Suicide shifts, comparing Frito-Lay and medical residency training
Editorial note: This blog was originally published on drlaurenwheeler.com in 2020 and was written for a clinician audience. I still stand by what it says, but I may have struck a more diplomatic tone if I had written the same piece today.
As a native Kansan, I sometimes take interest in the affairs of my home state. Lately, Topeka, KS has made national news with 2/3 of Frito-Lay factory employees striking for 3 weeks. For the uninitiated, Frito-Lay makes Ruffles, Cheetos, Fritos, and Lays.
The workers main complaints include “suicide shifts” or working 12+ hour shifts with 8 or fewer hours in between and forced overtime, up to 84 hours a week on occasion. As a former resident of a busy academic hospital, I laughed. That’s any given week in any given program in the country. Oh, and resident suicide rates are much higher than the 1-3 reported at Frito-Lay by this employee.
The Topeka Frito-Lay employees also complained about not getting raises that kept up with cost of living – one employee has only earned an additional 77 cents in 12 years. However, the wages of Frito-Lay employees in this plant range from $18.35 – $36.91 per hour.
How does resident compensation compare? In at least some cases, residents earn fewer than $15 per hour when their salary is divided over their working hours. Residents have been getting pay increases, at least in the years that Medscape has been keeping track. However, these pay increases clearly are not keeping up with the cost of medical education. (See this article comparing being a doc in 1970 to 2020.)
So why is it that when confronted with terrible working conditions, people who make potato chips decided to strike, and will likely see real change as a result, while other low-level employees who work for big companies even with the stress of people’s lives in their hands won’t?
Probably there are many reasons, but the ones that come to mind are these.
Frito-Lay employees are unionized. Not the way that a handful of residents are “unionized” by a paltry organization that also represents hospital cleaning crews. They have a real, powerful union who is willing and able to negotiate with the employer.
Residents don’t see the structure around them. In this telling letter written to the Topeka Capital Journal by a Frito-Lay worker, its clear that she is aware of how the larger organization operates around her – she knows what the safety hazards and inhumane policies are, who enacted them, and how they could be changed. I don’t think she’s atypical in that. Residents are either uniquely blind in the way they ignore how hospitals benefit from them, or they choose to ignore this on a misguided belief that one day things will be different, if not for residents, then at least for them as individuals.
Turnover. While the average factory worker probably understands that the company couldn’t run without them, they also know they don’t have a ton of possible career advancement. They are motivated to improve the conditions they find themselves in right now – residents seem to think they will only have to suffer for a few more years. (Again see this article comparing being a doc in 1970 to 2020 – compensation is not improving enough.)
Hazing. Residents believe that enduring the deplorable conditions of residency is a rite-of-passage into the esteemed field of medicine. Frito Lay workers likely suffer under no such delusions and call out their working conditions for what they are – cruel and unnecessary.
Egoistic relative deprivation. The way doctors isolate themselves into camps – OB vs. surgery vs. family, etc. – keeps them thinking that their peers have a worse situation (are more deprived). This, in turn, inspires gratitude for their relative position instead of collective anger or collective action.
Getting around some of these stumbling blocks would require a change in culture, in my opinion. If young physicians choose to value their years in residency – not as hazing, not as a prerequisite to life – as the first years of their career when they are the most vulnerable and exploitable, perhaps they would start to do things like socialize with each other across specialties and sub-specialties and maybe even across institutions. From there, they could more easily see how their organizations operate, how badly everyone has it, and maybe how insane it is to work under the conditions they do.
By the way, what started the Frito-Lay strike was the management’s offer to limit employee workweeks to 60 hours with a 2% wage increase. Could you imagine if residency truly ran under those (still extreme) conditions? Leave me a comment with your thoughts!
