Update (1/12): The strike ended today and nurses won a lot of the concessions they were looking for! They were all back at work today and it was really inspiring how energized and happy they were. It's pretty cool to see people who felt passionate enough to strike over this succeed and come back to work with that win. Now residents' focus is back on our upcoming unionization vote. Thanks for all the excellent questions and discussions and the massive support.


Post: Yesterday, NYSNA nurses at Montefiore and Mount Sinai hospitals in NYC went on strike to demand caps on the number of patients nurses can be assigned at once. At my hospital in the Bronx, we serve a large, impoverished, mostly minority community in the unhealthiest borough in NYC. Our Emergency Department is always overcrowded (so much so that we now admit patients to be cared for in our hallways), and with severe post-COVID nursing shortages, our nurses are regularly asked to care for up to 20 patients at once. NYSNA nurses at many other NYC hospitals recently came to agreements with their hospitals, and while Montefiore and Mt. Sinai nurses have already secured the same 19% raise (over 3 years) as their colleagues at other hospitals, they decided to proceed with their strike over these staffing ratios and patient safety.


Hospital administration has blasted out email after email accusing nurses of abandoning their patients and pointing to the already agreed upon salary increase accepted at other hospitals without engaging with the serious and legitimate concerns nurses have over safe staffing. In the mean time, hospital admin is offering eye-popping hourly rates to traveling nurses to help fill the gap. Elective surgeries are on hold, outpatient appointments have been cancelled to reallocate staff, and ambulances are being redirected to neighboring hospitals. One of our sister residency programs at Wakefield Hospital that is not directly affected by the strike has deployed residents to a new inpatient team to accommodate the influx in patient. At our hospitals, attending physicians have been recruited (without additional pay) to each inpatient team to assist in nursing tasks - transporting/repositioning patients, feeding and cleaning, taking blood pressures, administering medications, etc.

This is all happening while resident physicians at Montefiore approach a hard-fought vote over whether or not to unionize and join the Committee of Interns and Residents (CIR) - a national union for physicians in training. Residents are physicians who have completed medical school but are working for 3-7 years in different specialties under the supervision of attending physicians. We regularly work 80hr weeks or more at an hourly rate of $15 (my paycheck rate, not accounting for undocumented time we work) with not-infrequent 28hr shifts. We have little ability to negotiate for our benefits, pay, or working conditions and essentially commit to an employment contract before we even know where in the country we will do our training (due to the residency Match system). We have been organizing in earnest for the last year and half (and much longer than that) to garner support for resident unionization and achieved the threshold necessary to go public with our effort and force a National Labor Relations Board election over the issue. Montefiore chose not to voluntarily recognize our union despite the supermajority of trainees who signed on, and have hired a union-busting law firm which has been pumping out anti-union propaganda. We will be voting by mail in the first 2 weeks of February to determine whether we can form our union.



Hoping to answer what questions I can about the nursing strike, residency unionization, and anything else you might be wondering about NYC hospitals in this really exciting moment for organized labor in NY healthcare. AMA!



Edit: it’s almost 8 EST and taking a break but I’ll get back to it in a bit. Really appreciate all the engagement/support and excellent questions and responses from other doctors and nurses. Keep them coming!

Comments: 703 • Responses: 43  • Date: 

v_rose23709 karma

Bronx resident, recently had to take my dad to Einstein after a fall (he's okay) and saw firsthand just how crowded the ER is. Thank you for everything that you do!

What's an appropriate nurse-patient ratio, and how many more nurses need to be brought on to meet that?

DoctorAesthete393 karma

Hi! I did a research article on this that I would be happy to send forward via DM. We found a majority of ICUS in the world have a 2:1 or >2:1 staffing of patients to nurses. Studies suggest that anything greater than 1.5:1 staffing of nurses in the ICU compromises patient care.

MonteResident457 karma

Yeah, as I noted in another comment, California is leading the way and they say 1:5 for medical/surgical floors. 1:1 or 1:2 in ICUs.

heman8400292 karma

What absurd things has management done to pretend to show you they “care” about you?

