Hannah Kilcoyne, a first-year resident at Children’s National Hospital, started a recent 14-hour overnight shift with a tall order: spend as much time as possible with newly admitted patients, write treatment plans for each, tend to an anxious father’s questions about his sick child and maintain her humanity.

She made it all work but felt fried. She was sure that better working conditions — higher wages, a flexible mental health fund and a patient cap — would make her a better doctor.

Kilcoyne, 28, was among dozens of residents and their supporters who rallied Tuesday evening outside Children’s National Hospital in Northwest D.C. to press for these and other benefits as union negotiations continue with the Top 5 children’s hospital. Residents stood under makeshift tents in the driving rain across from the hospital as ambulances screamed by, carrying signs that read, “I’m tired,” “Children deserve healthy doctors” and “Fair contract = physician wellness,” highlighting the challenges providers face as respiratory illnesses stress the health-care system.

Doctors exhausted in the third year of a pandemic marked by chronic staff shortages are now facing a national spike in RSV during flu season with the coronavirus still circulating — and juggling more patients as demand for a dwindling number of pediatric intensive care beds outstrips capacity.

D.C.-area children’s hospitals are at capacity

“I felt like I had to choose what I wanted to do, and that’s not fair to these families,” Kilcoyne said in an interview Tuesday. “That’s not the kind of doctor I want to be … I want to be able to do it all.”

At Children’s National and hospitals across the country, residents — doctors who have completed medical school and are receiving specialty training for at least three years — say they need help coping with the demands of the job.

They are seeking a contract that provides higher wages, guaranteed mental health benefits outside the hospital and a contractually binding cap on the number of patients they can treat at a given time, which residents say can range from about 10 to 14 or more, depending on the shift. Doctors typically see more patients at night and on the weekend because there are fewer staff members working.

In a statement, Children’s National Hospital officials declined to discuss details of the negotiations, which the union said have been going on since April. Hospital officials thanked residents for their hard work in handling — with other hospital workers — a significant increase in emergency department visits and admissions.

“Children’s hospitals around the country are managing through record surges in patients while also managing health care workforce shortages. We also see some hospitals closing pediatric inpatient beds and even closing pediatric intensive care beds, which puts even greater stress on children’s hospitals,” hospital spokeswoman Diana Troese said in a statement.

“We remain hopeful that this surge in respiratory infections will subside to historical levels which would reduce some pressure on our teams.”

CDC warns of tough winter as flu, RSV and covid collide

Residents at Children’s National belong to the Committee of Interns and Residents, which is a branch of the Service Employees International Union and represents 22,000 resident physicians and fellows nationwide.

The D.C. rally, which organizers called a Unity Break, although only off-duty doctors attended, is part of a week of demonstrations in eight cities, including San Francisco, Los Angeles and Chicago, to support contract negotiations. The events come at a time of growth for the resident-physician union; a record 3,000 residents joined in one year, according to a CIR statement.

At UCSF Benioff Children’s Hospital Oakland, residents voted to authorize a strike — the first such vote in 30 years, according to the union — before reaching a deal last month with management. Residents at Montefiore Medical Center in the Bronx this month announced plans to unionize.

CIR officials said that after the coronavirus exposed structural inequities in health care and clinical training, “medicine should not continue its exploitative, traumatic and inequitable training culture.”

Health-care workers say they are drained from working at full tilt through covid and now RSV and wonder what crisis awaits them next.

Liz Taliaferro, 30, a graduate of the medical school at Brown University who uses they/them pronouns, said they realized in their third year of residency at Children’s National that residents are a hospital’s workhorses.

RSV, covid and flu are keeping kids out of school — and parents out of work

“What that means is when the hospital is stretched thin, residents are also stretched thin,” said Taliaferro.

Residents described working long shifts that often exceed 12 hours and caring for more patients than they have time for, which they said leaves them too exhausted to do much besides work and sleep — a recipe for poor mental health.

“I have personally experienced and witnessed our residents here stretch themselves to and beyond their emotional and physical limits,” Taliaferro said at the rally. “If you want kids to be well, you need their doctors to be well.”

Amber Shelton, 27, a first-year resident at Children’s National with family in Prince George’s County, entered medicine to work with the whole family unit. When time is short, she said, mining the possible genetic, environmental or autoimmune reasons for a child’s condition is impossible.

Shelton, a graduate of the medical school at Temple University, said doctors want to provide the best care.

“We want to be functioning at the level of a Top 5 children’s hospital,” she said. “We just need help doing that.”

The group’s numbers grew Tuesday evening as residents finished their shifts. Holding umbrellas, they walked across the street and joined the protest.

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