Why Can't Residents Unionize?

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Mt Kilimanjaro

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Random curiosity...

Why can't residents unionize and threaten to strike to leverage for overtime pay for work over 40 hours, better benefits, etc? Obviously if it actually happened the patients would suffer greatly, but it seems that this would be resolved extremely quickly since most teaching hospitals could not function very long without full resident staffing. Do you sign this right away when you enter the NRMP?

I remember hearing on the radio the author of a book called "County" a while back in which he describes the residents striking at a hospital in Chicago. Never read the book though.
 
To be honest, I never thought about it before. I'm not sure why they haven't. From my understanding, residents are one of the most (if not the most) exploited labor pools in the country.
 
If they did, hospitals would hire people like me as scabs. Busting a picket line of bulked-up orthopods might be tough, but I could probably find myself a nice optho residency to force my way into.
 
Resident unions do exist...at least some programs in NYC have them.
 
There are resident unions. Research CIR or Committee of Interns and Residents

Survivor DO
 
Because then residency would take twice as long.



Think of this: Anesthesia residency is 4 years, working ~80 hrs/wk. Would you rather it be 8 years at ~40 hrs/wk?
 
Spinach Dip said:
Because then residency would take twice as long.



Think of this: Anesthesia residency is 4 years, working ~80 hrs/wk. Would you rather it be 8 years at ~40 hrs/wk?
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He wasn't talking about that... He was talking about getting paid overtime for anything over 40 hours.
 
Plue00 said:
He wasn't talking about that... He was talking about getting paid overtime for anything over 40 hours.
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White collar workers (esp. professionals) are generally exempt from FLSA, which requires the "time and a half" pay for overtime. In that sense, sucks to be us.
 
mdpdgirl said:
Who says interns and residents can't unionize?

http://www.cirseiu.org/

But yes, traditionally residents have been considered students and not employees. Some places do not give residents the same benefits as other full time employees using the same rationalization.
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Yeah, but doesn't the federal government consider residents employees now for the purposes of FICA taxes or whatever, govt./employers can't have their cake and eat it too.... residents can't be students or employees depending on how it best suits them.
 
You signed the Hippocratic Oath. You have no rights.
 
DrBowtie said:
LOL at 40 hours of overtime.

You're a salaried professional. You work until the work gets done.
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Unless you're an equity partner, salary is the greatest scam in the history of the universe.
 
What about doctors striking? We've all seen teachers strike in cities over working conditions/pay. But we've never seen a bunch of doctors strike of decreased payments from Medicare or increased regulations.

If you don't like the tough work week at a minimal salary, don't become a resident (i. e. don't become a doctor).
 
Bangersandmash said:
What about doctors striking? We've all seen teachers strike in cities over working conditions/pay. But we've never seen a bunch of doctors strike of decreased payments from Medicare or increased regulations.

If you don't like the tough work week at a minimal salary, don't become a resident (i. e. don't become a doctor).
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I don't think physicians striking over reimbursements would find much sympathy among the public.
 
Bangersandmash said:
What about doctors striking? We've all seen teachers strike in cities over working conditions/pay. But we've never seen a bunch of doctors strike of decreased payments from Medicare or increased regulations.

If you don't like the tough work week at a minimal salary, don't become a resident (i. e. don't become a doctor).
Click to expand...

I remember wondering about this same question. What I found out is that doctors usually hold manager level position thus can't unionize. Hence the reason why teachers can strike because they are all employees. However, if the majority of doctors are employees of hospitals this can change.
 
IslandStyle808 said:
I remember wondering about this same question. What I found out is that doctors usually hold manager level position thus can't unionize. Hence the reason why teachers can strike because they are all employees. However, if the majority of doctors are employees of hospitals this can change.
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This is completely ignoring the ethical implications of striking. Are you actually going to refuse to treat patients because of your salary? Where do you draw the line? Are you going to see patients that come to the ER? Cancer patients presenting for chemo treatment? Little Johnny with his head cold? What happens if little Johnny ends up having something more severe and his course is seriously complicated because it wasn't worth your time initially?

