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What happens after unionization? On International Workers’ Day, the fight goes on for fair contracts for medical trainees

What happens after unionization? On International Workers’ Day, the fight goes on for fair contracts for medical trainees

On April 30, 2023, I received a text from my close friend from medical school, Heidi Carpenter: George Washington University Hospital (GWUH) residents successfully unionized in a landslide vote of 253-16. A first-year Obstetrics and Gynecology resident at the time, she (and others) strained under low salaries and systems-level changes out of their control. A vital part of the workforce at top academic medical centers, residents desired to be stakeholders in the direction of the health system that employed them. At the time, my co-trainees and I worked desperately towards a union election at Mass General Brigham (MGB). On June 8, 2023, with a vote 1215-412, we won.

One year later on International Workers’ Day, we reflect on why unionization is critical for medical trainees, lessons learned post-unionization, and what keeps us going.

The first question many people ask is, “Why do residents need a union?” Simply put, we are among the most vulnerable and exploited workers in the medical system. Residents and fellows have their medical degrees so continue their training as supervised doctors employed by hospitals. This stage lasts from three to seven years and 63% of doctors entering residency are age 27 or above, so much of our early family life is lived during this period (20% are married and 7% have children).

Per Accreditation Council requirements, trainees are capped at 80 hour workweeks on average–double the standard in other fields–but many programs still exceed this. Dr. Carpenter calculates her rough hourly pre-tax wage as $14.70–less than the minimum wage in Washington DC where she works. Then take into account that 50% of trainees have greater than $200,000 in debt. These stressors plus limited mental health resources have led to astronomical rates of burnout. It is no surprise that the number of trainees unionized with the Committee of Interns and Residents (CIR) skyrocketed from 20,000 in 2022 to 32,000 in 2024.

Another factor driving unionization in the medical field as a whole is the shift of hospitals and clinics to profit machines. As of 2022, 24% of hospitals were investor-owned, for-profit (a near-doubling since the early 2000s) and small practices continue to be purchased by larger health systems to the tune of 38 billion dollars in 2023 alone. In these for-profit systems, doctors are overburdened by administrative work that takes away from time with patients, struggling to provide their ideal quality of care, with no agency in their parent health system’s resource allocation.

So, to those considering unionization, going public like Kaiser Permanente, or grinding through contract negotiations like us, we have some May Day reminders:

Through the strength of our shared voice, we can protect mental health, promote medical professional diversity, and improve patient care.

As GWUH contract negotiations dragged on, a resident there died by suicide, highlighting the potentially fatal effects of toxic working conditions. While negotiations stretch over months, trainees continue to experience life-threatening stressors knowing that mental health protections may be just around the corner. For example, Stanford negotiated $50,000 annually for the Resident Wellness Committee and Children’s National Medical Center negotiated a $5,000 annual mental health stipend per trainee.

Medical students factor debt and future salary into their match list making residency programs in expensive cities inaccessible to groups that are underrepresented in medicine (URiM), such as first-generation physicians. Negotiating for higher wages reduces these disparities. Contracts also directly support diversity; Boston Medical Center negotiated $88,000 annually and a paid program manager for URiM efforts while Jackson Memorial established a Minority Inclusion Task Force.

Through unionization, we also seize the opportunity to advocate for our patients. Children’s National established a Patient Safety Committee and New York City Health System won a $60,000 Patient Care Trust Fund for necessary medical equipment. Many critics claim that unionization is just about working less and earning more, but it is so much more.

Contracts negotiated by a collective of employees are critical because promises are too often broken.

When the employer breaks promises or stalls progress after unionization, we are reminded that the only way to guarantee a say in our terms of employment is to negotiate a contract with the representation of a union. At MGB, we felt this lesson just after our election. The National Labor Relations Act dictates that working conditions and benefits are frozen during contract negotiations, yet MGB cut several departmental benefits, forcing the MGB Housestaff Union to file an Unfair Labor Practice charge with the National Labor Relations Board in September 2023. It remains under review as this process can take months.

GWUH trainees are battling their own set of negotiation roadblocks. Contract bargaining began with introduction of proposals in October 2023 and, since, trainees have pushed for the compensation and protections that they deserve–that GWU seems thus far unwilling to give.

Growing pains are felt deeply by trainees awaiting contract ratification–a process that takes so long that many who worked tirelessly to unionize do not benefit–but we know it will be worth it for those who come after us. Conditions of resident/fellow employment will never again be changed without our direct involvement.

Every union formed creates a ripple effect that empowers other workers.

The unionization movement ripples beyond medical trainees. In the Boston area alone this year, attending physicians at Salem Hospital, an MGB facility, voted to unionize. Then, non-tenure researchers voted to unionize as the Harvard Academic Workers. Not only does unionization impact the employees that come after us within our institution, but the city around us and the culture of the medical profession.

As we look back, exhausted by residency and the endless grassroots organizing required to form and maintain a union, we know it is worth it. If you are in the position to support medical trainees going through this process, we call on you to support them. If you are considering forming a union of your own, hold strong to your mission and know there is a vast network out there to cheer you on.

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