Dr. Monique Hedmann, a family medicine resident at Harbor-University of California, Los Angeles Medical Center in West Carson, works with patients from 8 a.m. to 5 p.m. But her day doesn't end there.
The third-year resident calls patients and writes clinical notes until the environmental services workers tell her she needs to leave. Then she goes home and continues working until she falls asleep.
"You don't have free time to take care of life. You're barely able to sleep. This is in the context of seeing very traumatic things in terms of patient care," Hedmann said. "You have no time to take care of yourself and heal from that. You just have to keep going."
Residents' hours are capped at 80 hours per week, but that's just on paper. They sometimes work up to 28-hour shifts, rarely get days off and are saddled with hundreds of thousands of dollars in medical school debt. While they may have lucrative careers ahead, three to seven years of residency can be "grueling," said Hedmann, who is regional vice president for southern California at the Committee of Interns and Residents, which has grown by 6,000 members to 22,000 since 2019.
Medicine historically hasn't been a haven of organized labor, even though unions are more common for nurses and other healthcare workers. Physicians are highly paid professionals and traditionally have practiced alone, in small groups or as independent practitioners working at hospitals and other facilities—conditions that don't lend themselves to union drives.
The culture of medicine also contributes to physicians' evident disinterest in banding together in the workplace. Doctors learn from medical school on that they must pay their dues to advance, and are loath to complain about long hours or difficult circumstances. And a go-it-alone mindset pervades the profession, said Rachel Flores, organizing director for the Union of American Physicians and Dentists, which represents 5,000 professionals. The labor organization added 250 members and organized another 200 in the past year.
"Doctors have had the mentality that 'I can do this on my own. I don't need someone to advocate for me,'" Flores said.
But as more practicing physicians become employees of health systems and other healthcare companies, attitudes may shift. And the ravages of the COVID-19 pandemic have made some doctors reconsider the benefits of speaking collectively to improve working conditions and patient care.
Doctors are "extremely interested in unionizing," said Joe Crane, national organizing director of the Doctors Council, which is affiliated with the Service Employees International Union and has 3,500 members. "They're broken, honestly. They're tired of the way healthcare has moved, the direction of profits over their patients, the pressures they have to deal with on a daily basis," he said. "Physicians across the country are reaching out and, sadly, saying, 'Help.'"
Newly minted doctors seem to be driving an uptick in unionization campaigns. The number of inquiries from residents interested in unionizing "skyrocketed" over the past two years, said Dr. Michael Zingman, secretary-treasurer of the SEIU-affiliated Committee of Interns and Residents. The number of requests this year has already exceeded the hundreds doctors made last year, he said.
"We're basically at the point where we're getting too many requests that we can't unionize all of these chapters," said Zingman, a third-year psychiatry resident at NYC Health+Hospitals/Bellevue in New York.
Residents have recently formed unions at healthcare employers such as University of Vermont Medical Center in Burlington, Vermont, Greater Lawrence Family Health Center in Lawrence, Massachusetts, and University of Southern California Keck School of Medicine in Los Angeles. The union has organized eight residency programs over the past two years, compared with one or two in a typical year, and has added 6,000 members during that time, according to the Committee of Interns and Residents.
Even if this trend were to continue and accelerate, the share of physicians who belong to labor unions is likely to remain low.
Only a tiny fraction of physicians and dentists belong to unions. The Bureau of Labor Statistics reports there are 824,000 physicians and dentists in the U.S., not including self-employed practitioners or those not working. Just an estimated 1% of physicians and dentists and 15% of medical residents are members of the Union of American Physicians and Dentists, the Doctors Council or the Committee of Interns and Residents. (Modern Healthcare derived these figures by analyzing data from the BLS, the Accreditation Council for Graduate Medical Education, the Association of American Medical Colleges and the unions.)
Labor activity in healthcare settings coincides with a renewed interest in unions in the economy at large, including highly public campaigns by Starbucks and Amazon employees. Workers filed nearly 2,000 petitions for union elections to the National Labor Relations Board during the first three quarters of fiscal 2022, a 58% increase from the corresponding period the previous fiscal year, the agency reported last week.
Nevertheless, the share of private sector workers who belong to unions is low and shrinking, the BLS reported in January. Last year, just 6.1% of people employed by private companies were union members.
The pandemic's toll
John August, program director of the Healthcare Labor Relations and Partners Program at Cornell University, attributes the rise in healthcare union activity to the stresses of the COVID-19 pandemic. The past few years have exacerbated the workforce shortage, leading to understaffed shifts and to residents taking on "extraordinary amounts of overtime" atop the "almost inhuman" hours they already work, he said.
Healthcare workers also complain of what's called "moral injury" from watching patients suffer and die and feeling powerless to help, August said. "This sense of additional stress and fear that occurred both for themselves and for their patients has been the main factor," he said.
Residents often are hesitant to speak up about working conditions because they need to please their superiors to get ahead, said Dr. Ben Solomon, a third-year pediatric resident at Palo Alto, California-based Stanford Health Care. "It's a period of time where you really are vulnerable," he said.
Historically, residents have been conditioned to accept negative circumstances as part of the graduate school process, Hedmann said. "If you keep your head down, you essentially go through hell, you pay your dues, then later you get this very fruitful career in medicine. That kind of thing has really been solidified in people's minds," she said.
A majority of the nearly 1,500 interns, residents and fellows at Stanford Health Care voted to join the Committee of Interns and Residents in May. "Unionization really has no downsides for residents," said Dr. Philip Sossenheimer, a third-year internal medicine resident at Stanford Health Care and a member of the union's bargaining committee.
"COVID has really opened up an opportunity for labor unions to capture and capitalize on some of the discontent that exists among our healthcare providers across the country," said Jill Lashay, a healthcare labor and employment attorney at Buchanan Ingersoll and Rooney who represents employers.
Despite the growing number of residents unionizing, the pace of organizing attending physicians is slower, union representatives said.
Yet as more physicians are directly employed by health systems and other companies instead of operating independently, they are more apt to see themselves as workers who get paychecks, August said. "Doctors, really, in many cases, are losing their historical autonomy," he said. "We're getting to a tipping point."
A rising share of physicians are now employees of hospitals, health systems or other companies, according to a study the Physicians Advocacy Institute and Avalere Health published in April. Between 2020 and 2021 alone, the proportion of employed doctors increased from 69.3% to 73.9%, the report shows.
For attending physicians—as it is for residents—considering a union is complicated, labor representatives said. Doctors take an oath to put patients first, which can seem at odds with being in a union and advocating for themselves.
But concerns over personal protective equipment and safety standards during the pandemic has them interested in organizing to protect patients and promote quality care, Crane said.
The way employers react to organizing efforts varies, August said. A minority welcome unions with open arms. Many are opposed. But a growing number see advantages to working with unions to solve problems, he said. "They have fears about the role of the union, but I think they also realize, in today's world, that healthcare has to be a team sport," he said.
Lashay recommends that healthcare employers be receptive when workers highlight problems. "We, as employers, need to be particularly attentive to the concerns our employees are raising at every single level," she said.
Employers should be proactive and have respectful and transparent conversations with workers, Lashay said. They also should be transparent about financial challenges and explain how they are tackling staffing shortages, she said.
"Management should strive to have the most collaborative labor-management relationship that it possibly can," Lashay said. "The concern, frankly, is not about unions organizing. It's genuinely about employee relations."