What is stopping residents from unionizing and demanding better pay?

[EC3]

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Can someone explain why residents have not been able to unionize and seek adequate wages for the services they provide?

A resident easily provides as much (if not more) service than your average PA, yet gets paid 1/2 to 1/3 of what a PA or NP makes. Why do residents just sit back and do nothing about this?

 

[BlackSails]

I believe there is court precedent outlawing this.

 

[dynx]

Can someone explain why residents have not been able to unionize and seek adequate wages for the services they provide?

A resident easily provides as much (if not more) service than your average PA, yet gets paid 1/2 to 1/3 of what a PA or NP makes. Why do residents just sit back and do nothing about this?

Because most medical students/residents are complete ******. They have been conditioned to think that asking for more money for the "honor" of treating patients is the equivalent of stealing from patients or punching someones grandma in the back of the head. They have been spouting the "I love medicine so much I would treat patients for free" since they wrote their personal statement and either have started to believe it or are so ashamed that they are pathetic hypocrites that they don't know how to reverse course and start to demand what they rightfully earn.

or maybe its a court precedent.

 

[EC3]

I believe there is court precedent outlawing this.

any chance of a link?

 

[EC3]

Because most medical students/residents are complete ******. They have been conditioned to think that asking for more money for the "honor" of treating patients is the equivalent of stealing from patients or punching someones grandma in the back of the head. They have been spouting the "I love medicine so much I would treat patients for free" since they wrote their personal statement and either have started to believe it or are so ashamed that they are pathetic hypocrites that they don't know how to reverse course and start to demand what they rightfully earn.

or maybe its a court precedent.

but the patients still pay the same amount regardless.

maybe they feel bad about taking money away from the hospital. i mean, afterall, if the roles were reverse, the hospital CEO would never demand more money.

 

[colbgw02]

I've always thought it's becaused we're all too tired and overwhelmed. Besides, by the time anything got done, we wouldn't be residents anymore. Salaries are still decent for staff physicians, so we tend to stay fixated on good it's gonna be when we're done. If they start making residencies longer or if reimbursement continues to go down the toilet, then maybe we'll see some movement.

 

[HoboCommander]

the residents are kept too busy to complain!

 

[barelyawake]

the residents are kept too busy to complain!

we are all sleep deprived!!!

 

[eviorr]

Uh... there is nothing to stop them. I am in a unionized residency. There are some limitation - the standard residents union (The Committee of Interns and Residents, or CIR, which is a subgroup of the Service Employees International Union) does not allow walk-outs, sick-outs, or strikes by residents for example, which removes a lot of the teeth from the whole unionization thing, but we have negotiated several perks, including compensation that is about $5-6 K more than other residents in the same city. When the unionization trend began to emerge among housestaff, the hospitals argued that we were more properly classified as students and not employees (thus we get a stipend, not a salary, exempting us from minimum wage requirements). Students cannot legally unionize. The National Labor Board ruled that residents were more like employees than students and therefore could unionize, although there is nothing to say that the decision could not be reversed pretty quickly (this is the threat that the union leadership hauls out frequently to scare members into donating money to their political lobbying fund).

 

[Faebinder]

Well folks with the new laws in that stop all residents from deferring their medical school loans... I think it's about time residency switched from an 'educational' position to official 'employment'. There are no benefits to being labeled 'educational' rather than 'employed'.

The only problem is once it's counted as employment then we need to find a way to regulate residencies because ACGME will no longer exist (we took the graduate education out of ACGME)? I suspect this is highly resisted by ACGME and the hospitals that benefit from residents. Maybe we can switch ACGME to something like TMM (Training Medical Monkeys?)

 

[johankriek]

There are some limitation - the standard residents union (The Committee of Interns and Residents, or CIR, which is a subgroup of the Service Employees International Union) does not allow walk-outs, sick-outs, or strikes by residents for example, which removes a lot of the teeth from the whole unionization thing, ).

I was in CIR when i was a resident as well. They also protect you if the residency program wants to fire you. But i agree, if you cant have a mass walkout.. where every single resident in the state or country just doesnt come to work, there wont be anything done about it. they will keep abusing residents until residents get tired of getting abused. Years ago it was worth it because when you graduated.. you were sitting pretty. you had agreat salary.. a practice where you called your shots. Nowadays you graduate you will be an employee pretty much your whole life.. little flexibility. it aint worth it folks..