The point here is that it is not as simple as "lol done seeing patients," and I'm not sure that not providing people medical care is the best route to go to get your point across.

Sent from my SAMSUNG-SGH-I717
 
They can.

Here at the University of Michigan, our residents are unionized under the University of Michigan House Officers Association. This unionization offers protections, good salaries, and a nice House Officer's Lounge in the main hospital.

We are definitely the exception rather than the rule, but I hope over time that more medical centers will adopt a similar association to treat their residents like people instead of slaves.
 
CrimsonKing said:
They can.

Here at the University of Michigan, our residents are unionized under the University of Michigan House Officers Association. This unionization offers protections, good salaries, and a nice House Officer's Lounge in the main hospital.

We are definitely the exception rather than the rule, but I hope over time that more medical centers will adopt a similar association to treat their residents like people instead of slaves.
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Probably not because residents have been trained to be spineless lackeys from, at the very least, undergrad and onward. :laugh:
 
mcloaf said:
I don't think physicians striking over reimbursements would find much sympathy among the public.
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Why is that relevant? People strike because they're sick of their working conditions. It helps to have public support, but do you really think thousands of parents stuck with kids at home during teacher's strikes are supporting the teacher's actions? They may think teachers deserve more pay, but they get pissed if their kid is at home all day.

The point is, whether or not doctors belong to a union, if a majority decided to not show up to work because of reduced Medicare reimbursements, a lot of people would be greatly affected. Both sides would point fingers and the public would be irate, but physicians would have us by the cajones.

IslandStyle808 said:
I remember wondering about this same question. What I found out is that doctors usually hold manager level position thus can't unionize. Hence the reason why teachers can strike because they are all employees. However, if the majority of doctors are employees of hospitals this can change.
Click to expand...

Good point, but that would be a little unfair to the hospitals. After all, the federal government is in charge of Medicare. Doctors should refuse to treat any fed employee that has the power to alter Medicare/Medicaid reimbursement. Let's see how fast things change when someone important can't get treatment :laugh:
 
Bangersandmash said:
Why is that relevant? People strike because they're sick of their working conditions. It helps to have public support, but do you really think thousands of parents stuck with kids at home during teacher's strikes are supporting the teacher's actions? They may think teachers deserve more pay, but they get pissed if their kid is at home all day.

The point is, whether or not doctors belong to a union, if a majority decided to not show up to work because of reduced Medicare reimbursements, a lot of people would be greatly affected. Both sides would point fingers and the public would be irate, but physicians would have us by the cajones.



Good point, but that would be a little unfair to the hospitals. After all, the federal government is in charge of Medicare. Doctors should refuse to treat any fed employee that has the power to alter Medicare/Medicaid reimbursement. Let's see how fast things change when someone important can't get treatment :laugh:
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While this is true, there are plenty of other professionals who belong to unions that are not allowed to strike. Public employees in New York are severely restricted in when or if they can strike, yet no one doubts that the teachers' or police union has a great deal of clout when negotiating with the city.

http://en.wikipedia.org/wiki/Taylor_Law
 
Shockwave456 said:
To be honest, I never thought about it before. I'm not sure why they haven't. From my understanding, residents are one of the most (if not the most) exploited labor pools in the country.
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You have no idea... as a med student I dated a resident for a while. All I have to say is... wow. They get destroyed.

It's almost like a hazing. I remember her telling me that she covered call one night... she made almost $15,000 in fee for service billings for her attending while he was at home sleeping. What'd she get for working 30 hours straight? 100 bucks and $5 voucher at the cafeteria.

medicus-workaloticus.gif
 
CodeBlu said:
You have no idea... as a med student I dated a resident for a while. All I have to say is... wow. They get destroyed.

