Residents Union

[ThinkTooMuch]

join?

http://www.cirseiu.org/action/Default.aspx

---

Members don't see this ad.

 

[SoCuteMD]

I dont'think you can unless you are a resident that has a CIR union.

 

[dragonfly99]

I have a friend who is training @ a hospital that has a residents' union, and she said that basically the working conditions, etc. are no different than other hospitals where she has trained (2 others). Also, she is forced to pay union dues...I mean all the residents have to pay for the union, dues each month...
The thing about residency is, the salaries are not really set competitively...they are funded by the gov't so basically you tend to get paid a very similar amount no matter where you train. As far as working conditions, residents still don't really have freedom to walk away and get another job (or switch residencies without MUCH trouble/hassle) so I don't see a lot of negotiating room there, either. Nobody I know who works @ a unionized residency hospital seems to think things are different vs. other hospitals where they have trained. Just my 2 cents.

 

[SoCuteMD]

I have a friend who is training @ a hospital that has a residents' union, and she said that basically the working conditions, etc. are no different than other hospitals where she has trained (2 others). Also, she is forced to pay union dues...I mean all the residents have to pay for the union, dues each month...
The thing about residency is, the salaries are not really set competitively...they are funded by the gov't so basically you tend to get paid a very similar amount no matter where you train. As far as working conditions, residents still don't really have freedom to walk away and get another job (or switch residencies without MUCH trouble/hassle) so I don't see a lot of negotiating room there, either. Nobody I know who works @ a unionized residency hospital seems to think things are different vs. other hospitals where they have trained. Just my 2 cents.

I think it really depends. The program I'm going to next year has good pay, excellent benefits and overall seems to treat their residents well - no residents' union. On the other hand, if you look at NYC and compare/contrast two hospitals - Saint Luke's-Roosevelt (a community hospital with a Columbia affiliation) and NYP (Columbia's university hospital). SL-R has a resident's union and NYP does not. SLR residents have better health insurance, subsidized housing (granted, this is more important as SLR is in an expensive part of town), a generous educational stipend and earn a few thousand more/yr. At NYP the health insurance isn't as good, there's no subsidized housing (in a cheaper, but still expensive neighborhood), NO educational stipend (residents are expected to buy their own textbooks), and a small housing stipend (<300/month).

On the interview trail I definitely noticed that some of the bigger name institutions provided a lot less (fewer meals, smaller educational stipends, and the lowest salaries in each metropolitan area) and I attribute this in part to a little bit of arrogance on the part of these institutions. I think some of these institutions could benefit from a collective bargaining unit.

 

[JSI124]

UMich is great in that sense. 7% bonus every November (to annual salary), extra 100% daily pay for every Bday/Major holiday you work...

 

[sirus_virus]

A union is only as effective as its willingness to strike.

 

[TTPHUS]

A union is only as effective as its willingness to strike.

unions are very powerful .

 

[gutonc]

unions are very powerful .

If they are willing to/can strike, yes. If, in their bylaws, they are prohibited from striking, not so much.

As an MD/PhD student, I was in a very weird position. The grad students at my school were unionized and, as such, I was a member of the union (an affiliate of the CWA). The residents at the hospital were also unionized under CIR. Their contract specifically prohibited strikes or other forms of work stoppage. At one point in my 3rd year, while I was still a member of the grad student union, nurses at our Univ Hospital staged a 1 day walkout. The Grad Student Union/CWA supported the walkout and told members not to cross the picket lines. The CIR told their members that they did not have to respect the picket lines so all the "unionized" residents went to work while I (the unionized med/grad student on an elective rotation) didn't.

Moral of the story is that, while I agree with your premise that unions can be powerful, if they don't have (as a group), the stones to back up their threats/demands, they're not all that useful.

 

[scab]

If they are willing to/can strike, yes. If, in their bylaws, they are prohibited from striking, not so much.

As an MD/PhD student, I was in a very weird position. The grad students at my school were unionized and, as such, I was a member of the union (an affiliate of the CWA). The residents at the hospital were also unionized under CIR. Their contract specifically prohibited strikes or other forms of work stoppage. At one point in my 3rd year, while I was still a member of the grad student union, nurses at our Univ Hospital staged a 1 day walkout. The Grad Student Union/CWA supported the walkout and told members not to cross the picket lines. The CIR told their members that they did not have to respect the picket lines so all the "unionized" residents went to work while I (the unionized med/grad student on an elective rotation) didn't.