MonteResident537 karma

Well they rounded up residents for mandatory anti-union meetings with our program directors. A lot of gaslighting in those meetings. Basically telling us that unions don't work, will ruin our working relationships, will have expensive dues, won't achieve what we're hoping for. Ironic in the setting of a very real demonstration of union power by our nurse colleagues.

Otherwise they haven't done much. A few free meals in the hospital. Nurses have been carrying "Patients over Pepperoni" signs to parody the fact that they often think some free pizza will solve our disgruntlement. We are at a non-profit hospital in a poor community so we don't expect much, but it's pretty pitiful.

nishbot238 karma

What are your feelings of the hospital being non-profit but the CEO made $13 million?

MonteResident356 karma

I mean it's ridiculous! A physician could never reach that kind of compensation doing clinical work and I think that really changes a leader's perspective and priorities. But it's also just part of the much wider American issue of out of control executive pay. I don't think we'll solve this one in healthcare until it's been addressed more globally.

conipto2 karma

When a doctor, a job people have aspired to and thought of as a high income occupation for my entire life, calls CEO pay out of control, that's a perspective people need to hear.

I mean not to imply you're overpaid, but the fact that people should recognize that careers we aspire to are still an absolute pittance compared to what these execs are making.

MonteResident3 karma

Doctors used to be some of the highest earners in society and you can have an argument about whether or not the pay was justified but I have to think doctoring provides more of a worthwhile/valuable service than whatever it is executives do. An interventional cardiologist who stops heart attacks all day gets paid 1/15th of the hospital CEO? The cardiologist is paid very well so I think that demonstrates how executive pay has become completely unmoored from what they actually do.

HelveticaTwitch220 karma

Not OP, but my girlfriend is a resident at a Chicago hospital. On national doctor appreciation day last year the hospital sent out a memo thanking them all for working so hard through the worst of the pandemic and treated them to a whole free coffee from the hospital cafeteria. Isn't that great! They also took out a full page ad in the Chicago Tribune to accept donations to the hospital to "thank our doctors". You can bet none of that actually made it to the medical staff though.

MonteResident154 karma

Yeah, that's pretty par for the course. Doctoring is not necessarily the glamorous life that many think it is. There are definitely private physicians pulling in high salaries and driving nice cars, but there are also many primary care, family medicine, pediatric doctors (the lowest paid specialties) who work incredibly long hours and make $100-200k after 7-10yrs of post-college training and who carry substantial debt. Residents make even less based on the promise of future earnings, and have lower salaries than nurses, physician assistants, and nurse practitioners.

picklesandmustard114 karma

I can’t believe how poorly nurses and residents are treated. 20:1?? How often do the nurses get to round on patients, like once a shift? Hope nobody codes. And at $15/hour you could work at target or McDonald’s or Walmart. That’s absurd for someone with a bachelors and an MD.

MonteResident117 karma

The 20:1 figure I've only really heard of in the ED which is a special type of chaos but the ratios are higher than they should be on the inpatient floors and ICUs. Having worked in the ED, I know it means that patients don't get their vitals done, labs drawn, medications given on time. Patients hate coming to our Emergency Department and guess who must accept the anger and frustration from patients who have been waiting for hours.

True, if I was prioritizing earnings in my career, I've made a terrible choice. It's true that doctors are well compensated when they've evolved into their full form but I don't have that money now. And I anticipate that I will complete my training in my mid 30s without making much of a dent in my debt (thank god for the student loan payment hold) which is a long time to live on the promise of future fair compensation.

Blinxs20993 karma

What has been the response and general attitudes of the attendings in terms of a) the residents efforts to unionize and b) the nurses striking?

It seems physicians are usually more conservative so not as receptive to union efforts.

MonteResident149 karma

It's been mixed but I think mostly supportive. We have a very large pool of young attendings who recently finished their training who are very supportive of all labor efforts. There's also been an exodus of many senior attendings, particularly in subspecialties over many of the same issues residents and nurses are fighting over and we've heard there have been discussion among attendings about their own unionization effort. Program directors attitudes have varied from anti-union to apathy/indifference as they are forced to share the hospitals anti-union messaging - some have been quietly supportive.

lost_in_life_3472 karma

how much does management make compared to doctors and nurses?

