Residency unions

[DarkBluMage]

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Why more resident physicians are looking to unionize

Are unions a factor for those who are selecting programs to match for residency?

Are these unions actually helping with quality of life/increased pay for those who were able to unionize?

 

[Babble Heap]

I'm not actively involved in our union, but the representation has certainly helped us obtain raises, educational stipends, housing bonuses, and equipment around the hospital. Personally, it wouldn't change my decision making about where to train, since my primary goal has always been quality of education, but I don't think it would be wrong to have it be a factor. There's no doubt that it has had a substantial impact on my financial security.

 

[KnightDoc]

I'm not actively involved in our union, but the representation has certainly helped us obtain raises, educational stipends, housing bonuses, and equipment around the hospital. Personally, it wouldn't change my decision making about where to train, since my primary goal has always been quality of education, but I don't think it would be wrong to have it be a factor. There's no doubt that it has had a substantial impact on my financial security.

This^^^^^. Having a union would be a great perk, but, at the end of the day, how many residents actually place pay, benefits or working conditions above connections, prestige and quality of training when choosing a residency?

My understanding is that if the answer was "everyone," that all the hospitals in NYC, including NYU, Columbia and Cornell, would be the easiest places in the country to get a residency, given how poorly residents are reportedly treated in NYC hospitals. Nursing unions there have a ton of power, and many over worked and under paid nurses apparently use it to treat residents like absolute crap.

In addition, the culture of medical training in NYC is just a lot more abusive toward residents than in many other parts of the country. Salaries also totally suck in relation to the cost of living there. It's just something you deal with in order to get world class training before moving on. After all, residency is not the end game, it's just the next step in training.

 

[wondervisions]

This^^^^^. Having a union would be a great perk, but, at the end of the day, how many residents actually place pay, benefits or working conditions above connections, prestige and quality of training when choosing a residency?

My understanding is that if the answer was "everyone," that all the hospitals in NYC, including NYU, Columbia and Cornell, would be the easiest places in the country to get a residency, given how poorly residents are reportedly treated in NYC hospitals. Nursing unions there have a ton of power, and many over worked and under paid nurses apparently use it to treat residents like absolute crap.

In addition, the culture of medical training in NYC is just a lot more abusive toward residents than in many other parts of the country. Salaries also totally suck in relation to the cost of living there. It's just something you deal with in order to get world class training before moving on. After all, residency is not the end game, it's just the next step in training.

This attitude is how the culture of abuse, low pay, and extremely harsh working conditions is perpetuated.

 

[DarkBluMage]

Preciate the insight yall!

 

[DarkBluMage]

This attitude is how the culture of abuse, low pay, and extremely harsh working conditions is perpetuated.

Yea I’m definitely not interested in being overworked in residency if I don’t have to be. The unions are definitely interesting. I feel like even while in training we’re still educated individuals that deserve good pay and a better work/life balance. I could see putting up with terrible conditions if it were only a year but some residencies are like 7 years. Just seems entirely too long to be miserable after dedicating so much time to education. At some point lifestyle, pay, and family outlook needs to improve and I don’t think that should start once you finally become an attending when you’re well into your late 30s, or even 40s for some people.

 

[KnightDoc]

This attitude is how the culture of abuse, low pay, and extremely harsh working conditions is perpetuated.

You are, of course, correct, but like med school admissions itself, the supply/demand imbalance between those seeking the training and the available spots allows it to continue. My deciding not to tolerate it is not going to change anything, and collectively, there are simply too many people chasing too few opportunities for any one person's attitude to have an impact.

Again, a union and great working conditions would be great things to have, but they are not typically in the Top 5 of things med students find important in terms of ranking residency opportunities. If they were, the NYC residencies would be almost exclusively staffed by IMGs.

 

[voxveritatisetlucis]

how would a resident union have any bargaining power when there are thousands who don’t match each cycle and would gladly take a position?

Don’t unions need viable alternative employment to have any sway? If residents don’t physician, they can’t practice medicine aside from urgent cares or something.

For the most part, unions have declined in power since the RICO act and the fall of the La cosa nostra.