It's almost like a hazing. I remember her telling me that she covered call one night... she made almost $15,000 in fee for service billings for her attending while he was at home sleeping. What'd she get for working 30 hours straight? 100 bucks and $5 voucher at the cafeteria.
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On the other hand, that same attending instead of spending time training that resident could be in private practice making a lot more than they do right now. We work with a lot of groups that have some attendings working with residents and others who do not. Attendings do not have to sacrifice their time and money to allow you to train with them. There is no exuse for hazing, harassment etc. But the whole money arguement doesn't hold a lot of water. This coming from someone who works in excess of 100 hours a week as a resident. (never over 80 clinical, of course...)
 
As others have said, residents can and do form unions to improve their working conditions and/or patient care. However, when residents (or other physicians) take job action, they don't completely stop work because they provide an essential service. So they still deal with emergencies and other time-sensitive needs, but might not do other parts of their job that aren't as urgent - it varies by the jurisdiction. The same is true of fire fighters or police or any other group that is considered to provide an essential service (as an aside, this is one way that the government can restrict the rights of striking workers - by declaring the service that they provide as essential and banning them from certain types of job actions).

The other reason you don't generally hear about striking doctors (and here I'm talking mainly attending physicians) is that taking job action is generally the strategy for workers who have no other power than to take collective action to hurt both themselves and the company they work for to improve the working conditions. Doctors, as a group, historically have been represented by powerful lobby groups like the AMA, and so had at least a certain degree of control over laws being passed and other ways that their jobs may be affected, in the same way that large companies represent their interests through lobbyists.

However, there are examples of doctors taking job action. Back when Medicare first passed congress and was signed into law, doctors struck to protest the fact that they would now be restricted to specific billing codes for patients covered by Medicare rather than being able to charge whatever they wanted as they had in the past. It was also largely due to physicians' intense lobbying through the AMA that Medicare only covered those over 65 rather than the whole population (universal coverage is what the Johnson administration originally intended).
 
Mt Kilimanjaro said:
I remember hearing on the radio the author of a book called "County" a while back in which he describes the residents striking at a hospital in Chicago. Never read the book though.
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The book is called "County" and the author is internist David Ansell. It tells the story of the old Cook County Hospital in Chicago, and most of it takes place during his residency training there in the 1970s. It details a lot of the abuses in the health care system in Chicago against poor people, and the unethical activities of city council members, the ways in which private hospitals like the University of Chicago turn profits by refusing care, and other terrible things that happen all the time but aren't really talked about. Mostly though, it just tells the tale of being a resident in an underfunded public hospital delivering care to a poor/discriminated population, and the ways in which he and others tried to improve conditions.
 
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wholeheartedly said:
Yeah, but doesn't the federal government consider residents employees now for the purposes of FICA taxes or whatever, govt./employers can't have their cake and eat it too.... residents can't be students or employees depending on how it best suits them.
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Well, that's not exactly what the ruling said. In simple terms, they basically said that some of the work residents do was taxable and that they weren't going to put the IRS to the task of trying to make allocations, so the whole thing just gets deemed wages under FICA. There are tons of federal and state employee regulations that still don't apply to residents.


In terms of unions, you have to remember that not all residents are similarly situated, and for example there are more than a few residents who feel "screwed" that they are mandatorily forced to leave the hospital and miss some once in a residency cases simply because seeing it would put them in a duty hour violation. Basically the rules protect them from getting better trained. (there's a Neurosurg thread about this someplace). This isn't always about being protected from long hours, it becomes more and more about being adequately trained as you get closer to the end of your residency and realize that there is still a ton to learn and inadequate time in which to learn it. And honestly salaries in residency are not unreasonable these days.
 
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Mt Kilimanjaro said:
What is a ballpark civilian resident salary for a major city? Does it include 401k?
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Around here resident salaries start in the high $40s, and increase a couple of grand a year. Bigger cities start in the low $50k range. 401k options vary but I think most places have that option after a year. It's a far cry from the 30k or less residents used to get not that many decades ago, when they were working a lot more hours.

