Residency Unions- Are they helpful or detrimental to the residency experience

[Director1]

Was wondering what kind of experience that those of you who are part of residency union have? What are the positives and negatives. There is an opinion piece that was written called The Fault in Our Systems- On Physician Unions. Do you think it has any interesting points? Any thoughts?

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[Raryn]

I didn't have one in residency, but the impression I have in general is that they're useless.

Residents at programs with unions don't seem to consistently get any more money, protection, or benefits compared to programs without unions. That's not to say that programs aren't widely variable, they certainly are... but there seems to be more intra-group than inter-group variability.

Every single GME institution in this country, union or not, has a resident committee that relays the house staffs concerns. I don't think unions are any more effective than that mechanism (which isn't that effective to start with, but that's another story).

 

[Psai]

Waste of union fees

 

[AdmiralChz]

Yeah, this sort of thing might be common outside of the southeast (I've honestly never heard of unionizing for residency) but it seems like it wouldn't work very well. At the core, the strongest stance a union can take is to go on strike, but unlike in other jobs if you choose to do this it would cut into or even halt your training - without completing residency you cannot become an attending physician, period. At some point you just have to trust in the processes in place at your institution. For starters, be honest on both internal and ACGME surveys about your perspectives, this often forces their hand in at least addressing concerns.

 

[kemper6036]

Generally not helpful. My state is a forced unionization state, meaning that you cannot opt out of joining the union. They get your money then use it for political causes which you may not support or even be aware that they are doing this. The residents joined a union a couple years back right before our contract came up and we got a 15% raise. However at that time, we were the lowest paid residents in the country so I felt like no matter what, we were going to get a raise.

 

[Temeraire]

I was talking about my health insurance benefits with my parents, and they were like "woah that's a sweet cadillac plan and it's cheaper than what we pay for at the big fortune 500 company dad works for" and I was like, "haha county hospital unions are the best."

I'm pretty happy with the perks we get, though I'm not sure how much to chalk them up to the regular county union vs the residents union.

 

[Raryn]

I was talking about my health insurance benefits with my parents, and they were like "woah that's a sweet cadillac plan and it's cheaper than what we pay for at the big fortune 500 company dad works for" and I was like, "haha county hospital unions are the best."

I'm pretty happy with the perks we get, though I'm not sure how much to chalk them up to the regular county union vs the residents union.

I think working for the government gets you a pretty good health plan regardless. In fact, I highly doubt you as a resident get any different than any other employee of the government, union or not.

I'm at a state program right now for fellowship (non-unionized) and my health plan is identical to any other employee of the university, except the GME administration decided to subsidize a first child a little bit more than is typical (which doesn't affect me b/c I don't have kids). I don't think a union could have made it any better.

 

[Winged Scapula]

My fellowship program had a residency union. As I recall one of the things our dues paid for was the fight to have our birthdays off.


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[Psai]

Generally not helpful. My state is a forced unionization state, meaning that you cannot opt out of joining the union. They get your money then use it for political causes which you may not support or even be aware that they are doing this. The residents joined a union a couple years back right before our contract came up and we got a 15% raise. However at that time, we were the lowest paid residents in the country so I felt like no matter what, we were going to get a raise.

Or they could have kept you the lowest paid residents in the country

My fellowship program had a residency union. As I recall one of the things our dues paid for was the fight to have our birthdays off.


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Do patients stop getting sick on your birthday?

 

[kemper6036]

possible, but by then the newspaper had gotten a hold of it and since its very difficult to recruit physicians to this area, i think it would have been increased regardless

 

[Winged Scapula]

Do patients stop getting sick on your birthday?

Right? Or how about just accepting that we're not 5 any more but rather adults with jobs who go to work on their birthday.



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[Perrotfish]

Right? Or how about just accepting that we're not 5 any more but rather adults with jobs who go to work on their birthday.



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At my residency one of the side effects of the increasing midlevel presence was that weekends and holidays have been disappearing for residents. Apparently most midlevels charge extra to work those days, so it was cheaper to force the residents to be 100% present on those days to keep the hospital adequately staffed. My second year they told us Interns, who used to get one major holiday a year, would now get none, and they're now talking about extending that policy to senior residents. Also about half of my services had switched from a policy of one weekend day off per week to one random weekday. These policies are obviously a great way to make sure that residents are completely isolated from both their friends and family, since you wouldn't share a day off with anyone you cared about for months at a time.