How do you think the nurses got so powerful? they planned walkouts all the time and cost the hospital millions until they figured out.. well give in to their demands because it is cheaper.. now they are pretty powerful. nurses in SF bay area start out at 105k per year with benefits.


tell me again why attending docs cant do this again? if nurses can do it why cant docs??

 

[PathMom]

I have CIR at my program too...we get paid a lot more that other programs in the city, have great benefits, disability, cheap parking...it's great.

 

[Flopotomist]

There are some limitation - the standard residents union (The Committee of Interns and Residents, or CIR, which is a subgroup of the Service Employees International Union) does not allow walk-outs, sick-outs, or strikes by residents

Strange, SEIU allows walkouts for nurses, paramedics, EMTs, and any ancillary staff.

I wonder why they don't allow it for residents. What is the point of a union if you neuter it? I can just see the negotiations now,

"We, the CIR want more money, or else!"

"Or else what?"

"Or else we will politely ask you again!"

"No... in fact, here is a pay cut"

 

[docB]

Strange, SEIU allows walkouts for nurses, paramedics, EMTs, and any ancillary staff.

I wonder why they don't allow it for residents. What is the point of a union if you neuter it? I can just see the negotiations now,

"We, the CIR want more money, or else!"

"Or else what?"

"Or else we will politely ask you again!"

"No... in fact, here is a pay cut"

Which brings up the question of why all these residents report that CIR has gotten them benefits, better pay, perks, etc. If the union has no ability to strike are they really getting these things from collective bargaining?

 

[Pilot Doc]

Which brings up the question of why all these residents report that CIR has gotten them benefits, better pay, perks, etc. If the union has no ability to strike are they really getting these things from collective bargaining?

Even without strikes or other actions that would have the real or perceived effect of harming patient care, residents can still do things that make the hospital's life harder. Refusing to complete discharge summaries, sign verbal orders, etc.

As for why residents don't make what NP's do, it's because they don't bring in additional revenue. Hospitals are effectively barred from charging for resident labor. CMS won't pay for resident services (excepting the annual GME payments), most private insurers won't either. Take a decent size hospital that has 200 residents. Do you think that the hospital is sitting on an extra $10 million dollars a year that it would take to double resident salaries? Resident salaries are pretty near market rates, especially given the supply of IMG's.

 

[johankriek]

Do you think that the hospital is sitting on an extra $10 million dollars a year that it would take to double resident salaries? Resident salaries are pretty near market rates, especially given the supply of IMG's.

umm of course they are at market rates.. when you control the market with the nrmp.. and keep residents as indentured slaves for four years..

 

[f_w]

I did my internship at a place where 1/3 of the class was employed by a CIR organized city hospital, about 1/3 by a state employee unionized hospital and 1/3 by various non-union private hospitals.

The residents at the CIR hospital had
- 5 different HMOs and PPO plans to choose from
- $4000/year tax-free food allowance
- $1000 book account
- an actual grievance process
- 20% more base salary than the others
- a 403b

The residents at the state hospital had
- 1 excellent BC/BS PPO plan (no co-pays, everything covered)
- $200 book allowance
- a 403b

The residents at the private places had
- crappy HMO coverage with several $100 co-pay/year
- could be fired at will by the hospital without consideration of the typical GME appeals process

Unionization works.

 

[RockShox]

As for why residents don't make what NP's do, it's because they don't bring in additional revenue. Hospitals are effectively barred from charging for resident labor. CMS won't pay for resident services (excepting the annual GME payments), most private insurers won't either. Take a decent size hospital that has 200 residents. Do you think that the hospital is sitting on an extra $10 million dollars a year that it would take to double resident salaries? Resident salaries are pretty near market rates, especially given the supply of IMG's.