But the money isn't really the point of residency. It's to pay down some bills, but virtually every resident would still do residency if they payed half of what they do now. It's training, and you learn a heck of a lot more than in the previous four years where you were paying out $30k a year. This is the reason unions generally get very little traction in residency, and tend to be more the focus of premeds than resident boards on SDN. When a good chunk of the residents care more about solid training to prepare them for and help them land the dream fellowship or job, and aren't really so concerned about the hours or $ in the interval, labor unions don't seem that appealing. Premeds see residency as some sort of hazing ritual where you don't get sleep and attendings are mean to you and you work so many hours that your per hour pay is below the minimum wage, and just feel things are not humane enough. And perhaps theres some truth to that from an outsider perspective. But when you get to later residency and start taking ownership of your training and what you ought to accomplish before you leave the safe haven of residency and are working without a net, you realize that shorter hours are not your friend, and that whether they pay you $45k or $50k just determines how fancy a board review course you will sign up for. It's a difference in perspective. And why unions will never be big with residents.
 
In the past, particularly in canada (with major support from the AMA), doctors did strike (they only would see emergency cases) and with no public support, their strikes were highly unsuccessful.

I am currently a unionized resident (CIR). But we are legally not allowed to strike. We don't get a 501K, but interns start at 51K, and next year as a PGY4 I'll be making over 60K, so we aren't making peanuts here, in my 20's and with DrMrsDrJoJo a PGY3 here, we make more than our parents combined...
 
Law2Doc said:
Around here resident salaries start in the high $40s, and increase a couple of grand a year. Bigger cities start in the low $50k range. 401k options vary but I think most places have that option after a year. It's a far cry from the 30k or less residents used to get not that many decades ago, when they were working a lot more hours.

But the money isn't really the point of residency. It's to pay down some bills, but virtually every resident would still do residency if they payed half of what they do now. It's training, and you learn a heck of a lot more than in the previous four years where you were paying out $30k a year. This is the reason unions generally get very little traction in residency, and tend to be more the focus of premeds than resident boards on SDN. When a good chunk of the residents care more about solid training to prepare them for and help them land the dream fellowship or job, and aren't really so concerned about the hours or $ in the interval, labor unions don't seem that appealing. Premeds see residency as some sort of hazing ritual where you don't get sleep and attendings are mean to you and you work so many hours that your per hour pay is below the minimum wage, and just feel things are not humane enough. And perhaps theres some truth to that from an outsider perspective. But when you get to later residency and start taking ownership of your training and what you ought to accomplish before you leave the safe haven of residency and are working without a net, you realize that shorter hours are not your friend, and that whether they pay you $45k or $50k just determines how fancy a board review course you will sign up for. It's a difference in perspective. And why unions will never be big with residents.
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Very well put.

Residency is the most crucial part of medical training and hospitals/CME are very nice to pay you anything at all. There are so many times that I know my training has resulted in double the work for my attendings and I'm grateful that they're willing to make the sacrifices to see that I get good training.

As a resident, your job isn't about watching the clock and trying to get home in time to watch the game. It's 3+ years to learn everything you possibly can to transition to practicing on your own.
 
thedrjojo said:
In the past, particularly in canada (with major support from the AMA), doctors did strike (they only would see emergency cases) and with no public support, their strikes were highly unsuccessful.

I am currently a unionized resident (CIR). But we are legally not allowed to strike. We don't get a 501K, but interns start at 51K, and next year as a PGY4 I'll be making over 60K, so we aren't making peanuts here, in my 20's and with DrMrsDrJoJo a PGY3 here, we make more than our parents combined...
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Glad to see all is going well, DJJ.

I feel the same way - we have more money than we need. It's also a disguised blessing to have so little time to spend the money I make.
 
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