A group of University of Washington residents took the day off from clinic Friday to see their own providers, something many trainees did not feel comfortable doing under their current contract with the university.

The staged "wellness day" was the latest action amidst growing tensions between the UW Housestaff Association (UWHA), which represents residents, and university administration. Trainees are upset with low wages and slow-moving contract negotiations, but also wanted to bring attention to national lapses in physician wellness, said Brandon Peplinski, MD, an internal medicine resident and UWHA board member.

Participating residents signed a UWHA pledge and gave their program directors six weeks' notice so that they could provide adequate coverage to patients, Peplinski said.

"It calls attention to how overworked and burned out so many of us are," Peplinski told MedPage Today. "Everyone has these stories of how they've neglected their own health for months or even years and a lot of it is because of programs or attendings discouraging them."

Monica Samelson, MD, chief psychiatric resident at Harborview Medical Center, used the day to take her 15-month-old daughter to the pediatrician.

"As a resident, working long hours, not having enough time to take your kid to the pediatrician is really demoralizing," Samelson told MedPage Today. "Especially when you're taking care of other patients, it becomes really clear how important it is to have that support."

UW currently covers two days of childcare annually, and the UWHA is asking for the institution to extend coverage to at least one month of childcare services per year. Currently in Seattle, it can take years to be accepted in childcare programs, and costs an average $1,213 per month per child, or roughly 40% of a PGY-1 resident's salary.

Around the country, residents participating in collective bargaining have been pushing for contract terms promoting more sustainable medical practices and physician wellness.

Close to half of practicing residents experience symptoms of burnout, and doctors die by suicide at up to twice the rate of the general U.S. population.

The UWHA is also pushing for higher wages. Although the administration's contract offer included a 1%-2% pay raise, that amount does not keep up with Seattle's increasing cost of living, which rose 2.54% from 2018 to 2019, Peplinski said.

"Because of call requirements, you have to be able to get to the hospital quickly, within 30 minutes of being called in, and that requires you to live in expensive areas," said Kat Jong, MD, a psychiatric resident.

In a UWHA analysis of 59 peer residency programs across the country, UW residents were underpaid $7,000 a year, with a housing stipend at least $6,000 lower than at other institutions. Three-quarters of peer institutions provided one to two weeks more vacation compared to UW, according to the analysis.

UWHA is advocating for a starting salary of $64,036 for PGY-1 residents, with increases of 4% a year to keep pace with Seattle's living costs.

In September, frustrated by a lack of response from the administration, about 500 residents staged a 15-minute walkout to protest ongoing contract negotiations.

The UW Department of Medicine did not respond to a request for comment.

Program directors signed a letter of support in November, backing new policies that would help them recruit economically diverse trainees and protect UW residents' well-being.

"A lot of people we're recruiting are coming from higher socioeconomic places and coming from having support at home ... and that's not representative of our general patient population in the U.S. or in Seattle," Samelson said. "We have a lot of data in medicine that indicates representative doctors treat patients better and we think it's really important we're recruiting people here at UW that are the best residents for our patients."

Job actions by residents have occurred elsewhere, especially in the University of California system, where 15-minute walkouts were staged at the San Francisco and Los Angeles campuses last year. At the latter, where negotiations had dragged on for 10 months, the protest was followed quickly by a tentative agreement with the administration establishing higher wages and unrestricted union access in the hospital.

At UW, however, the administration has stonewalled, Peplinski said. Around the time of the "sick-in," the graduate medical education office told residents via emails to complete a series of "wellness and professionalism modules," he added.

Although some administrators have expressed support for physician wellness initiatives, Peplinski said, the emails were "tone deaf."

"It really expresses how little they've listened to all our residents in the past year," Peplinski said.