Moral of the story is that, while I agree with your premise that unions can be powerful, if they don't have (as a group), the stones to back up their threats/demands, they're not all that useful.

not to beat a dead horse.. but scabs are EXTREMELY HATED all around whether it is carpenter's union or a medical union!

the pressure to conform can not be underestimated

hell a union (Transit Worker's) was able to shut down NYC in the height of XMAS shopping season.
sure don;t get more powerful than that!

 

[drfunktacular]

Seems to me that a residents'/doctors' union will always be a failure because of the political/social/moral quandaries associated with collective action on the part of the members (i.e., striking). Until you are willing to say, "I will let every patient in this hospital die unless I get my pay raise" (and you should never be willing to say that IMHO), the negotiating strength of a union is effectively neutered. Ergo, what's the point?

This is the fundamental problem of organized (in the sense of unionized) physicians--unless they're the kind of doctors you wouldn't want in the first place, the only true leverage a union has is unusable.

 

[dragonfly99]

gutonc
I can't believe your med school allowed you to strike. Not that I'm ragging on you personally, b/c I think it's a very interesting story, but I'm sure if I had done that as a med student, I would have failed the rotation...

Attending physicians are not allowed to unionize (I mean private practice physicians). Some people wanted to try it in order to be able to better negotiate with insurance companies, but they were prevented from doing so by antitrust legislation and court rulings. Because they are employees, residents at some hospitals have been able to unionize under CIR. Like I said, based on resident I know @unionized hospitals, and ones who are not @unionized hospitals, there doesn't seem to me to be any significant differences in pay or resident treatment. The thing is, residents' pay isn't going to vary much, as it is controlled by the federal gov't. Some hospitals have slush funds that they dip into for things like resident lunches during a lecture, buying a PDA for residents, or book stipends, etc. I just recently compared my PGY4 salary with several friends doing residencies @various hospitals, and it was amazing how similar our salaries are...all within a few hundred dollars of each other, even though we are in different programs in different states.

Also, I don't think it is just the ability to strike or have unions that determines the negotiating power vs. weakness of residents. The bottom line is that residents cannot "quit" a residency in most cases without dire consequences. It is very very hard to get another residency if you quit or are fired from one. You cannot practice medicine without completing a residency. Therefore, there is a huge power imbalance between programs and residents...the resident is basically in an indentured servant type position. If your program and the people there are generally benign, then they will teach you and you will be fairly happy (though often tired) IMHO, but if you get yourself into a bad situation usually there is nothing to do but stick it out.

 

[Law2Doc]

unions are very powerful .

See sirus's and dragonfly's posts above. Unions have no power unless their bark is as good as their bite. And a residents rights are so limited in this respect that are powerless. So in general this kind of union is just a hole in which you throw in dues -- it really can't help you because of the limitations that already exist.

 

[dragonfly99]

Yeah, my friends @unionized hospitals get their wages garnished to pay for union dues, and they had no choice about whether to join or not.

 

[gutonc]

gutonc
I can't believe your med school allowed you to strike. Not that I'm ragging on you personally, b/c I think it's a very interesting story, but I'm sure if I had done that as a med student, I would have failed the rotation...

It was an elective and it was one Friday. Not sure what I would have done if it had been a real rotation.

 

[surg]

There are plenty of other things that a unionized group of residents could do short of a strike to apply pressure. You have to be willing to accept the consequences though of your actions. However, most union actions are protected by labor laws, so in general, you can't be fired or retaliated against for doing union activities (you can however get a crummy evaluation for other reasons).

1) Informational picket; a few residents taking turns can man a picket without difficulty. Looks bad for the hospital, no impact to care.

2) Refusal to do non-doctor duties except as an emergency: Need a patient taken to radiology? Wait for the patient transport service. Radiology can't get it scheduled and its non-urgent, but pending discharge? Fine get it the next day. Need non-urgent blood drawn? wait for the next blood draw sweep. The hospital quickly bogs down with non-discharged patients, but all the patients are healthy and safe.

