Medical residents in many hospitals are unionizing. On May 8, The Committee of Unions and Residents at the University of Pennsylvania Health System (Penn Medicine) announced an 892-110 vote in favor of a union. The decision follows union efforts at major hospitals in Boston (Mass General Brigham), the District of Columbia (George Washington University Hospital), and New York City (Montefiore Medical Center). The Committee of Interns & Residents, part of Service Employees International Union Healthcare, claims it represents over 25,000 resident physicians. Health Care News talked to a medical student in Oklahoma who plans to graduate on May 20 about the prospects of being asked to join a union. The student asked to remain anonymous.
Health Care News: It is well known that medical residents can work up to 80 hours a week for often less than $75,000 a year. And they do this for several years. Did that factor into your decision of where to apply for residencies?
Medical Resident: In Oklahoma, the cost of living is lower than in many big cities. My residency salary will not be that much lower than what recent college graduates will earn. The residency salaries in these more expensive cities are not that much higher. There is a limit on how many hours residents work, but I’ve heard hospitals can exceed that.
Health Care News: You come from a conservative state and I imagine unionization does not have the same appeal as in more left-leaning areas. How do you reconcile the long hours for what might amount to being paid less than $20 an hour?
Medical Resident: Residents are truly running the hospital. I saw it when I was doing rounds, and residents just expected to be alerted at any time when a new patient came it. If it wasn’t for the residents, a lot of these hospitals really wouldn’t be able to run the way they do. They basically get free labor from the residents because I know they get funds from Congress, for Medicaid and such.
Health Care News: Aren’t there limits on how many hours a resident can work?
Medical Resident: The standard is 80 hours a week, but hospitals do exceed that and there is pressure on residents not to report on that. And if they do, the ACGME (Accreditation Council for Graduate Medical Education) could pull your program’s accreditation, which could harm your ability to finish your residency and get fully board certified to work independently after that. Congress, the hospital, and the American Medical Association control it and the residents have no say.
Health Care News: Are you open to joining a union?
Medical Resident: Personally, no. The fact that this issue is even coming up in hospitals is a signal that the market is not functioning like a free one. There are the employees—the residents—and the hospital, and these two groups can’t seem to come to the table to negotiate resolutions to these problems. Residents, individually, are unable to weigh competing offers like any other employee who might shop the market for better pay and work conditions. My issue with unions is they force everyone to toe the line of the union. They don’t get you to the free-market position where you as an individual can advocate what is best in your case.
Health Care News: Could and should hospitals be doing anything more to supplement resident salaries?
Medical Resident: Some hospitals in the more expensive cities do try to add living stipends. I have been told this extra pay could amount to $10,000 to $20,000 extra a year, which is not insignificant, but that may not be enough in some places. Some hospitals kick in free meals, these are all nice.
But hospitals need to realize it does benefit them to make sure their residents are compensated fairly or (aren’t) working to the point of exhaustion. After all, residents are caring for patients and need to be in peak shape.
Health Care News: Congress controls the number of residencies in the country and has a lot of say on how hospitals are run. So does the American Medical Association (AMA), in determining physician compensation, which influences residency choice. What would you like them to know about this trend toward resident organizing?
Medical Resident: Lawmakers need a more long-term vision. If they want doctors to last 30 to 40 years, they need to start on day one. It serves no one to have residents burned out by the time they’re ready to practice independently. It takes a long time to become a doctor, sometimes several decades, which is half the typical working life of many people.
The AMA is more a business than a professional group representing the interests of doctors. They make a lot of money from the (Current Procedural Terminology) code system they own that Medicare uses to pay doctors. They haven’t spoken loudly enough about resident pay and work conditions.
A big issue is morale. Seeing from the AMA and Congress a desire to invest in us and our well-being would go a long way to garner the support of current residents and medical students. This is all about investing in the future of physicians who are going to be caring for the population for the next few decades and creating an environment that makes us want to show up for work every day.