 

[KnightDoc]

how would a resident union have any bargaining power when there are thousands who don’t match each cycle and would gladly take a position?

Don’t unions need viable alternative employment to have any sway? If residents don’t physician, they can’t practice medicine aside from urgent cares or something.

For the most part, unions have declined in power since the RICO act and the fall of the La cosa nostra.

Really? Google Apple and Amazon and Starbucks and unions. They are making a comeback.

Study the history of unions. It was horrendous working conditions and a willingness to organize that created the environment for unionization. Not viable alternative employment. Employees went on strike. They didn't quit and go to work at another sweat shop, or auto maker, steel mill, etc.

You should probably check out the link in the OP to learn a little about how and why residents can unionize. That said, my points about working conditions not being a driver in med students choosing which programs to rank, and the fact that they only spend a few years in residency, are probably the reasons this did not catch fire years ago, and probably won't now. Although, if it happened in CA, NYC would definitely be a prime target and fertile ground for recruiting.

 

[DarkBluMage]

how would a resident union have any bargaining power when there are thousands who don’t match each cycle and would gladly take a position?

Don’t unions need viable alternative employment to have any sway? If residents don’t physician, they can’t practice medicine aside from urgent cares or something.

For the most part, unions have declined in power since the RICO act and the fall of the La cosa nostra.

I could see them having some bargaining power. I find it hard to believe that a program would be willing to let go of all their current residents who unionize. That would cause problems for the hospital and program I would think.

 

[KnightDoc]

I could see them having some bargaining power. I find it hard to believe that a program would be willing to let go of all their current residents who unionize. That would cause problems for the hospital and program I would think.

Plus, it would be illegal! 🙂

The bigger issue is just that this isn't a huge things for residents, who generally don't want to rock the boat because they are only there for a short time before moving on to lucrative careers. Unlike low paid retail workers, factory workers, etc., who are there for the long haul, which is where unions have traditionally thrived. As pointed out above, this is a great perk to have, but no one ranks a no-name program, in a less prestigious specialty, in the middle of nowhere that has a reputation for treating its residents well, above a prestigious NYC hospital.

When you match wherever you end up, are you going to invest the time and energy, and possibly risk your future by pissing off the wrong people, in order to maybe make things better for those coming after you? If so, you are a better person than most. People's natural desire to keep their heads down and focus on themselves is really why this perpetuates, to @wondervisions' point.

 

[Putkernerinthehall]

When you match wherever you end up, are you going to invest the time and energy, and possibly risk your future by pissing off the wrong people, in order to maybe make things better for those coming after you? If so, you are a better person than most. People's natural desire to keep their heads down and focus on themselves is really why this perpetuates, to @wondervisions' point.

Exactly right, and this is a society-wide problem. The root of much of our dysfunction.

 

[CyrilFiggis]

There have literally been studies looking at the cost to replace all residents in health systems with APPs or attending physicians. Our power is the fact that we are low cost, subsidized doctors who cover the majority of work force hours in a hospital. I will say I was ambivalent about our union, but they have provided better salary increases, parking, health care, guaranteed vacation etc. For those going into 4-6 year programs, I think a union is very beneficial and something you should consider.

Eliminating Residents Increases the Cost of Care

ABSTRACTBackground . Academic health centers are facing a potential reduction in Medicare financing for graduate medical education (GME). Both the Medicare Payment Advisory Commission and the National Commission on Fiscal Responsibility and Reform (Deficit Commission) have suggested cutting...

meridian.allenpress.com

 

[KnightDoc]

There have literally been studies looking at the cost to replace all residents in health systems with APPs or attending physicians. Our power is the fact that we are low cost, subsidized doctors who cover the majority of work force hours in a hospital. I will say I was ambivalent about our union, but they have provided better salary increases, parking, health care, guaranteed vacation etc. For those going into 4-6 year programs, I think a union is very beneficial and something you should consider.

Eliminating Residents Increases the Cost of Care

ABSTRACTBackground . Academic health centers are facing a potential reduction in Medicare financing for graduate medical education (GME). Both the Medicare Payment Advisory Commission and the National Commission on Fiscal Responsibility and Reform (Deficit Commission) have suggested cutting...

meridian.allenpress.com

Is there an easy way to find out which programs are unionized? Seems like a very awkward question to ask during interviews.

