Cambridge Residents Prioritize Mental Health Access

Dr. Michael Alpert, MD, Psychiatry
Cambridge Health Alliance

I’ll be honest, I was skeptical about the role of a resident union, given you’re locked into being at the hospital for a set amount of time. When I first hear about CIR as a first-year Psych resident, I was thinking, “What kind of collective action power could we really have? It’s not like we can go on strike” Residency is supposed to be tough, that’s what we’re told over and over, so how could having a union really make a difference?

I was introduced to CIR from our union representative at orientation. It seemed like negotiating options for the collective bargaining agreement (CBA) and collective action were pretty limited. And like most residents, while I was excited about the prospect of negotiating a fair contract, I was a bit concerned about how being part of a union might affect my professional aspirations. But after hearing about how residents had worked together for improved patient care and working conditions, I decided to become a department representative at CIR. That’s where I gained experience at the bargaining table.

One of the first things I realized as a part of the CIR leadership was just how important it was to have a resident voice. We have an insider’s perspective that administration wouldn’t understand otherwise. One of the biggest concerns residents have is around mental healthcare. Many residents have already established care with therapists who are out of network and while we were successful in negotiating a way for them continue with their therapist, the benefit won’t take effect for quite some time. Our current battle, then, is ensuring that residents have access to mental healthcare when they need it. For residents, that can be challenging due to our work schedules as well as proximity to actual providers. We found that even though our plan boasted “over 1000 providers,” when we did a search of providers within two miles of the hospital, there were none. We also took a look at the first 200 providers and found that only one would be able to provide care based on their proximity and hours. Additional research highlighted other issues with several of the providers in our plan:

  • Hours of operation were incompatible with resident hours and offered little flexibility
  • Many didn’t return our calls
  • Several were not accepting new patients
  • Some only provided medication adjustments and no psychotherapy
  • Many could not see residents during the hours that they were available
  • Proximity to the hospital was also a issue with many of the providers

But if there’s one thing that being a leader in CIR has shown me, it’s that our union is only as strong as its members. If we don’t participate and take ownership over our issues and contribute to make a change, then no changes can be made. As we move forward in negotiations on this issue, we recognize that we’ll need to establish coverage outside of our provider, Harvard Pilgrim insurance, while keeping co-pays to a minimum and work to find creative ways around some of the other barriers.

Ironically enough, many of our patients have similar issues accessing mental healthcare as well. Issues like this make our case for having a strong union even more relevant. One thing is for sure: our wellbeing directly affects the care that patients receive. By negotiating with hospital administration, we’re able to come up with creative solutions to complex problems of care.