Young doctors just out of medical school working as resident physicians, fellows and interns at major US hospitals are organizing unions at an increasing rate, citing long-running problems highlighted by the Covid-19 pandemic and a need to rethink the struggles young doctors face in the profession.
The Committee of Interns and Residents, an affiliate of SEIU, added five unionized sites in 2022 compared with about one a year before the pandemic and the surge has continued in 2023 with multiple union election filings. It currently represents over 25,000 residents, fellows and interns across the US, comprising about 15% of all resident and fellow physicians.
Over 2,500 residents and fellows at Mass General Brigham in Boston are currently waiting to have a union election date set after filing this year.
As with other industries facing a renewed interest in unionization from their staff, the US’s rich and powerful hospitals have responded with well-funded anti-union campaigns and tactics to delay union elections and contract negotiations.
Hospital management has opposed the unionization effort, declining to voluntarily recognize the union, encouraging residents not to sign union authorization cards ahead of the election filing and writing local op-eds in opposition to unionization.
Since going public with their union plans, staff have been sent emails and been invited to meetings to try to dissuade residents from unionizing, “often counting on myths around what unionizing would mean”, said Dr Sascha Murillo, a third-year internal medicine resident at Massachusetts general hospital.
“They tried to dangle some carrots with the salary increases and benefit changes that we’re going to see next year, but the only way we’re going to quantify that for the long term is by having a union and an actual contract,” said Murillo.
The unionizing campaign took off after vulnerabilities in the healthcare system were exposed by the Covid-19 pandemic, she said, with residents working on the frontlines and bearing the brunt of staffing shortages, an influx of Covid-19 patients, and patients who deferred medical care.
Residents often work 80 hours or more a week while being paid barely enough to cover rent in expensive cities like Boston. They often cannot leave or change jobs before they complete the three-year residency program.
“We’re the ones who are often the first faces that patients see. We’re privy to the issues our patients face and want to be able to advocate for our patients,” added Murillo. “These hospital systems are incredibly powerful. We’re seeing a trend across healthcare of these huge mergers and consolidation of power and it’s even more important for all workers in the healthcare system to be able to have a seat at the table to really ensure that those at the top understand what we face day to day in delivering patient care and that we’re able to check that power.”
About 1,400 residents at Penn Medicine in Philadelphia filed for a union election being held in the beginning of May 2023. Penn Medicine has hired law firm Cozen O’Connor, which specializes in union avoidance, in response to the union organizing effort and has encouraged residents to be wary of the union’s promises.
“It still feels like we aren’t being heard. It feels like the institution is still sending a message that they know what’s best for us, that they want to stay in a position of power,” said Dr Chantal Tapé, a third-year resident in family medicine.
Tapé said there was also a need to change the perception of residency programs as an inherently exploitative stage that residents just need to struggle through.
“Our big push is to have a union so that we have a seat at the table, so that there’s a system for accountability where resident voices are heard and hopefully persists across the years so that the issues that are most important to a resident at Penn 10 years from now have the same sort of venue for being heard as the issues that we’re experiencing right now,” she added.
Over 450 residents, interns and fellows at George Washington University are voting in a union election on 25 and 26 April.
“There’s been a large uproar of residents unionizing because residents and fellows across the nation have felt exploited in their jobs, undervalued, underappreciated, overworked in really unsustainable working conditions,” said Dr Maryssa Miller, a first-year internal medicine resident at George Washington. “My starting salary was right around $64,000, which when you divide that out into 80-hour work weeks, I make about $15 an hour, far below the living standard in the city, so more than half of my paycheck goes to rent.”
Ahead of their union election, the Dean of the GW School of Medicine, Dr Barbara Bass wrote an email to all residents where she argued in favor of a direct relationship, referring to the union as a third party and citing concerns about the impacts a union could have on professional and mentoring relationships between faculty and residents.
“I think that was really just a tactic to try to scare people. And it’s really just not true, and not something that any unionized campaign amongst residents and fellows has seen across the country,” added Miller. “We are really the ones that are on the frontlines,” said Miller. “But ironically, we’re the voice that’s not listened to and I think that’s kind of what’s been seen throughout all of these union campaigns that are popping up through America.”
Some 1,200 residents and fellows at Montefiore hospital in New York City won their union election in February 2023, with 82% voting in favor of the union. Residents at Sutter Health California Pacific medical center and Lifelong Medical Care in California also won union elections in 2023.
Ahead of the union vote in New York City, an anti-union video claimed “a vote for this union is a vote against us, your educational leaders”. The video presentation included slides with a misspelled “no ragrets” neck tattoo to warn about the “permanent decision” of unionizing, followed by a slide of a brain where a doctor encourages residents to use the right part of their brain in deciding on their vote.
Residents at the University of Vermont medical center, USC Keck and Greater Lawrence family health center in Massachusetts won union elections in 2022, and 1,500 residents at the University of Washington joined the CIR-SEIU.
At Stanford Health Care in California 1,478 residents and fellows won their union election in May 2022.
Stanford criticized unions ahead of the vote, claiming they prefer a direct relationship with individual residents. The National Labor Relations Board recently ruled against Stanford for refusing to furnish information before bargaining with the union.
Dr Philip Sossenheimer, an internal medicine resident at Stanford, explained the union drive was driven by issues residents experienced during the pandemic and doctors wanting to use unionization as a vehicle to address ongoing issues throughout the healthcare system and how those impact residents and patients.
“Our generation collectively is starting to realize the sort of losses that have come from degradation of labor strength in this country and declining rate of union membership, and I think broadly, as a society, we’re starting to reflect on what that power imbalance means for the average citizen, particularly since as people in this country, we spend a substantial amount of our time at work.”
At Children’s national hospital in Washington DC, residents organized a demonstration across the street from the hospital during breaks to demand better pay, improved staffing, and other demands central to the union in new contract negotiations. Though a contract was settled in December 2022, the hospital is currently taking legal action against the union over the demonstration, claiming the union violated a “no strike” clause. The hospital has not commented on the action due to the pending litigation.
“It feels like such a retaliation,” said Dr Lydia Lissanu, a first-year resident at Children’s national hospital. “At the very least if it feels like they want to intimidate us even if it doesn’t work, they want us to know they’re very upset with us.”
Lissanu added that residents have been increasingly organizing unions because of how they were the ones forced to pick up the slack for vulnerabilities exposed in the healthcare system during the Covid-19 pandemic.
“We’re being asked to pick up the slack essentially from all of the other shortages in the hospital, all of the things that have happened in Covid, all of the pediatric respiratory viruses surging all at once. A lot was expected of us, a lot of slack that we had to pick up with very little recognition, very little reward. We’re asking to be treated fairly and be paid for our labor, we no longer feel that we should be grateful for having this job, they should be grateful for us and what we bring to the table.”