I think the birthday idea is a good way to give residents at least one day off that has some meaning for them, in a training system that is showing ever less respect for their time and mental health. It emphasizes the idea that your birthday is an event, and should probably end with at least some kind of celebration (dinner with friends). Otherwise it becomes just another workday like Christmas, New years, and Thanksgiving.

 

[ThoracicGuy]

At my residency one of the side effects of the increasing midlevel presence was that weekends and holidays have been disappearing for residents. Apparently most midlevels charge extra to work those days, so it was cheaper to force the residents to be 100% present on those days to keep the hospital adequately staffed. My second year they told us Interns, who used to get one major holiday a year, would now get none, and they're now talking about extending that policy to senior residents. Also about half of my services had switched from a policy of one weekend day off per week to one random weekday. These policies are obviously a great way to make sure that residents are completely isolated from both their friends and family, since you wouldn't share a day off with anyone you cared about for months at a time.

I think the birthday idea is a good way to give residents at least one day off that has some meaning for them, in a training system that is showing ever less respect for their time and mental health. It emphasizes the idea that your birthday is an event, and should probably end with at least some kind of celebration (dinner with friends). Otherwise it becomes just another workday like Christmas, New years, and Thanksgiving.

If you need a day off to have dinner with friends, I would imagine that in turn most residents probably wouldn't have too many able to show up because they'd be working...

Having a birthday off is rather silly. I'd see much better having Christmas, NY, Thanksgiving, or the like off instead.

I'm not sure why your program needs all of the lower level residents to be staffing things for holidays like that. Our program covered multiple hospitals and we still managed to have a week off either during Christmas or the week after.

 

[AdmiralChz]

I'm not sure why your program needs all of the lower level residents to be staffing things for holidays like that. Our program covered multiple hospitals and we still managed to have a week off either during Christmas or the week after.

Agree - even busy academic centers slow down (particularly elective cases) in December. At my institution, surgery services often merge teams (since the census is quite a bit lower) to ensure more time off during this time for team members.

 

[Karrde]

I was in a union during residency at a county hospital (this is NOT the union for county employees btw!) and it was utterly useless. I happened to go sit on on a contract negotiation meeting my r3 year as I wasn't super busy on an evening call shift. The union got us a 0% raise in year 1 of contract, and 1% in year 2 and 3. Thanks guys!

 

[chocomorsel]

I belonged to a union in residency which I thought did a lot. They got us an increase to the median pay for our region over a period of three years, and the stating pay increased each year I was there, they got us more money for food and a more fair distribution among the departments, paid paternity leave, lawyer access if we were dues paying members, kept our health plans cheap when the hospital tried to hike them up and other little things I can't remember.

Before the union came, there was a resident committee that obviously did not get the same things accomplished as the union did. The pay was the lowest in the region and the first year the union negotiated, it went up about 7K. Actually one of the reasons I went to that program was because of the Union. And when things started going sour for me due to a bitch of a PD who tried to make an example out of me, the union was there for me and helped me not extend my residency as the bitch wanted.

Not all unions are useless.

 

[QofQuimica]

The problem with all unions is that they're coercive. I don't ever want to be forced to join a union, and I don't think anyone else should be forced to join one, either. But if joining the union is optional, then no one will want to join, because they'd rather free load off the suckers who do join and pay the dues. I have no idea how one could or would get around this basic logjam of competing rights.

The problem with residency unions specifically is that they're toothless. Not that an all-powerful union is such a great thing necessarily, because just like when corporations or government get too big, unions with too much power become corrupt. But as others have pointed out, it's not like residents can strike if they don't get what they want. And without the ability to strike, then who cares what the union thinks?

 

[Psai]

I just think union fees are too expensive

 

[kemper6036]

Right? Or how about just accepting that we're not 5 any more but rather adults with jobs who go to work on their birthday.



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i'm going to say just that to the people in my program who request their birthday off EVERY YEAR. Usually like a week off too!

 

[Raryn]

i'm going to say just that to the people in my program who request their birthday off EVERY YEAR. Usually like a week off too!

If you want to take your vacation on your birthday, more power to you. I doubt anyone will care when they make the vacation schedule, unless your birthday happens to fall in late November or later December.

If you want extra time off because it's your birthday? lol.

