Dear Loyola Medicine administration,

Several members of Loyola's housestaff community are formally expressing our concern and indignation about recent decisions that negatively affect our workflow, quality of life, and most importantly, as a direct result of the aforementioned, patient safety; specifically the decision to not increase resident salary to account for the unprecedentedly high inflation rates and the loss of healthy and affordable food options for overnight staff. Housestaff at academic, university-associated programs like Loyola represent not only the overwhelming majority of the physician workforce, but are essential to the daily operations of this facility. Stated plainly, this hospital could not function to treat patients or generate capital without residents or fellows.

We acknowledge that we benefit from several reforms put in place by the ACGME over time (eg, duty hour restrictions, call restrictions, etc.)—for these we are thankful. That said, it is obvious that residency remains an exceptionally challenging experience, with detrimental effects on housestaff physical, emotional, and spiritual wellness, few (to none) of which are meaningfully mitigated by routine lectures and modules about burnout. Given the above, and the potential for inadvertent adverse effects on patient care (ie, when residents lack a healthy and supportive workplace), it seems prudent to create a stable environment that optimizes housestaff wellness and safety. This includes basics such as a livable income reflecting a dynamic economy and consistent, healthy, and affordable food availability.

Resident physicians have found themselves in a unique position since March 2020, needing to balance their medical training with caring for patients affected by COVID-19. This placed an additional strain on resident wellness. Many of our trainees have contracted COVID-19 while caring for these patients, and, as such, many of us have worked unprecedented hours on service (gen med, ICU) to ensure continuity of care. This reality takes a physical and psychological toll on the health of trainees with studies demonstrating higher rates of depression, anxiety, and burnout while working during the COVID-19 pandemic (1). 

The recent decision to forego the annual increase in housestaff salaries is extremely disheartening. In our current economy, the Consumer Price Index was reported to have increased by a staggering 8.3% over the past 12 months (2); multiple global geopolitical forces (eg, the pandemic, the war in Ukraine) have caused inflation to rise extremely rapidly; and, more pragmatically, average gas prices for the Chicago metro area are at an all-time high of $5.70 per gallon (3). In this context, the institutional move to dispense with such a steadfast precedent of an annual salary increase counting for even routine inflation feels unreasonable and untimely.

Adding insult to injury, over the last few months, we housestaff (in addition to nurses, techs, and other staff) have had no reasonable, affordable option for warm or healthy food overnight. Per the ACGME Common Program Requirements:

“Care of patients within a hospital or health system occurs continually through the day and night. Such care requires that residents function at their peak abilities, which requires the work environment to provide them with the ability to meet their basic needs within proximity of their clinical responsibilities. Access to food and rest are examples of these basic needs, which must be met while residents are working. Residents should have access to refrigeration where food may be stored. Food should be available when residents are required to be in the hospital overnight.” (4)

You may respond that “Farmer’s Fridge,” new vending machines, or the nearly impossible-to-access “Mini Mart” in C-VICU meet these requirements, but none of these supplies healthy and affordable options for staff who work overnight. The expectation that food should be both reasonably healthy and affordable is implicit within the quoted ACGME statement. It is well known through evidence that staff who do not have access to consistent, nourishing food at work do not perform optimally, which puts patients at risk.

As essential employees in this facility utilizing a means of protest that is not compromising patient care, we demand action:

1. A reasonable global housestaff salary increase that accounts for at least average historical inflation.
2. Restoration of access to reasonably affordable and healthy food overnight.
3. Transparency of the deliberation process by which these demands are being considered.

We believe these demands are not only in good faith, but would be readily supported by the ACGME. We are also prepared to take alternative actions if these demands cannot be met through means of this form of protest.

1. https://pmj.bmj.com/content/97/1153/70
2. https://www.bls.gov/news.release/pdf/cpi.pdf
3. https://gasprices.aaa.com/?state=IL
4.https://www.acgme.org/globalassets/PFAssets/ProgramRequirements/CPRResidency2019.pdf