How my skepticism brought about a culture change in how our residency functions

“No one can know what you’re doing here.”

The resident across the table from me made this clear the moment we sat down. We were in her hospital’s cafeteria, talking discreetly at her request with the union coordinator. In an effort to generate more revenue for the hospital, her already substantial call duties had been increased yet again, leaving less time to spend with each patient with no discernible educational benefit. Several of her co-residents in other specialties joined us and told us about similar experiences. These residents’ superiors had gotten wind of their interest in organized labor and threatened to refuse to write fellowship letters of recommendation for anyone involved in union activities. In response to hearing about these illegal union-busting tactics, I described our negotiations process and some of the terms of our contracts, which the others listened to enviously. I left that day unsettled by these conversations and with a newfound appreciation for both my hospital and my union.

When I began working at Cambridge, I was skeptical of our residents union. What was the point of unionization if our salaries were not the highest in town? And what kind of leverage or negotiating tactics could we possibly use given the near impossibility of switching employers or going on strike? Besides, I thought, residency is supposed to be tough but it’s a temporary phase in our training, and at least we’re finally getting paid something for our labor. And if we need to make personal sacrifices to care for our patients and further our education, so be it. Furthermore, aren’t we already protected by the guidelines set forth by ACGME?

Through conversations with more experienced residents with backgrounds in economics, labor, and history, I soon came to realize that the very conditions underlying the place of resident physicians in the medical system grant us little power or agency and leave us vulnerable to exploitation. The typical resident enters postgraduate training with hundreds of thousands of dollars in debt, making it financially impossible to quit the field and enter into another profession.

For resident physicians from outside the United States, their ability to remain in this country legally rests on their employer’s willingness to sponsor a visa on their behalf. The National Residency Match Program — an institution that was granted specific immunity from antitrust legislation in order to stave off a lawsuit for collusion — continues to prevent trainees from negotiating the terms of their contracts before accepting a job offer, and resident physicians are routinely matched to programs in locations where they may have little to no existing social support.

In addition, the resident workforce includes individuals from an increasingly diverse range of ages, genders, and backgrounds, many of whom struggle to start and raise a family while working upwards of 80 hours a week in cities where child care expenses alone eat up the majority of their wages.  The minimal protections by the ACGME are both easily subverted and are insufficient to guarantee fair working conditions for residents.

In order to learn more about the union, I became involved as a representative and have participated in a number of contract negotiations throughout my time in residency. This gave me an in-depth look at the ways in which the union could assist resident physicians throughout their training. In response to the closure of our psychiatric emergency service, my co-residents successfully bargained for a substantial increase in our backup call salary pay. When I needed to take a leave of absence to recover from a major surgery, I didn’t have to extend my residency or cajole my program directors into giving me the time off that I needed but instead could make use of our generous sick day policy as spelled out in our contract.

Yet in spite of the clear benefits the future of public sector unions in this country is uncertain. Should the Supreme Court issue a ruling in Janus vs. AFSCME that would allow workers to refuse to pay their “fair share” union fees, many current union members will opt out of paying dues altogether and choose instead to keep this money for themselves while benefiting from a collectively bargained contract. This move would eviscerate the funding sources for unions such as ours.

Even if this ruling comes down against the position of organized labor, I’m still guardedly optimistic about the union and the working conditions for residents at my hospital in the years to come. Senior residents who have seen, time and again, how their union has made a positive difference in working conditions and patient care can hopefully share those experiences with the next generation of interns who will undoubtedly need their union as they come up against issues in the workplace. I have the privilege of training at a program whose leadership prides itself on advocating for the resident physicians and supporting their wellbeing and education in whatever ways are necessary.

But for my colleagues at non-unionized residencies who can’t count on the largesse of a benevolent program director, the barriers to forming such a union will become even greater. Without a union, resident physicians will continue to lie about their duty hours and delay starting their families while struggling not to get so depressed or burned out that they can no longer function at their jobs. A resident physicians union is no panacea for these and other labor issues that affect resident productivity, education, and well being, but it provides a unique space in which to address them. For those of you resident physicians reading this article who might not have thought such a union could exist, I encourage you to learn more about organized labor and your rights to unionize. Given the current political climate, you may soon lose rights that you didn’t even know that you had. The time to act is now.

Michael Alpert is a psychiatry resident.

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