MonteResident201 karma

I guess it depends on who we're talking about. Executive pay is a real sticking point and our hospital CEO, Dr. Philip Ozuah is an incredibly highly paid hospital exec who reportedly made $13million a few years ago. I can't imagine how a physician could make that much in good conscience while telling nurses they are being greedy but that's administrators for you.


Doctors and nurses vary a lot in salary depending on specialty, years of experience, etc. but no where near the millions of dollars of top admins. Think $100,000 to $800,000 (rarely).

PeanutSalsa67 karma

What obstacles stand in the way of building more hospitals and hiring more employees to lessen the burden on current employees?

MonteResident157 karma

It's really expensive! And in NYC, space is an issue. Montefiore has expanded significantly into Northern suburbs of NYC but we know it's because these areas are whiter, more affluent, and more profitable. In the mean time, they announced the closure of a critical ambulatory site in The Bronx where many needy patients receive their primary care.

Attracting employees is about pay, but also a good work environment. Montefiore is the teaching hospital of Albert Einstein School of Medicine and is a major academic institution so we expect to be able to do incredibly good medicine here and are faced with so many daily obstacles that are kind of unique to NYC and then to The Bronx. And in my time here, it feels like hospital admin is focused on profit and rarely with what it takes to make this a great place to work.

citysoils45 karma

How do the conditions compare to other facilities within the organization? My Mother is at the St. Luke’s montefiore hospital In Newburgh.

There was a traveling nurse there and the level of patient care definitely seemed lacking.

MonteResident43 karma

I wish I could answer more specifically but I've never worked at St. Luke's. I work at Moses and Weiler Hospitals and those are the Montefiore Hospitals affected by the strike. They are also our hospital systems largest and best equipped hospitals, and Moses in the tertiary care center where sick patients throughout the Monetefiore system are transferred for a higher level of care. So as you can imagine, if we're having issues at the core hospitals, they likely apply in one way or another at the satellites.

skiwith42 karma

Why are ERs used as primary care? Why is a hospital so much more expensive to provide primary care than a urgent care or Dr's office? Can we not set up a system that provides health care rather than 'insurance ' that costs 1200 a month yet seems to cover nothing?

jeremiadOtiose70 karma

Why are ERs used as primary care?

EMTALA, which requires an ED to treat anybody who walks thru the door, regardless of ability to pay.

Why is a hospital so much more expensive to provide primary care than a urgent care or Dr's office?

overhead, including being open 24/7

Can we not set up a system that provides health care rather than 'insurance ' that costs 1200 a month yet seems to cover nothing?

there are direct primary care clinics that charge $1-3k a year to join and you can see your doctor freely during the year. it doesn't cover labs, which you'd use insurance to pay, or find a lab that's cheap to do them at a cash rate (rare). they recommend keeping high deductible insurance, so you can get that expensive surgery, or if youa re in a trauma.

also there's a surgical center in Oklahoma that is cash only and publishes all their rates online, and is VERY competitive. https://surgerycenterok.com/

MonteResident52 karma

Pretty much answered here. There also many barriers to getting good primary care and many patients feel like they have no other option than to use the Emergency Department when they get sick even if it's not strictly an emergency. In The Bronx, we have too few doctors, long wait times to get appointments, and then the multitude of structural challenges that make it hard for poor patients to get to appointments and take good care of themselves.

onlinebeetfarmer38 karma

What can the public do to support the strike and resident unionization? It’s long overdue. Wishing you luck!

MonteResident40 karma

Thank you! I wish I had more for you, but call your representatives in government, support your own local labor efforts. If you're in NYC, go support the nurses standing in front of Monte and Mt. Sinai and especially call our representatives. If I can think of more concrete measures or get ideas from colleagues I will pass it on!

ann10214 karma

You can not go to that hospital. You can write to your government reps. You can demand the press cover the real issues and show the public what a danger this really represents to the public. Nurses are vital. Reasonable ratios for trained professionals are essential to your safety. You can join the nurses at the picket lines.

