What do the heroes of the COVID-19 pandemic need?

The COVID-19 pandemic has upended daily life for all of us and has remarkably highlighted the heroic work of our frontline health care workers. Residents and fellows are doctors who have earned their MD or DO in medical school and are currently being trained in a particular specialty or sub-specialty of medicine or surgery. They have seen their clinical responsibilities exponentially increased and have stepped up to the plate to meet this rising demand in COVID-19 patient care.

Residents and fellows are essential frontline health care workers who keep our health systems afloat and should be supported in a way equitable to other health care workers. In addition to supporting both their emotional and educational needs, other meaningful support including financial protections such as hazard pay and/or some form of full or partial loan forgiveness should also be considered. Residency ranges from three to eight years and is a very rigorous phase of clinical training. Residents work so many hours that, in an effort to reduce errors resulting from exhaustion, regulatory bodies now limit resident work hours to 80 per week. How much do residents earn for these two full time jobs? In the first year of training, an average of $57,191. Allowing for three weeks of vacation during the year, this comes out to approximately $15 per hour. In return, residents are provided with mentorship, educational opportunities, and guidance in building their medical career. During this pandemic, however, residents are often assuming roles that are not typical of residency training with much of their educational programming curtailed. Out of the spotlight and behind the scenes, residents are focusing on serving patients in need, risking their own lives in the process and receiving no additional pay for this work.

Many residents and fellows play a critical role in the frontline response to this pandemic, yet they have no decision making power regarding their clinical assignments. They are already managing the stress intrinsic to the incredibly steep learning curve of COVID-19 patient care while functioning as critical staff at teaching hospitals which are often safety-net hospitals for our nation’s most vulnerable. This pandemic is only pressing them further. Residents and fellows are separated from their spouses and children because of the risk of bringing COVID-19 back home. In fact, in a small study in JAMA assessing the major sources of extreme anxiety physicians are experiencing, 69 physicians were asked about their key concerns during COVID-19. Their top two responses were access to appropriate personal protective equipment (PPE) and being exposed to COVID-19 at work and then taking the infection home to their families. Our residents and fellows may also have chronic health conditions themselves and are fearful of the impact of this illness on them personally, yet they are showing up for work every day, even though colleagues of theirs have fallen ill and even died.

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Some critics might believe that these residents and fellows signed up for these inherent risks when they decided to become physicians. While trainees expect to work hard at great personal sacrifice for the well-being of patients, never before in modern medicine has there been the level of personal risk and sacrifice required by COVID-19. Most medical students have been removed from clinical care to avoid exposure to COVID-19, but our medical residents and fellows work harder, for less, than any other doctors. Many of them bear the greatest risk of illness or death in a pandemic like this one.

As work continues on another COVID-19 stimulus package, we call on Congress to pass a proposal that includes residents and fellows with hazard pay or loan forgiveness or forbearance for all or portions of their student loan debt for residents and fellows on the frontlines of the COVID-19 response. In teaching hospitals, which is where the sickest patients often go, residents, fellows, nurses and respiratory therapists have the most direct contact with patients and are truly essential to providing lifesaving care to patients with COVID-19. We are at war with an invisible enemy, and our residents and fellows are on the frontline. Even though many states are reopening, there is still the continued threat of an uptick of COVID-19 cases or second wave. We should support our doctors in training who have repeated, prolonged exposures to COVID-19 while working on the hospital floors and in the ICUs. Residents and fellows keep hospitals afloat and receive little in return. The least we can do is to support them as the heroes that they are.

Dr. Henry is an Assistant Professor of Medicine at Emory University School of Medicine. Dr. Niess is the Chief Medical Officer of Charlotte Community Health Clinic. Dr. Van Doren is an Internal Medicine resident at Emory University School of Medicine. Views are their own.