After medical school but prior to independent practice, physicians undergo a rigorous phase of training known as residency. During these years (anywhere from three to nine depending on specialty), resident physicians at Stanford Hospital are considered hospital employees, without formal ties to the University (and so are not entitled to University family benefits). As former elected resident representatives, we have heard repeatedly from our co-residents at Stanford that the costs of housing and child care are becoming untenable.

Let’s examine a concrete example. Consider a fictional character, Jamie. Jamie graduated from medical school with the national average $180,000 of debt (Jamie’s eventual total repayment will be around $400,000 due to deferments), and is going to start as a medical resident at Stanford Hospital in July. During the first year of residency, Jamie will be paid $58,260 (pre-tax), and will work an average of 80 hours per week and 49 weeks per year, and so will be paid $14.86/hour. Note that by 2018, San Francisco’s minimum wage will be $15/hour. Jamie needs to live within 30 minutes of the hospital, but the median rent for a one-bedroom apartment is $2,505, and has nearly doubled in the past six years. Jamie is ineligible for several apartments, since many leases require a monthly salary that is 2-3 times the rent. Most single residents thus live with roommates.

Now consider this: Jamie is 28 years old (the national average age of graduation from medical school) and married, and is going to be in residency for seven years. Jamie does not want to put off having kids, because Jamie and Pat (Jamie’s spouse) will be 35 years old at the end of training. At 35 years old, it becomes harder to get pregnant and riskier for the mother, and the risk of birth defects increases significantly. So Jamie and Pat decide to have a child during residency rather than risk the health of their family. The self-sufficiency standard (a real-world poverty estimate) for two adults and one child in Santa Clara county is $36.08 per hour. If Pat (Jamie’s spouse) decides to work, then most of that wage will go to pay for child care (~$2,100 per month). If Pat stays home with the kid(s), Jamie’s salary is less than half of what is needed. Like many residents with families, they take out personal loans just to pay the bills. As for their living space, the median rent for a two-bedroom apartment in Palo Alto is $3,194, which would be 85 percent of Jamie’s post-tax salary. The hospital requires that Jamie live within 30 minutes of it, so they struggle to find a cramped studio for their family of three.

Jamie’s case is eye-opening, but not farfetched. Some of these problems, such as medical school debt and the structure of training, are not unique to or solvable by Stanford Hospital. However, we believe that solutions do exist to the problems of housing and child care.

First, since residents are Stanford Hospital employees and (as of this writing) are not part of Stanford University, we are not eligible for the Stanford Child Care Subsidy Grants. The hospital could choose to enact this benefit for the subset of residents who have children. This could also make it easier for residents to get child care services at Stanford Hospital (residents are currently lowest priority on the waitlist).

The housing problem is more difficult. It is not surprising that the administration has been unable to respond to rising rents; the pace of increase is staggering. Purchasing housing units (such as other residency programs have done) requires enormous capital and likely wouldn’t be accomplished for years. Instead, a significant housing stipend is needed. Prospective residents are already choosing to train elsewhere, citing cost of living and family/child support issues.

We feel enormously privileged to be Stanford residents. We do not mean for the preceding to be an attack on the hospital, but rather a call to action. Stanford is unique in both its challenges and resources; it is, in our biased view, one of the best training hospitals in the world. We want it to stay that way.

 

Timothy E Sweeney, resident, general surgery

Ben Durkee, resident, radiation oncology

David Guo, resident, urology

Amanda Kumar, resident, anesthesiology

David Wang, resident, emergency medicine

 

Contact Timothy E. Sweeney at tes17 ‘at’ stanford.edu.