MonteResident27 karma

Agreed but we are encouraging everyone to continue to seek medical care if they need it! Don't let a nursing strike weigh on your decision to call 911 or go to the hospital (whichever hospital) if you think you need it.


astroams32 karma

Would you still recommend people become nurses or physicians given the seemingly bleak outlook of profit > patients for the next decade or so (or however long it takes to make a dent in the system)?

MonteResident62 karma

Yes! I don't think the answer is to turn away from the field because there are problems. If someone is passionate about science and medicine and wants to use that passion to serve others they should get in. But they should inform themselves of the challenges and what these jobs really look like. Anyone considering these careers should spend a lot of time talking to nurses or doctors they respect and shadow as much as possible to see the day to day. If it still seems worthwhile, go for it.

We are focusing on the negatives here and there are so many amazing parts of the job. But we need young and old healthcare professionals to remember that the services we provide are at the center of all of this and that we need to take more responsibility for all the machinery that has evolved to facilitate that central service.

RainCityRogue29 karma

If a hospital is at their safe nurse staffing ratios and a new patient shows up, what happens? Are patients turned away if there aren't enough nurses?

And if you have safe staffing ratios and then a lot of nurses get sick and can't work do you then have to discharge patients to bring the ratios in line?

MonteResident47 karma

In normal times, we don't turn away patients or discharge early - that has happened in this strike because we have only about a quarter of our nursing staff. But generally if ratios were in place and were exceeded the hospital would need to call in additional nurses to solve the problem. Nurses often work 3-5 shifts a week so they could be incentivized to work overtime.

I think in that specific instance, they might float a nurse from a less busy part of the hospital to the one at capacity. But generally this is a question of size of the nurse work force. Nurses are saying that Monte has not done more to fill the vacancies that exist and they shortfall is landing on our existing nurses. The hospital needs to do more to guarantee those vacancies are filled.

RainCityRogue8 karma

But knowing that there is a nationwide nursing shortage and insufficient capacity in education programs to meet nursing demand, there aren't many nurses out there to call in to cover a shift.

I agree that staffing ratios are important for patient and staff safety, but should we be creating a mandate that can't be enforced without limiting the availability of care?

MonteResident58 karma

True and I can't claim to have the solutions to the national nursing shortage but there are nurses out there, many of whom have left the bedside after COVID or for other reasons because the demands have become increasingly untenable. Return the job to what nurses signed up for in nursing school and we could see improvements. Pay more, pay for parking and transportation (we all just accept we have to pay to park at our workplace), offer moving stipends, bonuses for working holiday shifts/overtime, educational benefits. Other industries have learned how to court skilled employees and it just hasn't been a priority for hospitals because no one has had the power to make it one. And when the nurses just leave in response, the answer from admin is to make fewer people cover the same responsibilities? I don't accept that there isn't a better solution.

platon2022 karma

Are these NY hospitals still using 99% FMGs as slave labor and forcing their residents to transport patients and do all the blood draws instead of hiring phlebotomists?

MonteResident34 karma

There are still many programs that admit disproportionate numbers of Foreign Medical Graduates who are desperate to get into the American healthcare system and who will accept worse conditions and pay to do it. The top programs have fewer FMGs who are competing with American graduates. Montefiore's residency programs are well-regarded and competitive and the Moses/Weiler programs are the main "branch" and the most competitive. We have fewer FMGs than some of our sister institutions in The Bronx. They are fantastic doctors who bring diversity and unique experience and perspective to our hospitals and they deserve to be treated as any other trainee.

Importantly, we are the only residency program in The Bronx that has not already unionized.

As for non-physician tasks, we do still have too few phlebotomists but the problem is overstated. I will place an IV (usually with ultrasound) if my nurses have tried and struggled. I will draw blood if the test is needed more urgently than when we can expect phlebotomy to round or if the phlebotomist doesn't succeed. I will walk blood samples to our lab when we need a result urgently for a critical patient. I will walk to the blood bank to get blood for a patient when it's needed urgently. I accompany ICU level patients when they leave the ICU for imaging etc. (but rarely need to transport patients myself otherwise). Our programs have made progress on some of these longtime complaints in NYC hospitals but I know there would be more with some real union leverage.

