Doctors in training working at Cambridge Health Alliance say the health care system has significantly reduced mental health benefits they need as they face stressful work with up to 80 hours a week on duty. The residents and fellows, who are in contract negotiations, also are paid less than those in comparable programs, they say.
Residents are doctors who have finished medical school and are getting additional training at hospitals in fields such as internal medicine and psychiatry. Fellows have completed residency and are continuing their education in more specialized fields, such as cardiology. Institutions such as the Health Alliance provide the training and education and rely on residents and fellows to provide much of the care offered to patients.
At a rally outside CHA Cambridge Hospital on Wednesday, psychiatry resident Dr. José Dominguez said inadequate pay and mental health care could affect patients. “A fair contract with CIR is about ensuring that Cambridge Hospital residents are well and that we’re able to take care of our families – and that’s inseparable from patient care,” Dominguez said, referring to the Committee of Interns and Residents SEIU, which represents the doctors.
“Would you want [your] doctor to have constant financial stress running in the background of their mind, or for your psychiatrist not to have access to therapy themselves? CHA leadership needs to invest in care for this community by agreeing to a fair contract with CIR, and the City Council needs to use their powers to ensure that they do so,” he said.
CHA spokesperson David Cecere said: “As we navigate an environment in which health care institutions across the nation are facing significant financial challenges, Cambridge Health Alliance is making every effort to come to an agreement with CIR. We are still in negotiations and have included many benefits in our proposals.”
Cecere said the Alliance works “to be an employer of choice, prioritizing fair wages for our employees.” The Alliance gives “our residents and interns a comprehensive and competitive health insurance package as well as a supplemental mental health service which offers access to therapy and psychopharmacology at no cost to the resident and goes above and beyond benefits offered by other institutions. We are confident that our positions are fair, support outstanding patient care and reflect respect for the tremendous contributions our resident physicians and interns provide to patient care,” Cecere said.
In an interview, Dominguez said the Alliance previously offered unlimited therapy and psychiatric drug-prescribing visits to residents and fellows, provided by Tend Health, an organization founded specifically to help health care professionals deal with the mental health burdens of their work, particularly during the Covid-19 pandemic.
Residents and fellows were notified in May that starting in July, they could get only 10 therapy visits and four drug-prescribing visits a year from Tend, because of the cost of the program, he said. “It was quite a cutback,” Dominguez said.
Though doctors can see therapists and psychiatrists outside Tend as long as they’re in the Alliance health insurance network, those providers are likely to be colleagues or former CHA staff members, creating uncomfortable situations for mental health care, Dominguez said.
Tend providers also could deal with residents’ unpredictable work schedules, willing to see them at night or on weekends, unlike most therapists and psychiatrists, he said. Losing that is “a significant cut in our ability to access mental health care,” Dominguez said.
Dominguez, 31, said he’s in the fourth and last year of his residency. He said he chose to join the residency program at CHA because it has “a national reputation for giving top-tier care” and for serving “under-resourced communities.”
“It was what I wanted to do long-term,” he said.
The union contract expired June 30 after three years; the two sides are negotiating another three-year contract. CHA has struggled in recent years to operate consistently in the black. The Alliance’s budget for the current fiscal year, which began July 1, predicts a $6.4 million loss, mainly because increased revenues will be outstripped by rising expenses.
Cambridge vice mayor Marc McGovern, a social worker, attended the union rally Wednesday along with councillor Jivan Sobrinho-Wheeler. “I don’t understand how you can be asked to provide the level of care you provide to others while your workplace isn’t providing the level of care that you deserve,” McGovern said.
McGovern said he’s “hopeful that a resolution can be reached.” He added: “Cambridge City Council is behind you. We are with you.”
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