 

[pigsinacloth]

Is there an easy way to find out which programs are unionized? Seems like a very awkward question to ask during interviews.

There are spreadsheets every year that have info on programs. I don't think it's in any of them now, or at least not in the specialties I am interested in because it is not super wide spread. That being said if people really start doing this over the next few years it might be included when you're applying.

Also if you have a friend or close contact at the program you could always ask them on the down low and share it with everyone else if it is not widely known info.

 

[throwaway123342]

This^^^^^. Having a union would be a great perk, but, at the end of the day, how many residents actually place pay, benefits or working conditions above connections, prestige and quality of training when choosing a residency?

Depends on the field you are in. If you are going radiology and your program doesnt offer moonlighting for example, then you are going to the bottom of the list.

Personally, I am just laughing internally at the people who ranked NYC programs really high for "prestige" and are now paying 4k a month to share a shoebox.

 

[voxveritatisetlucis]

Personally, I am just laughing internally at the people who ranked NYC programs really high for "prestige" and are now paying 4k a month to share a shoebox.

Could be worse. California is just as expensive and restricts moonlighting.

I’m guessing many residents in these places don’t need the money.

 

[Dr G Oogle]

I think the main purpose of a residency union is to prevent retaliatory behavior from faculty and decrease abuse of residents. Pay increases will be marginal at best, there’s just no way a resident will get paid more than a fraction of what an attending makes, that makes systems unsustainable. You could argue they should make as much as APPs, but APPs make variable salary (CRNA >> surgical APP) but if you pay an anesthesia resident as much as a crna and surgical resident as much as a surgical APP there will be riots. Decreasing hours worked will also be marginal. There is just too limited a time and too much to learn to make a 10-12 hr workday work unless people are ok increasing duration of residency. Despite all that there is enough actual abuse of residents to justify unions as an extra layer of protection simply because most GME people lack any teeth when it comes to protecting them

 

[CyrilFiggis]

I think the main purpose of a residency union is to prevent retaliatory behavior from faculty and decrease abuse of residents. Pay increases will be marginal at best, there’s just no way a resident will get paid more than a fraction of what an attending makes, that makes systems unsustainable. You could argue they should make as much as APPs, but APPs make variable salary (CRNA >> surgical APP) but if you pay an anesthesia resident as much as a crna and surgical resident as much as a surgical APP there will be riots. Decreasing hours worked will also be marginal. There is just too limited a time and too much to learn to make a 10-12 hr workday work unless people are ok increasing duration of residency. Despite all that there is enough actual abuse of residents to justify unions as an extra layer of protection simply because most GME people lack any teeth when it comes to protecting them

It’s not always about a massive pay increase, for instance inflation is 8% and our program was only set to increase salaries by 2%. Effectively a pay cut. Our union renegotiated our salary to match inflation. There was never the expectation that we get paid extravagantly, just fairly.

 

[Dr G Oogle]

It’s not always about a massive pay increase, for instance inflation is 8% and our program was only set to increase salaries by 2%. Effectively a pay cut. Our union renegotiated our salary to match inflation. There was never the expectation that we get paid extravagantly, just fairly.

That makes sense, good on you guys

 

[DarkBluMage]

There are spreadsheets every year that have info on programs. I don't think it's in any of them now, or at least not in the specialties I am interested in because it is not super wide spread. That being said if people really start doing this over the next few years it might be included when you're applying.

Also if you have a friend or close contact at the program you could always ask them on the down low and share it with everyone else if it is not widely known info.

Where can the spreadsheets be found?

 

[pigsinacloth]

Where can the spreadsheets be found?

doesn't look like there are any up yet for this year yet, but this is the one for last year. Each specialty sheet is created by different people, so they all contain slightly different info in slightly different formats. Many have stats and rankings, but I encourage you to take this all with a grain of salt as these are obviously all self reported or arbitrary historic rankings.

 

[jambro]

Could be worse. California is just as expensive and restricts moonlighting.

I’m guessing many residents in these places don’t need the money.

