Unionization efforts reflect residents' desire for better quality of life

By Sarah Handzel, BSN, RN | Fact-checked by MDLinx staff
Published May 1, 2023

Key Takeaways

  • Doctor’s unions have existed for decades, but a new push toward unionization for medical residents is relatively new.

  • Residents’ concerns range from better pay to better working conditions.

  • Already, some unions are subject to litigation, and more could follow.

Learning to navigate the medical industry as a new resident involves exposure to difficult patients, exhausted attendings, grueling hours, sometimes thankless tasks, and relatively low pay. Residency offers a tremendous learning experience, but it can also be a source of significant stress that affects not only trainees but patients as well.

A recent history of doctors' unions

In response to these concerns and others, newly minted doctors are unionizing in hospitals across the country. Doctors’ unions are nothing new—for example, Doctors Council, a union for attending physicians, began forming in 1961.[]However, resident-led unionization efforts are somewhat new. 

A 2023 NPR report found that unionization efforts organized in collaboration with the Committee of Interns and Residents (CIR), the country’s largest union representing residents, interns, and fellows, increased to eight campaigns in 2022 from two in 2021.[] Successful unionization campaigns have already taken place at Penn Medicine, George Washington University in Washington, DC, Mass General Brigham in Boston, and Montefiore Hospital in New York, according to the report.

CIR already boasts 24,000 members from health systems nationwide,[] representing approximately 15% of US residency programs.[] The organization anticipates continued growth as more unionization efforts flourish.

Concerns: Better pay to staffing shortages

A variety of problems are leading new doctors toward unionization as they search for a better quality of life. 

For many, a key component of resident well-being is higher compensation. The American Medical Association reports the average resident salary is approximately $60,000 per year. However, many doctors graduate medical school with over $200,000 in debt.[] And while residents have access to benefits through their employers, they are not provided at discounted rates, further eating into each residents’ paycheck.

Pregnancy and childcare are also primary concerns for many. Residency typically falls within prime childbearing years following undergraduate education. For female physicians, pregnancy doesn’t mean a break—it’s not uncommon to hear of new doctors delaying pregnancy to go on to experience difficulty conceiving at a later age. 

The cost of childcare is also prohibitive for many—in the NPR report, one female resident described how she had to wait for childcare at her institution because enrolling her child in a community daycare center was too expensive. She said, “The cost of day care … in a month is about half of my salary in total, and the cost of a nanny is essentially the entirety of my salary.”

Another common complaint involves how many residents feel exploited for their work.

Each residency program is several years long, and residents can’t just choose to leave for another employer if they’re unhappy with their working situation. Many describe an unspoken expectation that they will simply work through several difficult years while earning their stripes. 

Workplace problems are compounded by milder issues affecting quality of life, according to the NPR report, including inadequate or nonexistent parking benefits at hospitals. Residents have also reported cockroaches, mice, and other problems in call rooms that prohibit rest during long shifts. 

Unions also a target for litigation

While unionization efforts continue to grow, some resident unions are already facing litigation in response to negotiations and contracts. In Washington, DC, Children’s National Hospital is pursuing legal action against CIR for a demonstration that occurred in late 2022, as reported by DCist in April 2023.[] According to the hospital, residents violated a “no strike clause” within the existing contract. Residents, in response, say the demonstration was actually a “Unity Break” because they were not allowed to strike.

Children’s National Hospital is filing for arbitration instead of an actual lawsuit, DCist said. Residents are concerned that, if the hospital wins arbitration, they will have substantially less bargaining power going forward. The next round of bargaining at Children’s National Hospital will occur in 2025.

It’s impossible to anticipate what will happen with litigation moving forward—either at Children’s National Hospital or any other facility in the nation. However, it is obvious  the traditional residency experience is no longer acceptable for many. No matter what side of the union divide a resident falls on, change is coming.

What this means for you

Unionization efforts for medical residents are growing nationally due to increasing concerns related to difficult working conditions, long hours, and other factors affecting residents’ quality of life. While unions may help provide better pay and benefits, residents should be aware of the potential ramifications. Those interested in unionizing should take care to understand their employer’s policies and regulations regarding unionizing and related employee-led efforts.

Read Next: Voices of residents: 'This is exactly why I went into medicine'
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