More doctors seek unions amid changing landscape, COVID-19
Dr. Monique Hedmann, a family medicine resident at Harbor-University of California, Los Angeles Medical Center in West Carson, works with patients from 8 a.m. to 5 p.m. But his day does not end there.
The third-year resident calls patients and writes clinical notes until environmental services workers tell her she has to leave. Then she goes home and continues to work until she falls asleep.
“You don’t have any free time to go about life. You’re barely able to sleep. It’s in the context of seeing some very traumatic things in terms of patient care,” Hedmann said. “You don’t have time to take care of yourself and heal from this. You just have to keep going.”
Resident hours are capped at 80 hours per week, but that’s only on paper. They sometimes work at the top at 28 hours shifts, rarely have days off and are saddled with hundreds of thousands of dollars in medical debt. Although they may have lucrative careers ahead of them, three to seven years of residency can be “grueling,” said Hedmann, who serves as regional vice president for the south. California to the Interns and Residents Committee, which has grown from 6,000 members to 22,000 since 2019.
Medicine has never been a haven for unionized workers, even though unions are more common for nurses and other healthcare workers. Physicians are highly paid professionals and traditionally have exercised alone, in small groups or as independent practitioners working in hospitals and other institutions, conditions that do not lend themselves to union campaigns.
The culture of medicine also contributes to the obvious disinterest of physicians in grouping together in the workplace. Physicians learn from medical school that they must pay their dues to advance and are loath to complain about long hours or difficult circumstances. And a mindset of going it alone pervades the profession, said Rachel Flores, organizing director of the Union of American Physicians and Dentists, which represents 5,000 professionals. The union organization added 250 members and organized another 200 over the past year.
“The doctors had the mentality that ‘I can do it myself. I don’t need someone to defend me,'” Flores said.
But as more practicing physicians become employees of health systems and other health care enterprises, attitudes may change. And the ravages of the COVID-19 pandemic have led some doctors to reconsider the value of talking to each other collectively to improve working conditions and patient care.
Doctors are “extremely interested in organizing,” said Joe Crane, national organizing director for the Council of Physicians, which is affiliated with the Service Employees International Union and has 3,500 members. “They’re broken, honestly. They’re fed up with the way health care has evolved, the orientation of profits to their patients, the pressures they have to deal with on a daily basis,” he said. said. “Doctors across the country are reaching out and sadly saying, ‘Help’.”
The new doctors seem to be behind an increase in union organizing campaigns. The number of inquiries from residents interested in unionizing “has skyrocketed” over the past two years, said Dr. Michael Zingman, secretary-treasurer of the SEIU Affiliate Trainee and Resident Committee. The number of applications this year has already exceeded the hundreds of doctors made last year, 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 psychiatry resident at NYC Health + Hospitals/Bellevue in New York City.
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 held eight residency programs in the past two years, down from one or two in a typical year, and added 6,000 members during that time, according to the Trainee and Resident Committee.
Even if this trend were to continue and accelerate, the share of unionized physicians should remain low.
Only a tiny fraction of doctors and dentists are unionized. The Bureau of Labor Statistics reports that there are 824,000 doctors and dentists in the United States, not counting independent practitioners or those who are not working. Just one an estimated 1% of physicians and dentists and 15% of medical residents are members of the Union of American Physicians and Dentists, the Doctors Council, or the Committee of Interns and Residents. (Modern Healthcare got these numbers by analyzing data from BLS, the Accreditation Council for Graduate Medical Education, the Association of American Medical Colleges, and labor unions.)
Labor activity in healthcare facilities coincides with renewed interest in unions in the broader economy, including very public campaigns by Starbucks and Amazon employees. Workers filed nearly 2,000 petitions for union elections to the National Labor Relations Board in the first three quarters of fiscal 2022, an increase of 58% over the corresponding period of the previous fiscal year, said reported the agency last week..
Nonetheless, the share of private sector workers who belong to unions is small and declining, the BLS reported in January. Last year, only 6.1% of people employed by private companies were unionized.
The assessment of the pandemic
John August, program director of the Healthcare Labor Relations and Partners program at Cornell University, attributes the increased activity of healthcare unions to the stress of the COVID-19 pandemic. The past few years have exacerbated the labor shortage, resulting in understaffed shifts and forcing residents to work ‘an extraordinary amount of overtime’ on top of the ‘almost inhumane’ hours they work already, he said.
Health care workers also complain about what is called “morality injury” seeing patients suffer and die and feeling powerless to help, August said. “, did he declare.
Residents are often hesitant to talk about working conditions because they have to please their superiors to get ahead, Dr. Ben Solomon, a third-year pediatric resident in Palo Alto, Calif., told Stanford Health Care. . “It’s a time when you’re really vulnerable,” he said.
Historically, residents have been conditioned to accept negative circumstances as part of the graduate school process, Hedmann said. “If you keep your head down, you basically go through hell, pay your dues, and then later on you get this very successful career in medicine. That kind of thing has really solidified in people’s minds,” she said.
A majority of Stanford Health Care’s nearly 1,500 interns, residents and fellows voted to join the interns and residents committee in May. “Unionization really doesn’t hurt residents,” said Dr. Philip Sossenheimer, a third-year internal medicine resident at Stanford Health Care and a member of the union’s bargaining committee.
“COVID has really opened up an opportunity for unions to capture and capitalize on some of the discontent that exists among our healthcare providers across the country,” said Jill Lashay, labor and employment attorney in the field. Health at Buchanan Ingersoll and Rooney representing employers.
Despite the growing number of residents unionizing, the pace of organizing for attending physicians is slower, union officials said.
Yet, as more doctors are directly employed by health systems and other businesses instead of operating independently, they are more likely to see themselves as workers who receive paychecks, said Aug. “Doctors, really, in many cases are losing their historical autonomy,” he said. “We are coming to a tipping point.”
A growing share of doctors are now employees of hospitals, health systems or other companies, according to research published in April by the Physicians Advocacy Institute and Avalere Health. Between 2020 and 2021 alone, the proportion of employed physicians rose from 69.3% to 73.9%, according to the report.
For attending physicians, as for residents, the possibility of unionizing is complicated, according to union representatives. Doctors take an oath to put patients first, which may seem at odds with being in a union and standing up for yourself.
But concerns about personal protective equipment and safety standards during the pandemic are prompting them to organize to protect patients and promote quality care, Crane said.
How employers respond to organizing efforts varies, August said. A minority welcomes the unions with open arms. Many oppose it. But a growing number see benefits in working with unions to solve problems, he said. “They have fears about the role of the union, but I think they also realize, in today’s world, that health care has to be a team sport,” he said.
Lashay recommends that healthcare employers be responsive when workers report concerns. “We, as employers, need to be particularly mindful of the concerns that our employees raise at all levels,” she said.
Employers need to be proactive and have respectful and transparent conversations with workers, Lashay said. They should also be transparent about financial challenges and how they are tackling staffing shortages, she said.
“Management should strive for the most collaborative labour-management relationship possible,” Lashay said. “The concern, frankly, is not about organizing unions. It’s really about employee relations.”