Dont think california ever restricted moonlighting but i believe that law was changed recently so theres no ambivalence anymore

 

[TelemarketingEnigma]

how would a resident union have any bargaining power when there are thousands who don’t match each cycle and would gladly take a position?

Don’t unions need viable alternative employment to have any sway? If residents don’t physician, they can’t practice medicine aside from urgent cares or something.

For the most part, unions have declined in power since the RICO act and the fall of the La cosa nostra.

LA County residents (at Harbor UCLA and LAC + USC) just got a pretty big win with a large jump in salary, housing benefits through their union bargaining. It took a strike threat to make it happen - they had voted to authorize a strike and set a date before the county caved.

Is there an easy way to find out which programs are unionized? Seems like a very awkward question to ask during interviews.

I think vast majority of unionized residents at this point are under CIR/SEIU, they have lists of programs on their website. Also at my interviews, residents in unionized programs would usually bring it up themselves

 

[NotAProgDirector]

When looking at programs, I'd look both at whether they have a union, or whether their benefits are good without it.

The news about LA county residents is interesting. I had always thought that although unions may help residents negotiate better working conditions, that strikes were not a viable option. Physicians going on strike could work against them in public opinion. Perhaps even more importantly, strike time would not count towards training -- you'd have to hope that programs agree to shorten training else you just get extended at the end (and I'm not certain the union can force GME to agree to shorten everyone as part of a settlement, since that's controlled by specialty boards). And last, if residents start striking a bunch, some programs might just get out of the GME business altogether.

 

[CyrilFiggis]

When looking at programs, I'd look both at whether they have a union, or whether their benefits are good without it.

The news about LA county residents is interesting. I had always thought that although unions may help residents negotiate better working conditions, that strikes were not a viable option. Physicians going on strike could work against them in public opinion. Perhaps even more importantly, strike time would not count towards training -- you'd have to hope that programs agree to shorten training else you just get extended at the end (and I'm not certain the union can force GME to agree to shorten everyone as part of a settlement, since that's controlled by specialty boards). And last, if residents start striking a bunch, some programs might just get out of the GME business altogether.

We had contemplated striking if negotiations broke down and there were lots of talk about public perception. There was a committee developed to figure out the PR message.

As my prior message pointed out, many programs and hospital systems wouldn’t stay solvent without residents so it’s a double edge sword.

 

[TelemarketingEnigma]

When looking at programs, I'd look both at whether they have a union, or whether their benefits are good without it.

The news about LA county residents is interesting. I had always thought that although unions may help residents negotiate better working conditions, that strikes were not a viable option. Physicians going on strike could work against them in public opinion. Perhaps even more importantly, strike time would not count towards training -- you'd have to hope that programs agree to shorten training else you just get extended at the end (and I'm not certain the union can force GME to agree to shorten everyone as part of a settlement, since that's controlled by specialty boards). And last, if residents start striking a bunch, some programs might just get out of the GME business altogether.

I think the last real cir/seiu strike was in the 90s, so I wouldn’t say real strikes are likely to become commonplace. But i imagine threats of strikes for residents who provide much of the labor to keep a hospital running are probably more effective than the actual strike itself. That part is a last resort. LA county desperately needed change - the wages were becoming practically unliveable compared to other nearby programs, and definitely hurting recruitment.

 

[butidontwantto]

This^^^^^. Having a union would be a great perk, but, at the end of the day, how many residents actually place pay, benefits or working conditions above connections, prestige and quality of training when choosing a residency?

My understanding is that if the answer was "everyone," that all the hospitals in NYC, including NYU, Columbia and Cornell, would be the easiest places in the country to get a residency, given how poorly residents are reportedly treated in NYC hospitals. Nursing unions there have a ton of power, and many over worked and under paid nurses apparently use it to treat residents like absolute crap.

In addition, the culture of medical training in NYC is just a lot more abusive toward residents than in many other parts of the country. Salaries also totally suck in relation to the cost of living there. It's just something you deal with in order to get world class training before moving on. After all, residency is not the end game, it's just the next step in training.

