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Ars Technica
One of the most challenging aspects of the initial round of vaccinations is deciding who receives the first doses of a limited supply. The need for a functional medical system in the face of an out-of-control pandemic has meant that most places have prioritized the doctors and nurses who provide the majority of face-to-face patient care. But the apparent lack of prioritization of caregivers at Stanford Medical Center has prompted many of its doctors to stage protests today.
Ars received a copy of an open letter sent by the Chief of Resident Physicians to the Stanford administration describing the problems that sparked these protests.
In the US, residency occurs after completion of medical school and is a requirement for the practice of medicine. Residents generally operate under the supervision of a physician in a training program at university hospitals and learn to practice a specialized branch of medicine, such as internal medicine or pediatrics. In many cases, residencies are followed by scholarships, which are used to develop further specializations. However, because these positions are temporary and necessary for the practice of medicine, those who hold them have little political weight within hospitals.
Despite their lack of involvement in the management of most hospitals, residents and fellows provide most of the direct patient care that physicians provide (nurses and other patient care specialists also provide a large amount). As such, residents would be expected to be at the highest risk of exposure to the SARS-CoV-2 coronavirus. However, according to the figures cited in the letter, less than one percent of Stanford residents and fellows will be vaccinated with the first round of doses.
Despite what seems like an obvious mistake, an email sent to residents by Stanford Medical Director Niraj Sehgal and provided anonymously to Ars indicated that the plan would go ahead regardless. Despite Seghal’s email explicitly saying “I personally couldn’t feel worse about that,” Thursday’s message suggests that the priority for the administration is simply to understand what went wrong. Residents are expected to wait until next week, when more vaccines are expected to be available.
That response prompted an outraged letter (also sent yesterday) from 17 heads of hospital residents. He also launched the protests that took place today. The letter from the chief resident describes the problems in detail.
Despite repeated promises to prioritize front-line providers of internal staff in this initial phase of vaccine administration, we have learned that only seven residents / fellows were eventually included. There is no articulated plan yet to vaccinate the remaining 1,300+ residents and fellows, including those on the frontline and directly treating COVID-19 patients.
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Stanford’s decision to downgrade residents and fellows is helpless on the basis of science, reason, ethics and equality. Many of us know senior professors who have worked from home since the pandemic began in March 2020, with no in-person patient responsibilities, who were selected for vaccination. Meanwhile, residents and fellows put on N95 masks during the 10th month of this pandemic without a clear and transparent plan for our protection.
This letter asks for a series of steps in response to the immediate problem, including an explanation of how the algorithm produced the results it produced, and an explanation of why, if its exit was apparently known on Tuesday, the administration decided to pursue it. he ended up with the plan he came up with even though he had three days to come up with a better one. Residents are demanding a plan that vaccinates them as quickly as possible, while allowing injections to be staggered due to the flu-like symptoms that often result when the immune system responds to the vaccine.
In the longer term, it lists the elements that would be necessary to restore residents’ confidence in the hospital administration. These largely revolve around placing resident representatives in positions of power within the hospital hierarchy, including on the hospital’s Board of Directors and the Graduate Medical Education Committee. Meanwhile, the protests have continued throughout the day on Friday.
Determining how to prioritize a limited resource will create a lot of tension over the next six months, and there will be decisions that will be moot, even if they mean well. However, if the head of residents’ account is correct, it is difficult to consider that this plan has good intentions. Instead, it appears that management outsourced decision making to an algorithm and did not question its outcome even after it was obvious that it was problematic.
We have asked Stanford for comments and will update this story if we receive any.
