Physicians-in-training at some of the top teaching hospitals in the US is joining unions in order to have higher pay and better working conditions. The Committee of Interns and Residents, the biggest representative of doctors in residency and fellowship programs, reported that they have added chapters at five teaching hospitals in 2020 and two in 2021, which is a higher rate than the usual one a year. CIR, which is connected to the Service Employees International Union, said that it represents about 15% of the 140,000 residents and fellows in the country.
The Covid-19 pandemic has pushed residents to organize, according to Simranvir Kaur, a fourth-year resident in obstetrics and gynecology at Stanford Medicine. Residents have had to work longer shifts without extra pay and treat Covid-19 patients without proper protective gear, Dr. Kaur said. Stanford, which is located in Palo Alto, California, is negotiating a union contract with its residents but declined to comment further.
Inflation is high and workers are in short supply, leading to workers in many industries trying to get better pay and terms. Unionized nurses at Montefiore Medical Center and Mount Sinai Hospital in New York City went on strike for three days to demand better pay and staffing. Graduate students at the University of California had a strike for over a month.
Philip Sossenheimer, a third-year Stanford internal medicine resident and union member, said that it is impossible to separate the national labor movement from what is happening among residents and within medicine.
Hospital administrators stated that residents and fellows are distinct from other healthcare workers due to their dual roles as both employees and students. They also noted that a strike among unionized residents could have a major impact on the hospital's ability to care for patients, and thus should be avoided if possible. The American Medical Association's ethics code advises physicians against engaging in strikes that could withhold essential medical services from patients. CIR, a union for residents, expressed that its members prioritize patients and would only resort to striking as a last resort. The last time a CIR union went on strike was in 1981. UIC and the University of Washington are both currently negotiating contracts for their respective resident unions. Residents hope that collective bargaining will bring better pay and working conditions that will help to reduce burnout and stress. CIR members have already won some concessions, such as better compensation at St. Elizabeths Hospital in Washington, D.C., and more protections for pregnant residents at the University of Washington. However, research has shown that unionized programs don't necessarily lead to less burnout, higher job satisfaction, or significantly higher salaries. Depression is common among residents and suicide is a leading cause of death. Additionally, research has linked restrictions on physicians' working hours to better patient outcomes.
Residents can work up to 80 hours a week in shifts of as long as 24 hours, according to the Accreditation Council for Graduate Medical Education. It is not uncommon for residents to exceed this limit, with some reporting they have worked more than 100 hours a week and up to 30 hours a shift. ACGME allows residents to report any work-hour violations through its ombudsperson office. The average pay for a first-year resident is around $60,000, according to a survey by the Association of American Medical Colleges. Residents in major cities, such as New York or Chicago, have expressed that their pay does not cover basic living expenses. Nicolette Alberti, a union member and second-year resident in emergency and internal medicine at UIC, commented that “advocating for living wages helps me be more focused on my patients, rather than worrying about if I can afford gas to get home or what I’m going to eat.”
Residents have expressed feelings of being disempowered due to the matching system used by hospitals to assign them to a program. In 2002, a class-action lawsuit was filed against the matching program, alleging that it violated antitrust laws and allowed for lower wages and exploitative working conditions. However, the lawsuit was dismissed two years later after Congress granted the matching program an antitrust exemption. Supporters of the system argue that it helps secure placements for medical school graduates and reduces inequities in the selection process. Despite this, some medical professionals, such as Rita Agarwal, a pediatric anesthesiologist at Stanford, believe that residents should be given more autonomy as employees and that their experience should not be overly difficult.
Meaghan Roy-O'Reilly, a third-year neurology resident and union member who has a neuromuscular genetic condition, commented that one voice is not enough to make institutional-level changes. Residents at Montefiore are planning to vote to officially establish a union in order to advocate for themselves and their underserved patients. Libby Wetterer, a third-year family medicine resident at Montefiore, noted that residents are often used as cheap labor. Montefiore responded by saying they are committed to their patients in the Bronx and to improving services to reach them.