There's a false assumption here, that quality of training comes at the cost of benefits or working conditions. I would argue that the best quality of training comes from places where you're supported as a trainee. No one learns best in a toxic environment. No one learns best working 24 hours shifts. No one learns best when they aren't allowed to rest and take the PTO that on paper they are supposed to have.

I will choose working conditions over prestige. Every. Single. Time. Life is too short to put up with that crap.

 

[operaman]

Echoing a couple others above to also look at what benefits non union programs provide. Given the way GME works, a Union may not offer that much additional advantage. Many non union programs have won similar concessions from their hospitals simply by working through the established systems.

We were not unionized but I would put our salary and benefits and quality of life up against the strongest union programs in the country. And of course we didn’t have to pay any union dues either.

A strong union may be a net positive, but it may also be no better than a good house staff advisory committee and a well run hospital system who already work well together.

 

[KnightDoc]

There's a false assumption here, that quality of training comes at the cost of benefits or working conditions. I would argue that the best quality of training comes from places where you're supported as a trainee. No one learns best in a toxic environment. No one learns best working 24 hours shifts. No one learns best when they aren't allowed to rest and take the PTO that on paper they are supposed to have.

I will choose working conditions over prestige. Every. Single. Time. Life is too short to put up with that crap.

I hear you, and agree that benefits or working conditions do not need to suck in order for the quality of training to be good. OTOH, you are the exception, rather than the rule, in placing working conditions over prestige, or quality of training.

This is why the NYC residencies are highly sought after, even though the working conditions are reported to absolutely SUCK. On top of everything else, uber powerful nursing unions have NYC residents performing a lot of tasks performed by nurses in other parts of the country.

In spite of this, the prestigious NYC teaching hospitals attract the best and the brightest. The people who train there learn just fine, and go on to do great things, in spite of the abuse. Some old timers would even claim because of it, kind of like a military mentality. As long as that is the case, there really is no impetus to change things. A lot of people have no use for NYC, but way more than enough are willing to do anything to live and train there. Just saying.

 

[jambro]

When looking at programs, I'd look both at whether they have a union, or whether their benefits are good without it.

The news about LA county residents is interesting. I had always thought that although unions may help residents negotiate better working conditions, that strikes were not a viable option. Physicians going on strike could work against them in public opinion. Perhaps even more importantly, strike time would not count towards training -- you'd have to hope that programs agree to shorten training else you just get extended at the end (and I'm not certain the union can force GME to agree to shorten everyone as part of a settlement, since that's controlled by specialty boards). And last, if residents start striking a bunch, some programs might just get out of the GME business altogether.

how long do you think a strike would actually go for? 2 days? seems even the threat was good enough to get USC residents like a 20% raise. and nurses strike all the time and it doesnt seem to hurt their PR

 

[Dr G Oogle]

I hear you, and agree that benefits or working conditions do not need to suck in order for the quality of training to be good. OTOH, you are the exception, rather than the rule, in placing working conditions over prestige, or quality of training.

This is why the NYC residencies are highly sought after, even though the working conditions are reported to absolutely SUCK. On top of everything else, uber powerful nursing unions have NYC residents performing a lot of tasks performed by nurses in other parts of the country.

In spite of this, the prestigious NYC teaching hospitals attract the best and the brightest. The people who train there learn just fine, and go on to do great things, in spite of the abuse. Some old timers would even claim because of it, kind of like a military mentality. As long as that is the case, there really is no impetus to change things. A lot of people have no use for NYC, but way more than enough are willing to do anything to live and train there. Just saying.

NYC is the draw not the institutions there necessarily. You don’t need to go to MSKCC or Columbia to learn to be a good internist or surgeon. The abysmal working conditions there are not a fair trade off for the 💩 show of trainee treatment that occurs there, though I understand that people have really dug their heals into that philosophy.

 

[dienekes88]

Why more resident physicians are looking to unionize

Are unions a factor for those who are selecting programs to match for residency?

Are these unions actually helping with quality of life/increased pay for those who were able to unionize?

I think one of the challenges of the union is that the residents are not a single monolithic group. What is important to the path resident will be different from the rads resident will be different from the surgical resident. And each of those departments may have different perks to the residency that will likely be wiped out as everything becomes more uniform.