New York University residents are seeking compensation for the increased risk they face as they are called to the front lines of the COVID-19 pandemic, but leadership has declined their request for hazard pay and now stands accused on social media of gaslighting residents.

Residents created a petition, addressed to NYU Langone Medical Center leadership, outlining the increased risk they face as the demand placed on the hospital system "skyrockets." They ask for life and disability insurance, as well as hazard pay.

"We are honored and willing to take on these greater clinical responsibilities ... but along with this comes an increased risk for disability and death," they wrote. "In light of the changing times, we believe there should be a change in our benefits to accurately reflect this new high-risk environment."

In an email sent to urology residents, department chair Herbert Lepor, MD, acknowledged that some of his residents had been assigned to COVID-19 wards, but said demanding hazard pay now was "not becoming of a compassionate and caring physician."

"Now is the time to accept the hazards of caring for the sick and do what we are trained to do and fulfill our commitment to the healthcare needs of our community rather than focusing on making a few extra dollars," he wrote.

Internal emails sent between Lepor and other superiors -- which were circulated on social media -- revealed leadership's attempt to deflect residents' compensation requests.

In one message, internal medicine residency director Patrick Cocks, MD, acknowledged that residents were hearing "we have $" and that if they explained the larger financial impact across institutions, "the more mature residents may understand."

NYU gastroenterology director Mark Pochapin, MD, asked to see the names of residents who signed the petition to see if any of his fellows' names were on it.

When asked to comment on the emails circulating on social media, Lisa Greiner, a hospital spokesperson, said Pochapin and others were misrepresented and their statements were taken out of context.

For example, Pochapin asked if his residents had signed the petition so he could meet with them to address the issue, and did not intend for it to be threatening, Greiner said.

One surgical trainee in New York City who spoke to MedPage Today on the condition of anonymity said the language in the leaked emails is representative of a residency culture in which trainees are taught suffering makes a good doctor.

Elements of that may be true, but when residents are asked to serve on the front lines of this unprecedented pandemic, institutions training them should provide them with the physical, psychological, and financial resources they need, the resident said.

"We are not soldiers," the trainee said. "No one is trained to confront this amount of death in such a short period of time."

Before COVID-19, residents across the country were pushing for higher wages, with one survey showing an average $61,200 salary in 2019. NYU internal medicine residents made as little as $67,432 in the 2017-2018 year, which increased with each training level.

When asked how NYU Langone has changed its policies to reflect the increasing demand placed on residents, Greiner told MedPage Today, "residents and fellows who have provided direct clinical care to COVID patients at a higher level of responsibility than usual will have their compensation advanced to the next PGY level retroactively to April 1, 2020, rather than July 1, 2020."

Calls for healthcare workers to start receiving hazard pay began as early as mid-March and a petition demanding the federal government provide hazard pay to front-line workers has racked up half a million signatures. New York Gov. Andrew Cuomo has also advocated for hazard pay for healthcare workers on the front lines.

Other local hospital systems have responded to the call. Northwell Health is slated to deposit $2,500 bonuses to front-line workers and New York-Presbyterian granted eligible staff a $1,250 bonus. At Mount Sinai Health System, top executives announced they would take a 50% pay cut to offset COVID-19 costs.

Nate Wood, MD, an internal medicine resident at Yale New Haven Hospital in Connecticut, said residents pushing for hazard pay are not only motivated by financial incentives, but are also seeking a gesture from leadership that demonstrates institutional support. His program has granted residents $1,800 bonuses, he said.

"I think what's going on is people on the front lines want their administrators to show them appreciation," Wood told MedPage Today. "The most tangible way to do that is for administration to put their money where their mouth is."

NYU Langone is projecting losses of $450 million a month and an operating deficit of $1.2 billion from increased expenses and lost revenues related to COVID-19, Greiner said.

The hospital system reported $2.1 billion in revenue in 2017 and made tuition free for medical students the following year. Lepor, who co-founded MedReview, was accused in 2017 of spending $2 million in profits on personal expenses such as ski vacations and his daughter's bat mitzvah.

On March 27, NYU Langone sent an email warning staff that speaking to media without approval would be "subject to disciplinary action, including termination."

When asked to comment on this email, Greiner said this policy was in place before COVID-19 and that its purpose was to protect the confidentiality of patients and staff.

"Because information related to coronavirus is constantly evolving, it is in the best interest of our staff and the institution that only those with the most updated information are permitted to address these issues with the media," Greiner said.

Daniel E. Choi, MD, a spinal surgeon in New York, said most physicians are willing to be deployed to the front lines but many may not have the financial protections in place to protect themselves and their families if they contract COVID-19.

"You're being asked to face death, and you're thinking, 'am I going to saddle my family with medical school debt?'" Choi told MedPage Today. "We're being asked to go to the front lines and put ourselves in harm's way, yet there are minimal conversations happening about how to protect us physically and economically."