Nixplosion17 karma

Nurses work the hardest, longest and are underpaid compared to the labor they put forth. Yet they strike over patient safety because that's truly what they care about.

What do you think can be done to attract more people to the field to fill desperately needed roles?

I'd imagine this would second hand solve patient safety issues if there are more people to run the ground level operations.

MonteResident61 karma

It's a hard question, especially after COVID stressed the system and burned out so many of our nurses and doctors. But I think we need to attract more nurses by increasing incentives and making the job less miserable. We need to increase pay for nurses, yes, but we also need to improve their working conditions which includes things like enforcing reasonable nurse:patient ratios.

California is leading the way in legislating nursing ratios and suggests 1:6 at most. There's research about what's safe that I won't get into now but it's clearly a far way away from the 1:20 that our nurses are fighting over.


Another thing. Montefiore has responded by offering to create more nursing positions in their negotiations which is disingenuous because we have a huge surplus of unfilled positions now. Nurses are demanding guarantees that changes will be made to fill those vacancies. And we know they have the money as they're paying travel nurses many times the going rate to cover this strike.

wingsrul14 karma

How do unions help patients?

MonteResident57 karma

Unions provide a point of leverage for hospital employees, and in many cases, hospital staff are more cognizant of and aligned with the needs of patients than hospital administration which, through my observations thus far, is focused first on profits.

The current strike is an excellent example. This is a case in which nurses have already secured a pretty significant pay raise but went on strike anyway specifically for staffing ratios. Sure, better staffing ratios makes life easier for nurses, but it's also a major safety issue. Nurses are supposed to check in with their patients every hour, regularly take vitals, give medications, respond to calls, etc. When they have 20 patients, that can't happen and things fall through the cracks. It's not uncommon in our Emergency Department to find that patients haven't had vitals checked in hours, that medication administration was delayed or forgotten, that blood was never drawn, or even that staff can't locate the patient. The answer to an incredibly busy ED is more space and more staff and union negotiations might be the only real way to force admins hand.

TwoPintsNoneTheRichr10 karma

Good for you guys. How are you managing/balancing the challenges associated with wanting to improve working conditions and, effectively risking your future careers to do so?

MonteResident31 karma

Well I think it's safety in numbers. Our unionization effort has wide support among residents and fellows so we're hoping that the hospital won't be able to single people out for retribution. We also prioritized secrecy. Until recently, all of our organizing efforts were happening underground to avoid admin attention. We went public when we had the numbers. It's scary but it's the same challenge union proponents have in any industry.

TwoPintsNoneTheRichr23 karma

I think the challenge for you, specifically, is that unlike other industries you have 300k+ in student loan debt and getting blackballed in the residency system likely means you wouldn't be able to practice as a physician and have the capacity to pay that off.

Hats off to you guys for your bravery.

MonteResident23 karma

Yup the stakes are high but I'm hoping physicians who have gone through the residency process will recognize what an unusual and powerless labor market residency represents and will respect our efforts to make things better. In the mean time, I will have to keep posting anonymously.

Endures9 karma

So a truck driver can't work more than 12 hours, but I can get a doctor on his 27th hour awake? That's fucked

MonteResident2 karma

Yup! We are able to sleep at night if it's quiet but then you still need to wake up to respond to pages or any other issues. We go into every 24 praying that its not a sleepless one but if the admissions are rolling in, awake the whole time.

dreadpiratew9 karma

What do you think would happen if a junior mint was accidentally left inside a patient during surgery?

MonteResident10 karma

I feel like I learned something about this once and I’m pretty sure the junior mint would stave off infection and save the patients life (to Jerry and Kramer’s relief).

OryxTempel8 karma

How would unionizing affect your malpractice insurance?

MonteResident28 karma

As trainees, nothing would change as far as I know. Residents do not have independent medical licenses (at least in NY) and we operate under the licenses and supervision of our attendings. We are all covered under general hospital malpractice insurance and most of the liability falls on our attendings. I think that answer would be far more complicated for an attending union but I don't know more.

