Dr Alok Patel discusses the benefits and potential downsides of residency program unionization.
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More and more residency programs are unionizing. There could be a secret meeting happening at your work right now. I want to ask you all a simple question. What do you think are the downsides to residents unionizing?
Assuming you aren't a hospital administrator who is trying to save dollars, I'm legitimately curious. Even residents who are pro-union advocate for open dialogue and hearing from all sides. Let's chat about it.
The Surge in Resident Unionization: Process and Impact
Thousands of residents across the country are in house staff unions or are voting to form one right now. According to the Association of American Medical Colleges, roughly 15% of US house staff in more than 60 hospitals are represented by the Committee of Interns and Residents (CIR), which is part of the Service Employees International Union. That's about 30,000 residents. The CIR's website has an extensive list of benefits they've been able to get for fellows and residents.
Here's a quick overview of how the unionization process goes. If residents have a list of requests or grievances, they have the right to unionize. The hospital can then say, "Okay, cool," and recognize the requests, or they can put it up to a formal vote, which is what's more likely to happen. That vote is overseen by the National Labor Relations Board, and from there, if there is a majority, a union forms and bargaining starts.
Unionization Benefits: Pay, Work Conditions, and Perks
The benefits of unionizing are pretty obvious. If you listen to any residents who are amid a unionization process or you read articles about it, issues such as low pay, burnout from working long hours, no childcare options, a lack of leave time, parking fees, and more are among the many cited reasons that residents want to take this on.
Did I mention childcare? Some residents who are working 70-80 hours a week obviously need some form of childcare and report spending upward of 40%-50% of their monthly salaries on it.
Now, I'm not going to go on and on, but there are plenty of resident testimonials on this topic, and you can read up.
At some programs, residents actually received better benefits after unionizing. University of Michigan, for example, has holiday pay for residents, which I have always been jealous of, especially when other staff members like nurses get this. I'm like, where's mine?
Stanford medical residents got a 21% salary increase, which really helps when the average medical school debt is about $200,000.
Residents and fellows at the University of Washington, after unionizing, received more vacation time, concessions for transportation, childcare, and a list of other fringe benefits. There are plenty of other examples.
Concerns and Criticisms of Resident Unionization
On the flip side, let's run through some specific concerns or reported downsides to unionizing.
Hospital administrators and some department heads have been vocal about the potential for unions to affect both the attending-resident relationship and the ability for residents to directly discuss concerns and educational plans.
Critics feel that having a third party at the table, such as a union representative who isn't as knowledgeable about the nuances of medical education, could complicate the decision-making process.
Sometimes, there are institution-specific issues as well. One example was at Loma Linda. They argued that unionization would go against their religious principles. They filed a lawsuit. That didn't go through, and the residents won a few months later.
I know there's always that one senior, older doctor who says, "Back in our day, we just worked, and we never complained."
Look at the current situation that residents are facing now, with housing and rent prices and increasing costs of childcare. Sprinkle in some inflation, poor hospital staffing, increasing workload, and add in the fact that the average first-year resident salary in 2023 was around $64,000.
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