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More medical residents across the country are joining a union known as the Committee of Interns and Residents (CIR).
They want a stronger collective voice in advocating for a safe and healthy training environment as they move toward being fully fledged practicing physicians.
“Residents at Penn and across the country are unionizing because unions provide residents the means to advocate collectively for better working conditions and support systems,” Dr. Chioma Elechi, an emergency medicine first-year resident at the Hospital of the University of Pennsylvania in Philadelphia, told Online News 72h Digital.
Residents want more reasonable work hours and breaks, fair pay and improved employee benefits, such as health insurance and access to mental health resources, Elechi also said.
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“Having a seat at the table for institutional decisions allows us to work together with our institutions to create a healthier, more sustainable work environment,” she added.
Here’s a deeper dive into what’s going on.
What are residents? Why is this important?
Sir William Osler created the first residency program in the U.S. New doctors resided in the hospital, so they were termed “residents,” according to Johns Hopkins Medicine.
Over time, residents did not live in the hospitals where they trained, but the term became synonymous with doctors in training.
The primary role of medical residents is “to be trained … so that upon graduation from residency training, they are prepared to be fully independent practicing physicians,” said a chief health care officer. (iStock)
“Resident physicians are medical school graduates who are in a training program that is a working apprenticeship,” Dr. Jonathan B. Jaffery, chief health care officer of the Association of American Medical Colleges (AAMC) in Washington, D.C., told Online News 72h Digital.
“Their primary role in the program is to be trained, under direct and indirect supervision of a teaching physician, so that upon graduation from residency training, they are prepared to be fully independent practicing physicians.”
The Committee of Interns and Residents (CIR) represents 76 residency programs across nine states.
Residents started to form unions in the United States dating back to 1934 when the Interne Council of Greater New York organized for better work conditions, more learning and for compensation — since up to that point, they were not getting paid, according to the AAMC.
More residency programs unionized despite legal hurdles, which said residents didn’t have the right to unionize since they were still in training, per the AAMC.
Over the past five years, the health system increased salaries for its first-year residents by nearly 18%, “making our wages highly competitive as compared to local and national peer institutions.” (iStock)
In 1999, the National Labor Relations Board (NLRB) later ruled residents were employees with respect to federal labor labs. But it also confirmed residents were “students,” so the board could not interfere when it pertained to their education, according to a previous report.
CIR is now the largest “house staff” union to represent doctors in training.
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It represents 76 residency programs across nine states, for a total of 25,000 members, Sunyata Altenor, the communications director of CIR in Long Island City, New York, told Online News 72h Digital.
Over the past five years, the health system increased salaries for its first-year residents by nearly 18%.
A supermajority of over 1,400 physicians in training employed by the University of Pennsylvania Health System (UPHS) have recently demanded formal recognition of a union with the CIR, per a recent press release.
They are the eighth group of residency physicians to join the union in the past 11 months, the release said.
Penn Medicine, however, advocates for resolution through its existing Graduate Medical Education Committee structure by working directly with the UPHS administration, a Penn Medicine spokesperson told Online News 72h Digital.
Starting this July, Penn Medicine’s first-year residents will earn more $69,000 a year, according to its website. (iStock)
Over the past five years, the health system increased salaries for its first-year residents by nearly 18%, “making our wages highly competitive as compared to local and national peer institutions.”
Starting this July, their first-year residents will earn more $69,000 a year, according to Penn Medicine’s website.
Trainees also get retirement benefits including employer contributions, reimbursement for required national testing and medical licensing costs.
That’s almost a 7% increase compared to the current level, “with increases of 7.5 to 11% as residents and fellows move from one year to the next over the course of their multi-year training,” the spokesperson added.
Trainees also get retirement benefits including employer contributions, reimbursement for required national testing and medical licensing costs as well as subsidized public transportation, which many of the house staff use, the spokesperson noted.
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The NLRB plans to conduct the residents’ election this May.
Work-hour restrictions
Residents joining unions often advocate for better work hours as residents often work long and irregular hours often with little breaks and little sleep.
In 2003, the Accreditation Council for Graduate Medical Education (ACGME) mandated work hour restrictions after concern for patient safety and overworked residents, according to its website.
The work hour regulations went into effect July 2011, noting residents could only work a maximum of 80 hours per week averaged over a four-week period, per ACGME.
Many residents are too overwhelmed with their hospital demands to concentrate fully on learning, experts say. (iStock)
Experts remind people that residency also serves an invaluable educational training environment for doctors in training to learn to become independent physicians — but many residents are too overwhelmed with their hospital demands to concentrate fully on learning.
The AAMC said it is working to ensure a good education for residents.
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“By providing education and training to teaching health system staff, faculty and residents, we work to ensure residents receive effective training and support from teaching hospitals and schools of medicine that both addresses resident experience concerns and prepares them for a career in medicine,” Jaffery noted.
Many residents feel a loss of control when they apply for a position in residency through the National Resident Matching Program.
“The AAMC convenes two professional development groups that specifically address resident training issues, and their concerns nationally: the Group on Resident Affairs and the Organization of Resident Representatives.”
‘The Match’
Many residents also feel a loss of control when they apply for a position in residency through the National Resident Matching Program, also known as “The Match.”
“After the application and interview process, students submit a ‘match list’ ranking the programs they’re interested in and residency programs submit a rank list of the students they’re interested in,” Dr. Candice Chen, associate professor of health policy and management at George Washington University in Washington, D.C., told Online News 72h Digital.
A computer algorithm tries to “match” the students to a residency slot based on both the students’ and the residency’s top choices.
Given “The Match” system, “it may not be surprising that residents unionize at a higher rate than physicians in general,” said one professor. (iStock)
If “matched,” they must go to that residency.
“You can see that this process is different from how we apply for jobs or even higher education/medical school, so there is some argument for it changing the nature of competition and negotiation between students and residency programs,” Chen added in an email.
The program tries to maximize the placement of almost 40,000 people every year, Chen added.
“This process is different from how we apply for jobs or even higher education/medical school.”
“Graduating medical students are assigned their place of work for the next three to nine years through The Match algorithm, which removes the ability applicants have in selecting their workplace and negotiating for benefits which can contribute to unfair working conditions,” Elechi said.
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In the early 2000s, a group of students and residents filed a lawsuit, arguing the match process was anti-competitive, Chen recalled.
“Ultimately, Congress stepped in and created an anti-trust exclusion for the match,” Chen noted.
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“However, with the match system, it may not be surprising that residents unionize at a higher rate than physicians in general.”
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