It’s 7 a.m., and I head into the hospital coffee shop to grab breakfast. I chat with Mimi at the register. When I texted Mimi a few days earlier, she told me she was working longer hours to pay for grocery deliveries to her mother. Naively, I suggested that she look into the free grocery delivery services that exist for elderly people in Boston. She responded, “Oh, actually, my mom lives in Trinidad, and I have to mail her the groceries, so it’s very expensive.”
In early April, Mimi started wearing surgical masks before it was a hospital-wide policy for every employee to wear one. I watched her ask the customer in front of me to stand farther away as she tried to scan a bag of chips from a distance. Curious, I asked her if she felt safe working behind the cash register. She replied, “Not really, I wish I had a barrier between me and the customers. They get too close.” I jokingly said she should tell me her boss’s name so that I could email him to request a plexiglass protective box around her cash register. She laughed along. Afterward, I went home and emailed him. A few weeks later, thankfully, she was granted the plexiglass box. At that time, the hospital was in full “coronavirus mode,” with all patients and visitors required to wear masks.
As physicians, we took an oath to protect our patients and to care for those who are most vulnerable in our communities. We have been honored to serve patients during the COVID-19 pandemic, and are grateful to work in a profession that is not only purposeful and well-respected but also well-paid. Many of our colleagues who — like us — have worked extra hours and risked their lives to serve our communities, are not so lucky.
Custodians, clerks, transport workers, valets, personal care assistants, food service workers, and many others are vital to the safe and effective functioning of our hospitals. If employees like Mimi were to leave their positions or call out sick, operations at the hospital would be disrupted. Who would serve food to patient’s visitors and hospital staff who need sustenance? Who would disinfect patient rooms to prevent the spread of COVID-19? Who would transport the patients down to CT or MRI or the procedural suite to provide diagnostics and therapeutics? However, many are paid what amount to poverty wages for a major city like Boston, with starting wages of $13 per hour.
Mimi’s predicament exemplifies the experience of frontline essential workers, who are disproportionately immigrants and Black Indigenous People of Color (BIPOC). They are our first line of defense against COVID-19, and also feel the greatest economic impact of the outbreak. Underpayment and underappreciation of our colleagues is a problem that predates the coronavirus. Nationally, more than 1 million healthcare workers, disproportionately women of color, and their families live in poverty. However, the COVID-19 pandemic has made this injustice particularly salient, as our colleagues risk their lives to keep our hospitals running while receiving wages that do not allow them to properly feed, clothe, nor house themselves and their families.
Moreover, many do not have a choice in the risks they are taking; social distancing and working from home are privileges. Underpaid essential workers put their lives at risk not only at work but also on their commute, as many must use public transit. Coronavirus is not the great equalizer it was initially claimed to be; Black, Latinx, and other workers of color are disproportionately affected due to structural discrimination such as redlining, mass incarceration, lack of educational and employment opportunities, all of which lead to higher rates of low-wage essential worker roles. That these working-class individuals are disproportionately immigrants and BIPOC is not just a historical accident; the pandemic’s impact, and the risks taken by essential workers and their households specifically, highlight the systemic racism that intertwines with economic injustice in our society.
Data from our hospital system shows that the custodial and food services staff, who are disproportionately BIPOC and/or non-English speaking, test positive for COVID-19 at higher rates than other groups of workers. While they face substantial health risks, many workers like Mimi have to work extra shifts to support their families during this pandemic. If Mimi stopped working, she would lose the income she needs to feed her mother. She would also lose her healthcare coverage; nearly half of low-wage workers rely on employer-based health insurance. Many were already financially insecure prior to the pandemic and would be unable to pay for health care costs if they become ill.
Some opponents of the living wage state that raising wages would result in fewer jobs available since employers want to avoid cutting into their profits. In actuality, research shows that providing living wages has no real impact on the number of jobs available. This is likely because employers would benefit from increased efficiency and productivity from improved employee morale as well as decreased employee turnover. The cost to recruit, hire, and train new employees exceeds the cost of paying current employees living wages. Where would this money come from? Many of the best-paid healthcare executives ironically work for non-profits and/or state-run facilities, with C-suite executives earning upwards of millions of dollars per year. There is arguably enough money to go around so that essential workers like Mimi who work full-time should at least be able to make ends meet.
Earlier on in the pandemic, there were many who called for providing hazard or “hero” pay to essential workers. Some non-medical companies provided temporary pay increases — an extra $2–3 extra per hour, for example — for workers to risk their health, but many of these minor bumps in wages quickly went away after a few months, despite the pandemic projected to have lasting detrimental effects on our economy. Many essential workers actually earn less, even with hazard pay, than if they chose to receive unemployment benefits from the federal government. Although there have been attempts by the federal government through the CARES Act and some state governments (like State Representative Maria Duaime Robins’ Bill H.4745), mandates to provide hazard pay have yet to be widely successful.
Marginalized communities are afraid to ask for the resources that they need, regardless of how badly they need and deserve them. Mimi cannot demand an increase in wages for fear of being fired. We request for her and her coworkers that the minimum wage for all essential workers be raised to a living wage for a family of four with one working adult, (which would be $32.00 per hour in Boston). Our colleagues deserve to live with dignity as they work tirelessly to provide safe and clean hospitals.
Dr. Sunny Kung is an internal medicine resident at Brigham and Women's Hospital. She is interested in racial justice, health equity, and addiction medicine.
Dr. Kathyrn Himmelstein is an internal medicine resident at Massachusetts General Hospital. She is interested in racial justice, health equity, and primary care.