LateCircumcision7 karma

Legitimate concern: if the doctors and nurses go on strike, what is the potential patient life cost? I mean to say isn't there a strong possibility that patients will die while care workers are on strike?

MonteResident4 karma

This worries all of us. No one wants to strike. Keep in mind that nurses are not paid while they are striking. But there comes a breaking point. We constantly advocate for our patients, writing reports when we see a safety issue in the hospital, bringing up problems to our chief residents, program directors, department chairs. And time after time we are told about why the issue is challenging to solve and that our concerns will be passed on. Nothing changes. When a contract expires and the negotiations for a new one begin, employees finally have an opportunity to hold our employer accountable. And this is the result.

We make every effort to ensure patients are well cared for despite the strike. Residents and attendings across the hospital have stepped up to fill in for nurses and care for patients in their absence. But we are not nurses and do not have their training nor their expertise. I don't doubt that bad things are happening that wouldn't be happening if nurses were at work. And I contend that responsibility lies squarely with hospital administration.

HHS20196 karma

Hello. Thank you for doing this.

Aren't you afraid that if one of your patients dies in your absence during a dispute over salary that you would be subject to a wrongful death suit, given the American definition of a physicians' legal duty of care?

MonteResident63 karma

To be clear, resident physicians aren't currently striking. We are still at work caring for our patients. In a theoretical resident strike, I would be worried about my patients in our absence, but technically a hospital should be able to run without trainees. We are supervised by attendings and without us, attendings would fill in. In reality, hospitals rely on residents much more than they let on and a strike would be devastating to operations. I think this means hospitals would be much less likely to hold out on negotiations if a strike was looming. But there are other ways for residents to protest - for example not doing the appropriate documentation so that the hospital can't bill patients. Unionized residents in LA county threatened a strike over their contracts last year and it was averted because the hospital knew the consequences. Ultimately, we will find ways to care for our patients while advocating for them and ourselves.


stingrayerr5 karma

How can healthcare be so expensive (compared to the rest of the world) yet be understaffed and underresourced?

MonteResident19 karma

I think we have a lot of bloat in our system. There are administrators and non-clinical employees at every level of our system who facilitate the money side of what we are doing in the hospital. There are entire buildings of insurance company employees whose entire job it is to review claims and finds ways to contest or deny them. There's a larger debate on whether or not universal healthcare would solve these problems but everybody knows that Americans spend way more on healthcare for the same or less care.

rednib4 karma

What is the name of the law firm?

MonteResident5 karma

We've been told it's called Jackson Lewis.

BK12874 karma

Are you familiar with the group Left Voice? They were quite vocal throughout COVID and a nurse I know from high school helped with some of their organizing efforts. Just curious if they are still active in NYC.

Unionization in healthcare seems like a necessity at this point and this public health professional is rooting for you. I've hired/spoken with so many front line healthcare workers over the past 2 years that have transitioned out of direct care for patients because of the unsafe working conditions or being required to work way above licensure.

It's absolutely crazy how little these workers are paid compared to the hardships and absolute danger they face each and every shift. Hoping for better days, but know that letting the status quo continue isn't the way. Keep up the great work raising attention to these issues.

MonteResident3 karma

I wasn't familiar but thanks for turning me on to it. And I see that they have an interview on their front page with one of our fantastic nurses who I've worked with and who is leading her colleagues most admirably.


chadharnav3 karma

I want to become a surgeon in the future and will be starting med school in 2025. If offered, would you take option A: reduce hours at same rate with overtime, with annual inflation adjustments or option B: keep the current system but increase pay to 25 an hr, with annual inflation adjustments?

MonteResident10 karma

Congrats! And don't be deterred by some of the negativity here. It's a hard and long path but I think there are so many profound and wonderful aspects of the job.