3) Refusal to do purely billing duties: Provide only minimal clinical documentation required. Progress notes are short, to the point and only for transmitting information. Nothing extra to help the billing. (Non-pertinent Review of Systems otherwise negative? Additional diagnoses that increase billing? who cares). Costs the hospital money, but again, patients are not harmed.

4) Refusal to do non-essential paperwork: Disability paperwork, multiple forms, etc. Pass all that up to the attending. Makes attendings annoyed, but isn't necessarily part of your scope of work as a resident.

5) Send all outside phone calls to attendings or send EVERY patient to the ER. Many services answer their night calls with a resident pager. You could kick every phone call up to an attending level. Again, makes attendings annoyed. Could impact your eval.


As you can see, none of those would impact the patients directly under your care, which is your primary job as a resident, but as a collective action would quickly overwhelm the institution. Not advocating anyone try this as a wildcat strike, but just to point out that residents are not entirely powerless at most institutions, even without a strike threat option.

 

[Law2Doc]

...
2) Refusal to do non-doctor duties except as an emergency: Need a patient taken to radiology? Wait for the patient transport service. Radiology can't get it scheduled and its non-urgent, but pending discharge? Fine get it the next day. Need non-urgent blood drawn? wait for the next blood draw sweep. The hospital quickly bogs down with non-discharged patients, but all the patients are healthy and safe.

3) Refusal to do purely billing duties: Provide only minimal clinical documentation required. Progress notes are short, to the point and only for transmitting information. Nothing extra to help the billing. (Non-pertinent Review of Systems otherwise negative? Additional diagnoses that increase billing? who cares). Costs the hospital money, but again, patients are not harmed.

4) Refusal to do non-essential paperwork: Disability paperwork, multiple forms, etc. Pass all that up to the attending. Makes attendings annoyed, but isn't necessarily part of your scope of work as a resident.

5) Send all outside phone calls to attendings or send EVERY patient to the ER. Many services answer their night calls with a resident pager. You could kick every phone call up to an attending level. Again, makes attendings annoyed. Could impact your eval.
...

And you seriously think you can do all this without it affecting your evaluations, which in turn affect your employment? I don't think so. It's not like your job description as a resident is so limited that you can say "no" to the "non-essential" tasks, boot things back to the attendings, etc. Being in a union might not be something you can be legally fired for, but being a crummy resident sure could. Really bad idea in terms of your career. And if your only ability to have power is to put your career at risk (which I suggest you will be doing if you do 2-5 above all things that they are allowed to rely on in giving you a bad evaluation), you are powerless.

 

[MediumDef]

There are plenty of other things that a unionized group of residents could do short of a strike to apply pressure. You have to be willing to accept the consequences though of your actions. However, most union actions are protected by labor laws, so in general, you can't be fired or retaliated against for doing union activities (you can however get a crummy evaluation for other reasons).

1) Informational picket; a few residents taking turns can man a picket without difficulty. Looks bad for the hospital, no impact to care.

2) Refusal to do non-doctor duties except as an emergency: Need a patient taken to radiology? Wait for the patient transport service. Radiology can't get it scheduled and its non-urgent, but pending discharge? Fine get it the next day. Need non-urgent blood drawn? wait for the next blood draw sweep. The hospital quickly bogs down with non-discharged patients, but all the patients are healthy and safe.

3) Refusal to do purely billing duties: Provide only minimal clinical documentation required. Progress notes are short, to the point and only for transmitting information. Nothing extra to help the billing. (Non-pertinent Review of Systems otherwise negative? Additional diagnoses that increase billing? who cares). Costs the hospital money, but again, patients are not harmed.

4) Refusal to do non-essential paperwork: Disability paperwork, multiple forms, etc. Pass all that up to the attending. Makes attendings annoyed, but isn't necessarily part of your scope of work as a resident.

5) Send all outside phone calls to attendings or send EVERY patient to the ER. Many services answer their night calls with a resident pager. You could kick every phone call up to an attending level. Again, makes attendings annoyed. Could impact your eval.


