education, which went into effect in July.

The union also fights for minimum staffing levels for ancillary hospital personnel, so hospitals can’t cut nurses or technicians and expect residents to fill in. Those kind of cuts are bad for residents and for patients, Potee says. “The hospital can’t balance its budget on the backs of residents,” she says. But with budget deficits in most states, hospitals’ finances aren’t likely to improve any time soon. “I worry that residents are the group that tends to fill in the cracks, and the cracks are ever widening.”