Residency is known to be grueling. And during the covid-19 pandemic, the pressure upon residents only increased. As a result, a growing number of residents at hospitals within the U.S. are forming unions to formalize decisions related to pay and working conditions. Sunyata Altenor, Communications Director for the Committee of Interns and Residents (CIR), the nation’s largest resident’s union, said, “Every year, we had one or two new organizing campaigns, but once COVID hit, that number pretty much tripled.” She continued, “It was a massive wave, and we anticipate that it will continue to grow.” Currently, 15 percent of medical residents in more than 60 hospitals are unionized and represented by CIR, while a smaller proportion have either formed a local union or joined a larger medical provider union.
Oversight organizations, including the AAMC and the AMA, provide high-arching policy guidance on unions but leave the decision-making to the hospital and the residents who work there. According to Janis Orlowski, MD and AAMC Chief Health Care Officer, “The AAMC leaves it to each institution and its house staff to determine how to achieve the best possible education, working conditions, and patient care.” The AMA, for its part, notes that its policy on resident unions strongly encourages separating academic issues from union-covered employment conditions. They note also that unions must abide by the AMA Principles of Medical Ethics, which disallow “such organizations or any of its members from engaging in any strike by the withholding of essential medical services from patients.”
The benefits of unions include providing medical residents a collective voice to negotiate more favorable pay and working conditions. The Accreditation Council for Graduate Medical Education (ACGME) regulates the maximum number of working hours for residents, but not salary. In 2021, according to AAMC data, first-year residents earned just below $60K on average, with many working up to 80 hours weekly. And while working conditions vary by hospital and department, unions can also provide residents more control over their intense work schedules and demands. For example, University of Washington’s Resident and Fellow Physician Union-Northwest (RFPU) won the right for pregnant residents to decline 24-hour shifts.
Other union benefits include encouraging departments to clearly delineate the rules and rights of residents, and improve social justice efforts through additional support and means to report racial (or other) discrimination for residents of color or sexual minorities. Proponents of resident unions including Kaley Kinnamon, MD and Resident at the University of Vermont Medical Center, which recently voted to launch a residents’ union, noted that unions also bolster the conditions that allow residents to focus on providing the best patient care. “In order to take good care of others, we need to be able to care for ourselves,” she said. “We love being residents and caring for patients. But we can’t do that well if we neglect ourselves.”
There are also downsides to resident unionization. For one, there is a significant financial cost, particularly post-pandemic when many hospitals are still financially vulnerable. While hospitals receive federal funding to support resident salaries, most come from the hospital itself. There is also a drawback in creating blanket conditions for all hospital residents during training, as there is a need for flexibility and differentiation between departments based on residents’ learning needs. One resident, interviewed by AAMC, noted that surgical residents are required to fulfill a certain number of cases and hours—regardless of union negotiations—in order to qualify for board certification. Furthermore, hospitals have raised the concerning nature of a strike, which would make it almost impossible to adequately staff the hospital.
Jason Sanders, MD, and Executive Vice President for Clinical Affairs at the University of Vermont Health Network, suggests that hospital leaders pay attention, but look beyond immediate questions of unionization, to focus on the bigger picture. “Whether or not residents have a union, their concerns exist. The question we leaders need to ask ourselves is, how are we going to address them?” he said.
