dr Monique Hedmann, a general practitioner at Harbor-University of California, Los Angeles Medical Center in West Carson, works with patients from 8 a.m. to 5 p.m. But her day doesn’t end there.
The third-year resident calls patients and writes clinical notes until environmental service staff tell her to go. Then she goes home and continues to work until she falls asleep.
“They have no free time to attend to life. They can hardly sleep. This is related to very traumatic things in terms of patient care,” Hedmann said. “You don’t have time to take care of yourself and heal from it. You just have to keep going.”
Residents’ working hours are limited to 80 hours per week, but that’s only on paper. she sometimes work high to 28 hours Shifts, rarely get days off, and are saddled with hundreds of thousands of dollars in medical school debt. While they may have lucrative careers ahead, three to seven years of residency can be “grueling,” said Hedmann, regional vice president for the South California at the Committee of Interns and Residents, which has grown by 6,000 to 22,000 members since 2019.
Medicine has historically not been a haven of organized labor, although unions are more common for nurses and other health workers. Physicians are highly paid professionals and traditional to have practiced alone, in small groups, or as independent practitioners working in hospitals and other settings—conditions that do not lend themselves to union action.
The culture of medicine also contributes to physicians’ apparent disinterest in collaboration in the workplace. Physicians learn from medical school that they must pay their fees to get ahead and are reluctant to complain about long hours or difficult circumstances. And going it alone penetrates the profession, said Rachel Flores, organizing director of the Union of American Physicians and Dentists, which represents 5,000 professionals. The labor organization added 250 members and organized another 200 in the past year.
“Doctors had the mentality that I could do it on my own. I don’t need anyone to stand up for me,” Flores said.
However, as more practicing physicians become employees of healthcare systems and other healthcare companies, attitudes may change. And the ravages of the COVID-19 pandemic have prompted some physicians to reconsider the benefits of speaking together to improve working conditions and patient care.
Physicians are “very interested in unionizing,” said Joe Crane, national organizing director of the Physicians’ Council, which is affiliated with Service Employees International Union and has 3,500 members. “They’re frankly broken. They’re fed up with the way healthcare has evolved, the direction of gains toward their patients, the pressures they have to deal with on a daily basis,” he said said. “Doctors across the country are turning to her and sadly saying ‘help.'”
New doctors seem to be driving the union campaigns. The number of inquiries from residents interested in unionizing has “exploded” in the past two years, said Dr. Michael Zingman, Secretary and Treasurer of the SEIU-affiliated Committee of Interns and Residents. The number of applications this year has already surpassed last year’s hundreds from doctors, he said.
“We’re basically at the point where we’re getting too many requests that we can’t unionize all of these chapters,” said Zingman, a third-year psychiatrist at NYC Health+Hospitals/Bellevue in New York.
Residents have recently formed unions at healthcare employers such as the University of Vermont Medical Center in Burlington, Vermont, the Greater Lawrence Family Health Center in Lawrence, Massachusetts, and the University of Southern California Keck School of Medicine in Los Angeles. The union has organized eight residency programs in the past two years, compared to one or two in a typical year, and has added 6,000 members in that time, according to the Interns and Residents Committee.
Even if this trend were to continue and accelerate, the proportion of physicians organized in unions is likely to remain low.
Only a tiny fraction of doctors and dentists belong to unions. The Bureau of Labor Statistics reports that there are 824,000 physicians and dentists in the US, not counting self-employed or informal physicians. only one An estimated 1% of physicians and dentists and 15% of medical professionals are members of the Union of American Physicians and Dentists, the Doctors Council, or the Committee of Interns and Residents. (Modern Healthcare derived these numbers by analyzing data from the BLS, the Accreditation Council for Graduate Medical Education, the Association of American Medical Colleges, and unions.)
Healthcare work has coincided with renewed interest in unions in the wider economy, including high-profile campaigns by Starbucks and Amazon workers. Workers filed nearly 2,000 petitions for union elections with the National Labor Relations Board in the first three quarters of fiscal 2022, a 58% increase from the corresponding period in the previous fiscal year, the agency reported last week.
Still, the proportion of private sector workers who are unionized is small and shrinking, the BLS reported in January. Last year, only 6.1% of workers in private companies were union members.
That the toll of the pandemic
John August, program director for the Healthcare Labor Relations and Partners Program at Cornell University, attributes the surge in healthcare union activity to the stresses of the COVID-19 pandemic. Recent years have exacerbated labor shortages, leading to understaffed shifts and residents working “an extraordinary amount of overtime” on top of the “nearly inhuman” hours they are already working, he said.
Health care workers also complain about what is called “moral”. Injuries,” August said, because they saw patients suffer and die and felt powerless to help. “That feeling of added stress and anxiety that was happening to both themselves and their patients was the main factor,” he said.
Residents are often reluctant to talk about working conditions because they need to please their bosses in order to move forward, said Dr. Ben Solomon, a third-year pediatrician at Stanford Health Care, Calif. in Palo Alto. “It’s a time when you’re really vulnerable,” he said.
In the past, residents have been conditioned to accept negative circumstances as part of the graduate school process, Hedmann said. “If you keep your head down you’re essentially going through hell, you pay your dues, then later you get this very fruitful career in medicine. Something like that really got stuck in people’s minds,” she said.
A majority of Stanford Health Care’s nearly 1,500 interns, residents and fellows voted in May to join the interns and residents committee. “There really is no downside to unionization for residents,” said Dr. Philip Sossenheimer, a third-year internist at Stanford Health Care and a member of the union’s bargaining committee.
“COVID has really presented an opportunity for unions to capture and capitalize on some of the discontent among our healthcare providers across the country,” said Jill Lashay, employment and healthcare employment attorney at Buchanan Ingersoll and Rooney, who represents employers.
Despite the growing number of unionized residents, the pace of organizing treating physicians is slowing, union officials said.
But because a greater number of doctors are employed directly by health systems and other companies, rather than working independently, they tend to see themselves as workers receiving paychecks, August said. “Doctors are actually losing their historical autonomy in many cases,” he said. “We are coming to a turning point.”
According to a study published in April by the Physicians Advocacy Institute and Avalere Health, more and more doctors are employees of hospitals, health care systems or other companies. The report shows that between 2020 and 2021 alone, the proportion of employed doctors rose from 69.3% to 73.9%.
It is complicated for treating physicians – like residents – to consider a union, workers’ representatives said. Doctors take an oath to put patients first, which can be at odds with being in a union and standing up for yourself.
But concerns about personal protective equipment and safety standards during the pandemic have gotten them interested in organizing to protect patients and promote quality care, Crane said.
The way employers respond to organizing efforts varies, August said. A minority welcome unions with open arms. Many are against it. But a growing number see benefits in working with unions to solve problems, he said. “They are scared of the role of the union, but I think they also recognize that healthcare has to be a team sport in today’s world,” he said.
Lashay recommends healthcare employers to be open when workers raise issues. “We as employers need to pay special attention to the concerns raised by our employees at all levels,” she said.
Employers should be proactive and have respectful and transparent conversations with workers, Lashay said. she It should also be transparent about financial challenges and how they are addressing staffing shortages, she said said.
“Management should strive to build the most collaborative worker-management relationship possible,” Lashay said. “Frankly, the concern is not with unionization. It’s really about employee relations.”