This is not entirely true. First the hospital actually gets just about double what they actually pay the resident. The extra money you don't see covers the hospitals "training expenses" so for every resident they get about $100,000 per year from the government. On top of this when you realize that they essentially have a large cheap staff of physicians to do the work, and they get to market the title of "academic teaching center", oooh and the prestige of having research arms and such...its really not a bad deal....(there are many hospitals that salivate at the idea of getting new and more residencies when the government allocates more thus indicating that it really is a money maker for them).

and just an FYI...hospitals are not wanting for money...they actually make a fair amount but have a great marketing and lobby department to make you think they are destitute.

 

[Coastie]

Residents don't bring in revenue, but NP's do?



Good one!

Even without strikes or other actions that would have the real or perceived effect of harming patient care, residents can still do things that make the hospital's life harder. Refusing to complete discharge summaries, sign verbal orders, etc.

As for why residents don't make what NP's do, it's because they don't bring in additional revenue. Hospitals are effectively barred from charging for resident labor. CMS won't pay for resident services (excepting the annual GME payments), most private insurers won't either. Take a decent size hospital that has 200 residents. Do you think that the hospital is sitting on an extra $10 million dollars a year that it would take to double resident salaries? Resident salaries are pretty near market rates, especially given the supply of IMG's.

 

[Coastie]

Answer:

Residents.

Can someone explain why residents have not been able to unionize and seek adequate wages for the services they provide?

A resident easily provides as much (if not more) service than your average PA, yet gets paid 1/2 to 1/3 of what a PA or NP makes. Why do residents just sit back and do nothing about this?

 

[docB]

Even without strikes or other actions that would have the real or perceived effect of harming patient care, residents can still do things that make the hospital's life harder. Refusing to complete discharge summaries, sign verbal orders, etc.

So strikes are out but work slow downs are OK? How do they deal with the JCAHO problems that arise from refusing to sign orders and complete charts? Does it really not affect patient care to do these things?

 

[docB]

I did my internship at a place where 1/3 of the class was employed by a CIR organized city hospital, about 1/3 by a state employee unionized hospital and 1/3 by various non-union private hospitals.

The residents at the CIR hospital had
- 5 different HMOs and PPO plans to choose from
- $4000/year tax-free food allowance
- $1000 book account
- an actual grievance process
- 20% more base salary than the others

The residents at the state hospital had
- 1 excellent BC/BS PPO plan (no co-pays, everything covered)
- $200 book allowance

The residents at the private places had
- crappy HMO coverage with several $100 co-pay/year
- could be fired at will by the hospital without consideration of the typical GME appeals process

Unionization works.

But how does it work? If there's no ability to strike why does the hospital have any incentive to give in on demands?

 

[Coastie]

Not to mention residents provide the front-line patient care. The hours we put in, the work load, etc.

Nurses provide nursing care for 3-4 patients at a time, tops. This includes, on the floors, q6 vitals, med delivery, and calls for non-emergent requests such as food, water, and bathroom care.

The nurses at my hospital get paid anywhere from $32/hr (day shift) to $55/hr (night shift) on the floors.

Residents cover far more patients, making life threatening decisions, 6-7 days straight, "80" hours a week, etc , etc, etc, etc, and make, what, $7-8 an hour?

Without residents bringing in revenue from rounds, patient care, and procedures, large teaching hospitals couldn't function.

This is not entirely true. First the hospital actually gets just about double what they actually pay the resident. The extra money you don't see covers the hospitals "training expenses" so for every resident they get about $100,000 per year from the government. On top of this when you realize that they essentially have a large cheap staff of physicians to do the work, and they get to market the title of "academic teaching center", oooh and the prestige of having research arms and such...its really not a bad deal....(there are many hospitals that salivate at the idea of getting new and more residencies when the government allocates more thus indicating that it really is a money maker for them).

and just an FYI...hospitals are not wanting for money...they actually make a fair amount but have a great marketing and lobby department to make you think they are destitute.

 

[Coastie]

Yeah, not signing your d/c summaries or co-signing orders isn't making it harder on the hospital in a good sort of way, it's making yourself look like a lazy arse to your team.

So strikes are out but work slow downs are OK? How do they deal with the JCAHO problems that arise from refusing to sign orders and complete charts? Does it really not affect patient care to do these things?

