Frequently Asked Questions

What is CRR?

CRR (Coalition for Residency Reform) is a resident-led movement demanding structural change in graduate medical education. We expose unsafe, unethical, and exploitative conditions that persist under the current residency system — and we're organizing to change them.

Is CRR anti-residency?

No. We believe in medical training — but not in systems that exploit resident physicians and rely on overwork, fear, and silence. CRR advocates for reforms that prioritize the protection of residents and patients, including fair labor standards, psychological safety, and genuine accountability.

How does residency violate labor laws?

Residents are exempt from most Fair Labor Standards Act (FLSA) protections due to a an exemption that considers them "students," not workers. This means:

  • No overtime pay

  • No guaranteed breaks

  • No standard workplace protections

Additionally, common practices in residency may violate:

  • OSHA safety standards (e.g., extreme fatigue on 24 hour shifts)

  • Title VII (e.g., pregnancy discrimination, sexual harassment)

  • FMLA access (only recently extended to residents and often undermined in practice)

Is it true that 24-hour shifts are dangerous or even carcinogenic?

Yes. Long shifts and circadian rhythm disruption are classified as Group 2A probable carcinogens by the International Agency for Research on Cancer (IARC). This includes night shift work and chronic sleep deprivation — both of which are common in residency.

Sleep deprivation has been linked to:

  • Impaired decision-making and cognition

  • Higher rates of depression, anxiety, and suicidality

  • Increased risk of motor vehicle accidents post-call

  • A higher rate of medical errors and near-miss events

  • One of the most well-known and tragic cases was Libby Zion, an 18-year-old who died in a New York hospital in 1984 while under the care of overworked, unsupervised residents on a 36-hour shift. Her death led to public outrage and the creation of New York's 405 regulations, which were the first attempt at limiting resident work hours. Her case is still cited as a key example of how resident fatigue can directly harm patients.

Are residents vulnerable to retaliation if they speak up?

Yes. Surveys and lawsuits show retaliation is widespread:

  • Many residents face retaliation after voicing concerns.

  • Protections under whistleblower laws (e.g. 29 U.S. Code § 660(c)) are often weakly enforced in academic hospitals

  • Many are threatened with poor evaluations, visa consequences, or blacklisting

  • 'Professionalism' is often wielded as a tool to silence residents.

Why don't residents unionize more often?

Systemic fear and lack of legal clarity. Hospitals often:

  • Spread misinformation about the legality of unionizing.

  • Pressure residents not to engage.

  • Use "student" status to undermine organizing.

Still, unionized residents have successfully won:

  • Pay increases

  • Formal grievance protections

  • Parental leave improvements

CIR‑SEIU, a national resident union organization founded in 1957, now represents over 34,000 graduate medical trainees.

What are some realistic reforms CRR is advocating for?

CRR isn't just exposing the problem — we're working toward structural solutions. These are attainable, systems-level reforms that would protect residents and restore fundamental labor rights:

1. Reform the Match

We're advocating for legal scrutiny and reform of the NRMP Match, including:

  • Replacing it with a tiered, competitive, free-market system that respects resident autonomy

  • Allowing residents to negotiate contracts directly, compare offers, and choose jobs that fit their needs

  • Investigating the monopsonistic structure of the Match, which suppresses wages and removes standard market protections from medical graduates

2. Fair Pay and Wage Protections

  • Push for transparent pay standards tied to hours worked, cost of living, and inflation.

  • End residency's exemption from key labor laws, including:

    - FLSA (which currently denies residents overtime pay and standard protections)

    - Antitrust laws (which the Match may violate by suppressing wage competition)

  • Recognize residents as workers first, not "trainees," under U.S. labor law.

3. Legal Accountability and Abuse Reporting

  • Implement anonymous, protected reporting systems for workplace abuse, harassment, or retaliation

  • Create a federal or independent oversight body separate from ACGME to monitor violations and protect whistleblowers

4. Psychological and Physical Safety

  • Guarantee protected time off for medical care, mental health, or therapy

  • Protect pregnant residents and new parents from retaliation or career sabotage.

5. End Blacklisting and Career Retaliation

  • Ban informal blacklisting for residents who speak up, report mistreatment, or leave toxic programs

  • Require programs to provide transparent transfer processes and fair evaluations

6. Establish a Resident Bill of Rights

  • A national document outlining baseline protections — covering work hours, leave, pay transparency, and retaliation protections — enforceable across all ACGME-accredited programs.

Isn't this just part of paying your dues? Everyone went through it.

That argument has been used to justify mistreatment and exploitation in medical training for decades.

Defending mistreatment is not strength — it's a trauma response.

Evidence shows this culture contributes to:

  • Burnout

  • Depression

  • Physician attrition

  • Patient safety failures

This system doesn't build strength — it exploits residents, until there's nothing left to give.