I guess I would take option B? To be honest, I don't really think of my residency compensation this way. I want enough salary to pay for the high cost of living in NYC with some leftover to fund a life in those rare times we're away from work. Many of us just cover the living expenses now. I think we also want to be respected as physicians amongst our other colleagues. At least pay parity with our nurse, PA, and NP colleagues is appropriate. To be clear, I don't think nurses, PAs, and NPs are paid too much. We are paid too little and that reflects how little power residents have relative to other roles in the hospital.

anothernotavailable23 karma

Are you afraid that a union will make your graduating residents less attractive for fellowships/jobs as they may seemed less trained? If you're able to limit hours to 60 or 40, that could be a significant decrease in clinical time for residents.

In turn, that could make the residency program less attractive to med students.

MonteResident20 karma

I'm not too worried about that. Many residency programs across the country have already unionized and are reaping the benefits. CIR, the union we are electing to join, already represents ~25,000 house staff (residents and fellows) across the country and some top programs (Stanford, UCSF, NYU, UCLA) are unionized without any appreciable damage to their reputation. In fact, unions are increasingly a selling point for residency applicants because those programs on average have better pay and benefits as well as an opportunity to shape their work place.

An important thing to note is that we haven't settled on any contract provisions, like limitations in working hours. At this stage we are only demanding a seat at the negotiating table. I think if residents did manage to negotiate for that significant of a decrease in hours there would be concerns, but our training is still dictated by the ACGME, and any contract would have to be in line with their accreditation requirements. Finally, most residents know that this is the time in our careers where we have to learn to be doctors. We don't like long hours and only one day off a week but we also know that it isn't forever, and that it makes us stronger clinicians. I think that a 40hr work week would not be a priority for most residents but there are ways to make incredibly long work weeks more humane.

Pof_no3 karma

What is the safe/ideal patient to nurse ratio? If the strike is successful how will montefiore successfully fulfill those open positions when it seems like every hospital is in a similar situation?

Are there other issues that need to be solved besides increasing nursing staff such as tech and process?

MonteResident5 karma

I'm no expert on nursing ratios but depending on where in the hospital we are discussing, the thought is about 1:5 or 6 at most. Other comments have broken down some of the research on this.

As a resident, I don't know the day to day specifics of the current nursing negotiations and what guarantees about staffing NYSNA is looking for but I think the hospital will have to show some real progress towards actually filling their vacancies and not just creating more unfilled positions.

There are a lot of other issues and I think residents are hoping we can prioritize some of the most egregious issues and force progress on them with a union contract negotiation. For example, we have far too few technicians in our radiology department meaning that patients can wait days for a critical CT or MRI while we do absolutely nothing for them. Monte hired McKinsey consultants last year to recommend cost-cutting measures and their suggestion was to decrease the size of our radiology department. Mind boggling that they took that advice.

ECU_BSN3 karma

Thank you for supporting us.

What is your favorite supper?

MonteResident6 karma

A doctor can't do much without their nurses. A nurse can't do much without their doctors. We're all in this together.

Ughhh always hard to pick a favorite so I'll say a NY slice with some pepperoni hits different.

DollarThrill3 karma

Do you ever see the bills sent to patients based on the work you perform?

MonteResident24 karma

No! Healthcare costs are a Pandora's box of issues but generally we are only tasked with choosing the right care for the patient. Inpatient, we order what we believe are the correct tests to diagnose an issue, order the appropriate medications, and do the needed interventions without ever seeing a bill or dollar figures. That doesn't mean we don't consider costs. There's an active movement prioritizing value-based care for patients which tries to ensure we are as efficient as possible in doing all those things. We also interact with the money side of things all the time when insurance companies refuse to cover certain indicated treatments or tests and we have to pursue prior-authorization.

Insurance companies are the bane of any doctor's existence and I think most of us have big problems with how American healthcare is structured and paid for but you might be surprised to learn that doctors have only so much influence over how the whole thing runs. Cogs in the machine...

rollie822 karma

One of the drivers for ER overcrowding is the 'free' aspect for low income patients. What in your eyes would be the optimal system of medical service provision and payment? Common options would be medicade/medicare for all, a new 'single provider' option, or perhaps government run hospitals to cut out all elements of capitalism with regard to patient health (e.g., the hospital is trying to make money).