 

[f_w]

But how does it work? If there's no ability to strike why does the hospital have any incentive to give in on demands?

Don't know how they did it, but the result was exactly what I described. You have to remember that CIR is part of SEIU (and thereby hooked up with people like janitors who can strike).

Its probably enough just to have someone actually negotiating.

 

[Faebinder]

Even without strikes or other actions that would have the real or perceived effect of harming patient care, residents can still do things that make the hospital's life harder. Refusing to complete discharge summaries, sign verbal orders, etc.

As for why residents don't make what NP's do, it's because they don't bring in additional revenue. Hospitals are effectively barred from charging for resident labor. CMS won't pay for resident services (excepting the annual GME payments), most private insurers won't either. Take a decent size hospital that has 200 residents. Do you think that the hospital is sitting on an extra $10 million dollars a year that it would take to double resident salaries? Resident salaries are pretty near market rates, especially given the supply of IMG's.

This is probably my biggest beef out there. Why are private insurers not paying for resident services? At least medicare can argue that they pay for resident's education... what is the excuse of the private insurance? It's cause hospitals let them get away with it. They get their money via other routes.

 

[DrWBD]

A few reasons I can think of off the top of my head (in response to the original post)...

1) Physicians, especially residents, are independent thinkers, and generally act in their own selfish best interests rather than that of their program. This is because your colleagues are often your competition as well. If you want that job/fellowship position after graduation and you're competing against your own classmates, would you support them if they walked out? Of course not, you'd work and make sure it was known to your superiors that while the "quitters, complainers, and troublemakers" were on the picket line, you were doing your job.

2) Residents are expendable. You want to walk out of your ultra-competitive Surgery residency spot? There are 10 people waiting to fill that spot, and a few who would do it for free.

So, while the idea of unionizing residents is a great idea (I support CIR) it does have limitations.

 

[Pilot Doc]

Residents don't bring in revenue, but NP's do?



Good one!

Yeah....

NP's can bill for their services just like attendings can.

Residents don't bill for anything.

 

[Pilot Doc]

umm of course they are at market rates.. when you control the market with the nrmp.. and keep residents as indentured slaves for four years..

What's primarily controlling the market are hospital and insurance practices that leave new med school grads with no marketable skills. They HAVE to complete a residency or the time and money they spent on medical school is largely useless. Given that you can't just join your dad's ortho practice and learn on the job while billing for knee scopes (which is essentially what architects, accountants and lawyers do) there is a major lack of bargaining clout by residents

If the NRMP was abolished and the resident job market was opened up like the market for MBA or law grads, salaries would not change substantially. Salaries would very likely go down in those fields where US senior applicants exceed positions. Plenty of people would take a derm spot for no pay.

Even in IM or FP, given the minimal revenue stream that residents generate, I very much doubt salaries would rise substantially. There are already thousands of IMG's beating down the doors hungry for a US residency slot. If US seniors don't want them, they'll be happy to take them.

 

[Pilot Doc]

So strikes are out but work slow downs are OK? How do they deal with the JCAHO problems that arise from refusing to sign orders and complete charts? Does it really not affect patient care to do these things?

HO = healthcare organization. THe paperwork problems are the hospital's and not the MD's. While paperwork actions might cause the hospital to lose money or even close, they don't acutely hurt individual patients who are vulnerable and unable to help themselves as walking off the job would.

The issue here is perception. Docs leaving a hospital en masse and picketing would make for sensational news and polarize public opinion. "Doctors in training protest by focusing on patients, not paperwork" doesn't turn people against you

 

[Trismegistus4]

Well folks with the new laws in that stop all residents from deferring their medical school loans...

WHAT?! When was this? This must have been huge news. Howcome everyone here isn't talking about it?

 

[docB]

Its probably enough just to have someone actually negotiating.

That is actually the answer. It's not the union. It's the negoiating. If you're in a union like this then you're paying the union to bargain for you. It's amazing to me how many people who are in unions don't get this. If you feel that you are getting your $s worth then kudos.

 

[docB]

HO = healthcare organization. THe paperwork problems are the hospital's and not the MD's. While paperwork actions might cause the hospital to lose money or even close, they don't acutely hurt individual patients who are vulnerable and unable to help themselves as walking off the job would.