As you can see, none of those would impact the patients directly under your care, which is your primary job as a resident, but as a collective action would quickly overwhelm the institution. Not advocating anyone try this as a wildcat strike, but just to point out that residents are not entirely powerless at most institutions, even without a strike threat option.

Seems benign but if you bring the top floors of the hospital to a grinding halt you will turn the ER into a boarding house and public opinion is never on the side of the doctors so the first headline reading "Gramma dies in waiting room due to doctor slowdown" will sink you.

 

[dragonfly99]

These suggestions are not practical and at my residency any or all of them could have resulted in being fired or being sent for mandatory psych evaluation, and I didn't even do residency at some place that is malignant, understaffed and doesn't have money. The reality is if you tick off the attendings or program director, you're not going to get any fellowship or any decent job, and you'll be lucky if you even finish residency. Most of the hospitals that treat residents really crappy wouldn't have a problem firing a lot of people if they needed to...there are always more people willing to take their spots, particularly FMG's who really need a residency spot.

 

[dacrocytic]

These suggestions are not practical and at my residency any or all of them could have resulted in being fired or being sent for mandatory psych evaluation, and I didn't even do residency at some place that is malignant, understaffed and doesn't have money. The reality is if you tick off the attendings or program director, you're not going to get any fellowship or any decent job, and you'll be lucky if you even finish residency. Most of the hospitals that treat residents really crappy wouldn't have a problem firing a lot of people if they needed to...there are always more people willing to take their spots, particularly FMG's who really need a residency spot.

Guess FMG's have no problems being scabs.
are unions a primarily American idea?

 

[TTPHUS]

These suggestions are not practical and at my residency any or all of them could have resulted in being fired or being sent for mandatory psych evaluation, and I didn't even do residency at some place that is malignant, understaffed and doesn't have money. The reality is if you tick off the attendings or program director, you're not going to get any fellowship or any decent job, and you'll be lucky if you even finish residency. Most of the hospitals that treat residents really crappy wouldn't have a problem firing a lot of people if they needed to...there are always more people willing to take their spots, particularly FMG's who really need a residency spot.

what ever happened to being professional ?

 

[Law2Doc]

what ever happened to being professional ?

I agree that you need to conduct yourself professionally, and most of the things described above wouldn't fit that bill. That being said, I don't think "professionals" per se should be exploited simply because by virtue of being a professional, it is unbecoming to protest. However this is not really the time unions are needed -- residents are making huge strides in terms of hours without unions and so it's kind of silly to join a union now.

 

[Gold 5]

Just to give a slightly different position on unions. Many moons ago I had a family member who worked in Admin for a hospital. They wound up having a nursing strike demanding the standard stuff. The hospital was tight on money and really could not give them what was demanded. In the end, the strike worked for the nurses for a short while. During the strike, the unions trashed the hospitals in the paper, handed out pamphlets, etc. When all was said and done, they did get some extra goodies but in the process put the hospital into a financial hole (the census never recovered) that they could never get out of. Within I believe two years, they had to close it down. In some ways it reminds me of what is happening in Detroit. I would hate to be a resident and have the hospital fall out from underneath me.

 

[surg]

Look, I'm not promoting any of those things. BUT, someone asked about the teeth of a union without strike capabilities. I would point out that the residents' jobs are related to learning and patient care. The attending (me now) is responsible for billing and carries the ultimate responsibility in getting the patients' care (if a resident screws up, it is still on me).

In no way shape or form should ANY resident think that doing any of those things I outlined (especially #2 and #5) outside of a institution-wide announced labor action won't get them fired or held back in quick order.

For some perspective, when my father was a resident, virtually a whole class of residents got fired for daring to ask for a raise. It was pyramidal back then, so it was a little easier to get rid of people. When I was a resident I was part of resident union negotiating team and during a negotiation breakdown where management walked away from the table, we considered each of the above actions. We did informationally pamphlet one day and we had buttons that virtually every resident wore, telling patients to ask us about what residents were doing to improve their care. We, as a union, had already ruled out striking under any circumstances, so that was never an option. The others (particularly #3 and #4), were however in our back pocket and the administration knew it, and came back to the table with new proposals quickly after seeing the seriousness of intent on our side of the table.