MonteResident4 karma

This one is over my pay grade (which I'm learning is way lower than people think) and any quick answer here will say more about my own opinions and politics. I think we need to cut so much of the bloat that is unrelated to patient care but is focused on the money making side of medicine. Some form of universal healthcare could do the trick but how you implement that I'll leave to the policy makers who spend all their time trying to figure out this issue.

matryoshkas2 karma

Do you think that this will set a precedent for other facilities throughout the country in terms of staff to patient ratios? Will this be the spark that starts the larger discussion that upper management is continually content in dismissing?

MonteResident2 karma

I don't know if it will have implications beyond NYC. I hope so! I'm here trying to raise awareness of what's happening in The Bronx because I know many of the same challenges apply around the country. But NYC hospitals have a reputation for being very different and there are many hyperlocal specifics. I think we need to have a national conversation about the state of healthcare and national legislation. In the best case scenario, the NYSNA strike helps to get the ball rolling or keeps the momentum going.

[deleted]1 karma


MonteResident18 karma

I have to reveal that I never watched Gray's. I was more of a House/Scrubs person and now that I'm a doctor I generally avoid medical dramas/comedy because I don't need more medicine in my life.

GoDeeper250 karma

Is your OC 10% any holes in it?

MonteResident1 karma

Not sure I understand the question. Are you referring to our union organizing committee? If so, what do you mean by holes in it?

Olympus___Mons-5 karma

What is your opinion on UFOs?

MonteResident7 karma

Is this an acronym I don't know or is it just what I'm thinking of?

Didn't think much of UFOs until I saw that Navy footage and now I don't know what to make of them. Probably there is other life in the universe. Probably intelligent alien beings haven't interacted with humanity in space ships.

studzmckenzyy-8 karma

Part of the nursing staff issue stems from hospitals firing (or not hiring) nurses and other staff who did not receive a covid vaccine. Two questions: Did your hospital do that? Given what we know now about post-vax transmission, do you think the hospitals should reverse their decisions?

MonteResident11 karma

Ooohhh this is a tough one and an excellent question. Montefiore did in fact fire nurses who were unwilling to receive the COVID vaccination. At the time and now I agree with that decision.

Of course we want as many capable nurses as possible but COVID vaccination was such a basic and necessary minimum requirement for employment in a hospital that I think it was right not to budge on this, especially considering it was coming after what was essentially a war-time environment in NYC hospitals. I don't want to debate vaccines, but pretty much the entire medical establishment agreed that vaccines were and still are our best tool against COVID. We require a battery of vaccinations and yearly screening in the US to work in healthcare and the COVID vaccine should be no different. If the medical consensus is that everyone should be vaccinated, and especially among those with frequent exposure to COVID, staff has to be on board. There's a lot more to say and discuss but ill leave it at that for now.

Ninac4116-11 karma

How common are doctor/nurse affairs?

MonteResident29 karma

Haha I love it, nothing to do with organized labor but we want the gossip. Honestly, not sure as I think people smartly make efforts to keep that on the down low but there are certainly doctor/nurse couples who meet in the hospital. Definitely not Grey's Anatomy levels.

0wlington-16 karma

Why do doctors charge so much money when they supposedly want to save lives?

MonteResident12 karma

Doctors are rarely the ones doing the charging! I mentioned in another comment that we don't actually see the bills for patient care or know exactly how much what we're doing costs. In fact, no one probably knows when the tests are ordered and treatments given. The bill is calculated by administrators and insurance companies and negotiated over and varies patient-to-patient, insurance-to-insurance.

We just do what the patient needs, and good doctors will try to do that with the minimum necessary number of tests and treatments. This is especially true for residents who collect an annual salary and don't receive additional pay for particular services. Attending doctors in other healthcare settings (eg. a private practice cardiothoracic surgeon) are likely much more intimately involved in costs.

And sometimes this stuff is just incredibly expensive! To do a coronary bypass surgery you have to pay for the operating room, equipment costs, medications, tests, images, and the time and expertise of 4-8 highly trained experts who are all there to do your surgery. There's literally a machine and technician who circulate and oxygenate all of your blood while the surgeons work. Its miraculous and expensive.