The issue here is perception. Docs leaving a hospital en masse and picketing would make for sensational news and polarize public opinion. "Doctors in training protest by focusing on patients, not paperwork" doesn't turn people against you

I disagree. If there's a problem like a law suit and the orders weren't signed just get out your check book. If you get suspended for failure to sign the orders you can wind up with lots of problems. If you continue to refuse and your suspension drags out you'll at least have to repeat your blocks, at worst get fired. Check your contracts. And if you don't do your dictations how will other docs, the patients primary and so on know what happened? I'd say that will negatively impact patient care.

 

[Winged Scapula]

WHAT?! When was this? This must have been huge news. Howcome everyone here isn't talking about it?

There's a thread in the Fin Aid forum, I believe.

 

[eviorr]

Regarding resident unions being toothless without the ability to strike, and yet unionized residents still get benefits beyond what non-union residents receive:
I think one of the benefits to the union is that in contract negotiations with the hospital, if we don't reach agreement, we can force the issue to go into arbitration. I'm not sure that is possible without a union.

 

[3dtp]

Regarding resident unions being toothless without the ability to strike, and yet unionized residents still get benefits beyond what non-union residents receive:
I think one of the benefits to the union is that in contract negotiations with the hospital, if we don't reach agreement, we can force the issue to go into arbitration. I'm not sure that is possible without a union.

The union doesn't make it possible to go to arbitration, but arbitration is very expensive for residents, individually. Also, the hospitals, were they not legally insulated would probably require binding arbitration in a resident contract. But it so happens that hospitals are incredibly legally insulated from their bad actions, and doubly so, since any resident who even tries to challenge bad behavior will be branded.

I agree with that without availability of a job action, the CIR is mostly castrati. However, there was an old union at the University of Michigan that did strike in the '70s. According to old news articles in the Detroit News, they didn't walk off the job, but they did picket the place and according to one article those who did see patients in the clinic refused to fill out billing forms so the patients were seen for free (or at the hospital's expense). This can't happen today since MC/MCD doesn't allow residents to bill, but it was a novel way to get things done.

The idea of a non-work stoppage job action does have merit in a hospital system that is an otherwise union shop since most unions have agency contracts that require other unions to honor picket lines. This might have some merit. Let's flesh this out. CIR unionizes a bad hospital. The hospital says initially, we'll fire your butts if you sign the petition, which is likely. Now, there is an unfair labor practice to grieve and the NLRB is on board. The union is formed, and hospital says, nice, send your money to SEIU who cares, now get back to work, and by the way, we're going to make your life miserable wobblie!
So, a "job action is called." A strike picket is set up at the loading docks and front entrances and bad PR is had by all, but the non-picketing residents do go to the clinics and do see patients and do everything they're supposed to do. This could still cause the hospital great consternation for a lot of reasons. First is it will likely make the TV news these days, causing the hospital anxiety. Second, it might disrupt the delivery of supplies and good the hospital needs to run its operations, if say, the Teamsters and Afscme refuse to cross the picket lines.

This could be the worst possible nightmare for a hospital in a highly unionized environment.
A job action that is not a job action, per se.
A strike picket which is not a work stoppage, but causes others to honor the picket line.
The resident's get their message out in the clear light of day (nothing like the clear light of day to make cockroaches scatter).
Bad PR, very bad PR for the hospital (what're they gonna say? We only work 'em 80 hours a week and 30 hours at a stretch without sleep while paying them less than the burger flipper you got your MI from?)

Hmmm, the more I think about this, the more I think there may be some merit here. Probably need to talk to the AFL/CIO and the trades councils since most job actions are real work stoppages, but then, residents are not in the usual situation and perhaps the union leadership needs to make accommodation for this. But will they?

 

[3dtp]

PS. For the record, before I got into residency, I was strongly anti-union. Seeing first hand the abuses that go on, changed my mind and got me interested in the history of industrial unions in America. At times they are very necessary.

 

[johankriek]

Look what happened when sidney zion brought to light the graduate medical education system. Sweeping work hour reform. I think there is a lot more work to be done to revamp the medical education system.