 

[QofQuimica]

If you want to take your vacation on your birthday, more power to you. I doubt anyone will care when they make the vacation schedule, unless your birthday happens to fall in late November or later December.

Even if it does, it's not unreasonable to request some time off for one of the major end of year holidays (Thanksgiving, Christmas, or New Years). But as a resident or as an attending in a hospital-based specialty, you should expect to work at least one if not both of the other two. This year I'm taking two weeks off at Thanksgiving and working the two weeks of Christmas and New Years.

 

[kemper6036]

If you want to take your vacation on your birthday, more power to you. I doubt anyone will care when they make the vacation schedule, unless your birthday happens to fall in late November or later December.

If you want extra time off because it's your birthday? lol.

or unless you're scheduled to do a rotation during that time where no vacation can be taken

 

[Raryn]

or unless you're scheduled to do a rotation during that time where no vacation can be taken

Many programs will let you swap rotations with your classmates. It's variable. In residency, when there were >15 of us a year, I could almost always find someone to swap a block with. So move an elective to an inpatient block and vice versa. As long as the trade is ultimately fair, program shouldn't care.

In fellowship, when theres just a few of us, it's a lot more difficult... but still doable if I really have a reason to need that weekend off.

 

[kemper6036]

Many programs will let you swap rotations with your classmates. It's variable. In residency, when there were >15 of us a year, I could almost always find someone to swap a block with. So move an elective to an inpatient block and vice versa. As long as the trade is ultimately fair, program shouldn't care.

In fellowship, when theres just a few of us, it's a lot more difficult... but still doable if I really have a reason to need that weekend off.

depends on the size of your residency i guess. we have a very small class size, so getting someone to switch is a big challenge

 

[Buzz Me]

Agree - even busy academic centers slow down (particularly elective cases) in December. At my institution, surgery services often merge teams (since the census is quite a bit lower) to ensure more time off during this time for team members.

Our program worked around this by just making everyone take Q2 call for a week, then you could miss a call the next week.

 

[dpmd]

Generally not helpful. My state is a forced unionization state, meaning that you cannot opt out of joining the union. They get your money then use it for political causes which you may not support or even be aware that they are doing this. The residents joined a union a couple years back right before our contract came up and we got a 15% raise. However at that time, we were the lowest paid residents in the country so I felt like no matter what, we were going to get a raise.

Don't forget that raise came with a limiting of the food allowance. Or that a few years prior the non unionized residents were able to get the hospital to give a raise (can't remember the amount but it was noticeable). But the union had a lot of alcohol at all the parties they threw while trying to get people to join...

 

[DoctwoB]

At a non-unionized program, but I see resident unions on the whole as a mixed bag, but generally as a positive thing.

The downside is clear: they require dues. Additionally there is the issue of leadership. If they are led by current residents/fellows, then that person can't devote much time to it and is by definition transient. If there are people whose only job it is to run the union, then they can become more interested in preserving their job then providing benefits. Finally, they have limited leverage, because residents haven't shown a willingness to strike and they have to meet acgme (including time off work) to graduate.

That being said, the places I interviewed with resident unions tended to have better pay relative to their regional peers, more vacation, and perks like holiday pay, free food/parking, etc. While leverage may be limited, it at least gives the residents a spot at the table which we otherwise lack, and you know that everyone else, from midlevels to nurses and administration is making their desires known. If my program unionized I would be happy about it, but its hardly a major priority.

 

[kemper6036]

Don't forget that raise came with a limiting of the food allowance. Or that a few years prior the non unionized residents were able to get the hospital to give a raise (can't remember the amount but it was noticeable). But the union had a lot of alcohol at all the parties they threw while trying to get people to join...

now it got even further limited. they took away the meal card and instead you get a stipend which comes out to 80 bucks per paycheck....half of the original amount we used to get a month

 

[Handinhand]

There are a few programs that come to mind where I think unions benefit residents quite a bit; UMichigan and Washington come to mind.

Michigan union contract: https://hoaumich.org/contract/2013/

Great salary, an extra months salary every November to encourage savings, 1/365 Annual pay on any holiday worked, heavily subsidized health, dental and vision insurance, monthly food allowance (for certain specialities), etc..

I do agree that a union for residents, at least conceptually, is kind of silly since there's really no action that can be taken if the hospital gives them the finger -- you can't strike; however, I think in big programs where the dues can be spread over a larger group of residents, some real changes can be made regarding salary and in-hospital perks for residents.