Yes, it is awkward to negotiate across the table from your program director, attendings, and hospital admins then go right back to work the next morning, but the good ones recognize that you are just doing your job. It's not personal, it's just what you've been elected to do by your peers. Similarly, they, as chair or director, often have to tell people no, even when they have good ideas, because that's their job too. As long as you keep the negotiating table professional and avoid personal attacks, it usually works out ok. In fact, during the worst of our negotiation, we had many attendings stand in support of the residents against the administration, as we contemplated what the next steps should be.

The bulk of what resident unions really want is better for patients too. Besides improved pay, holiday pay, etc., we routinely negotiated for things like more ancillary support for patient care activities (patient transport, blood draw sweep frequency, etc.). Even little details, like if you got called in for a consult from home, the ability to park in the ER parking lot for a short period of time to improve response times for consults. These benefited all clinicians, residents and attendings alike. Negotiation does not have to be adversarial, but when I see programs that the residents are suffering and complain that they are powerless, it occurs to me that having official aggressive representation is not always a bad thing.

Being a professional is putting forth a code of ethics and living by them, even when they hurt you. In our case as physicians, it means putting the patient over your own needs. It does not have to mean putting the administration's needs before your own needs as well. It is our job to make the system work as well as possible, that means actively pointing out to administration how to make things better. If you think a union is only about getting more money for residents, then, you probably don't need a union at your institution.

 

[Law2Doc]

...
The bulk of what resident unions really want is better for patients too. ...
Being a professional is putting forth a code of ethics and living by them, even when they hurt you. In our case as physicians, it means putting the patient over your own needs. It does not have to mean putting the administration's needs before your own needs as well. It is our job to make the system work as well as possible, that means actively pointing out to administration how to make things better. If you think a union is only about getting more money for residents, then, you probably don't need a union at your institution.

Saying "what's good for the union is good for the customer" has been the battlecry of unions for generations. But in fact any economics course will teach you otherwise. Unions are absolutely a necessary evil to protect exploited employees, but in fact having exploited employees almost always ends up better for the customer. Want cheap goods? Use foreign child labor. Want you medical care to be dirt cheap? When employees are working absurdly long hours for peanuts, the savings generally gets passed down. The consumer wins when employees are beaten down. Will the product be inferior? Not as long as there's malpractice liability forcing everyone to uphold a reasonable standard of care. So having residents killing themselves is good for the patients in terms of giving them the best value. So it's really the administration and the patients on the same side, and the residents on the other side. You aren't helping the patients by helping yourself. The cheese stands alone here.

 

[dragonfly99]

lawdoc,
not necessarily true in some cases,
Such as what surg mentioned about letting the consult person(s) park in the ER parking lot to get to the ER consult patient faster. That would improve patient care. Also, having adequate phlebotomy services can speed up lab results, and thus clinical decision making. It costs money, but it could improve patient care, which could provide greater value to the patient.

 

[Law2Doc]

lawdoc,
not necessarily true in some cases,
Such as what surg mentioned about letting the consult person(s) park in the ER parking lot to get to the ER consult patient faster. That would improve patient care. Also, having adequate phlebotomy services can speed up lab results, and thus clinical decision making. It costs money, but it could improve patient care, which could provide greater value to the patient.

In both of these cases there are better ways to leverage the appropriate channels to make this happen than collective bargaining/striking. And no sane resident is going to risk his employment to get a parking spot for a consult person. What the resident IS going to presumably do through a union will relate to the resident (hours, pay, benefits). Historically this is what unions are all about -- salary, hours, treatment, benefits. Not better services for patients. Sometimes that's a happy byproduct, but it's NEVER the primary reason folks upset the apple cart, and do things that potentially risk their employment or slow down the hospital etc. These are simply throw ins. They aren't the reason you strike, but once you do strike you throw in these demands too, on top of your hours or whatever you are REALLY protesting. Because you always want to have multiple demands because that way you can sacrifice some in the name of compromise. And these sacrificial demands almost always could have been gotten through other means because they aren't really the bone of contention between the employees and the hospital. Not buying it, sorry. And this is from someone who has been involved at the lawyer end of some collective bargaining type disputes.