A wave of labor organization continues among doctors, residents and fellows as more than 3,000 have joined unions so far this year, driven by worries about burnout, administrative burden and inadequate patient care.
Doctors and support staff are seeking contracts across organizations that ensure reduced workloads and more one-on-one patient care time. However, where doctors want more decision-making power, residents are pushing for better benefits and higher pay.
Related: Resident, doctors unions see new interest, membership
Last month, more than 1,000 residents and fellows at the University of Chicago Medical Center and 400 physicians-in-training at Kaiser Permanente’s Northern California facilities voted to join the Committee of Interns and Residents/Service Employees International Union. Several hundred physicians with Wilmington, Deleware-based ChristianaCare petitioned the National Labor Relations Board to vote on joining the Doctors Council, an affiliate of SEIU.
Earlier this year, more than 1,300 residents and fellows at Northwestern University's McGaw Medical Center, 130 doctors at Allina Health and 25 physicians working under a contract with Sound Physicians moved to unionize with Committee of Interns and Residents/SEIU, Doctors Council and the Union of American Physicians and Dentists, respectively. The unions have seen record growth in recent years, collectively adding more than 10,000 members since 2021.
Cost of living increases, 80-hour work weeks, and burnout experienced during the COVID-19 pandemic were the impetus for residents’ organizing efforts at Kaiser Permanente’s Oakland Medical Center, said Berneen Bal, a third-year psychiatry resident.
“There was a collective realization that we should be protected and better compensated as it is such an important service that residents are providing to communities,” Bal said. “You're investing so much of your youth and your enthusiasm into a program so that you can provide good clinical care. It's important that we're also taken care of as well.”
Representation at the bargaining table is crucial for residents to be able to advocate for their needs, she said, especially given the flawed structure of resident training, including a lack of caps on work hours and individuals covering extra shifts without pay.
At Kaiser Permanente’s San Francisco Medical Center, the breaking point for unionization came when residents and fellows were the only workers excluded from a $2,700 performance-based bonus, said Brandon Anderson, a second-year internal medicine resident and organizing member of the facility’s CIR/SEIU unit.
“We wouldn't be doing this if it weren't the last option,” Anderson said. “The reason we form a union is not simply to just get some more money. We hope we can safely and carefully continue to provide really high quality care for our patients.”
Kaiser Permanente did not comment on the staff bonuses. The health system said in a statement that it respects the rights of employees who choose to be represented by a union and looks forward to working with CIR/SEIU.
Once contract bargaining begins, residents will likely be focused on getting salaries that match rates of inflation, gaining fertility and family planning-related benefits and finding ways to manage the mental health crisis that physicians-in-training are dealing with due to financial and emotional stressors, Anderson said.
Groups like the Association of American Medical Colleges have raised concerns around residents' and fellows' mental health for years, pointing to 2017 data from the Accreditation Council for Graduate Medical Education that shows suicide is the leading cause of death among male residents and the second most common cause for female residents.
University of Chicago Medical Center residents and fellows want to negotiate for maternity and paternity benefits, more meal plan funding and matched retirement benefits that start immediately upon residency, said Nicholas Kowalczyk, a first-year nephrology fellow at the facility.
Residents hope that union representation means they won’t be left to the mercy of whatever benefits and pay the Graduate Medical Education Department and the hospital deem fair, Kowalczyk said.
The University of Chicago Medical Center did not comment on union members' desired benefits.
Other residents and fellows are waiting to ratify their contracts.
On June 1, CIR/SEIU members reached a tentative agreement with New York City Health and Hospitals covering more than 2,300 residents. If ratified, the five-year contract would increase wages by more than 16% over the course of the agreement, provide lump sum payments of $4,000 to $6,000 and raise residents’ starting salary from $66,247 to $81,238.
Residents at Santa Clara Valley Medical Center in Fruitdale, California, also recently came to a tentative agreement with the facility, including 16% pay increases for interns, an additional week of paid vacation time, orientation pay and increased meal stipends.
Doctors are less interested in using union power for pay raises. Instead, physicians aim to have more influence on how their hospitals operate and how patient care is delivered.
“Wages are not a huge priority for this group, because it's not something that is going to increase the quality of life that we have,” said Dr. Matt Hoffman, a family medicine physician with Allina Health, a health system based in Minneapolis.
Physicians are generally unionizing because they feel like their voices are lost to healthcare executives and they want representation on committees that decide issues like how many clinical workers a facility needs to support physicians and how much time doctors should spend with patients, Hoffman said.
"We are committed to negotiating a contract that honors the contributions of our employees, while balancing the needs of our patients and other employees," Allina Health said in a statement.
Following their decision to join Doctors Council in October, physicians at Allina Health have been bargaining for a first contract and talking with health system leaders about issues such as how to better distribute physicians’ administrative responsibilities — including responding to MyChart messages, answering phone calls and reviewing test results — among other staff. As a result of unionizing, potential changes to physicians’ jobs or practice must now be cleared with union members, which is a positive change, Hoffman said.
Union members are also talking with Allina Health about the health system’s plans to implement value-based care and how those might impact patients’ access to physician care, Hoffman said.
“Our concern is that under a value-based payment system, our company is going to be incentivized to have less in-person patient visits,” he said.
Labor representation is becoming increasingly attractive to physicians as a way to advocate for certain standards of practice.
At ChristianaCare, organizing efforts have significantly improved the work culture and relationships between physicians, said Dr. Gennadiy Ryklin, an internal medicine hospitalist with the health system.
“Now we all know each other, and when you feel safe talking to all your colleagues and you’re all working towards all your best interests together, that just helps improve patient care at the end of the day,” Ryklin said.
More doctors outside the health system have also expressed interest in joining a unionized physician group for the ability to see a safe number of patients and reduce their workload, he said.
“Prior to unionizing, we had a lot of people leaving primary care,” Hoffman said. “If they weren't leaving, they were cutting down hours or working less days because they were feeling burned out. Now, our bargaining unit is bigger than it was when we unionized.”
ChristianaCare said in a statement it is focused on maintaining a direct relationship with physicians and providing accurate information to help doctors make an informed decision on whether or not they want to join a union.
