Nov 7, 2022 - Health

More physicians unionize in the face of burnout, consolidation

Illustration of hands in medical gloves holding red picket signs, forming a red cross symbol.

Illustration: Shoshana Gordon/Axios

Burnout and health industry consolidation are driving more doctors and doctors-in-training to unionize to demand better pay, benefits and working conditions.

Driving the news: More than 1,200 resident physicians and interns at Montefiore Medical Center last week asked the Bronx, N.Y. hospital to recognize their bargaining unit after an organizing vote.

  • It was another sign that 80-plus hour work weeks, combined with inflation and other stressors, are prompting more doctors to demand a seat at the table.
  • The Committee of Interns and Residents, part of the Service Employees International Union, said it had a record year organizing unions at five hospitals across the country, and now has more than 22,000 members.
  • Doctors have also joined with other big labor organizations including the American Federation of State, County and Municipal Employees and the American Federation of Teachers.

By the numbers: There were more than 67,000 physician union members, or about 7% of all practicing U.S. doctors, as of 2019, according to the American Medical Association. The numbers have likely increased since then, in response to hospital consolidation and more physicians working as employees of a health system or other provider.

  • The average resident physician's salary in the U.S. in 2021 was $64,000, according to Medscape. Younger doctors who are unionizing say that's not enough to contend with general inflation and the cost of living, especially in markets like New York and Los Angeles. The workload and residents with student loan debt are also factors, per Fierce Healthcare.
  • The Accreditation Council for Graduate Medical Education has set a maximum number of hours a resident can work each week at 80 hours.
  • Residents are not only asking for higher wages but for better working conditions, from longer breaks and meal options to moving stipends and wages that make living near their hospitals affordable.

Yes, but: There are concerns that doctors taking collective action could undermine public trust and jeopardize patient safety. And the prospect of physicians walking off the job nearly became reality over the summer, during a labor dispute involving 1,300 residents and fellows at three big Los Angeles County hospitals.

  • Hospitals face complex financial calculations that go beyond paying for hours worked, particularly when it comes to their trainees, Association of American Medical Colleges chief health care officer Janis Orlowski said in an article posted by AAMC.
  • "On one hand, residents work long hours and contribute significantly to the care of patients. For this they receive a stipend," Orlowski said. "On the other hand, they’re apprentices who are receiving very valuable training that is expensive for institutions to provide."

The intrigue: So far, Montefiore Medical Center hasn't recognized the residents' union and chose not to voluntarily recognize it as of Friday.

  • "The National Labor Relations Act guarantees our residents the right to determine whether or not they should be represented by a union. We respect their right to make that decision through a secret ballot process, free from outside influence," the hospital said in a statement issued on Friday.

What they're saying: "For me as a provider to bring solutions for some of those gaps I am seeing, I need a voice and seat at the table and be able to express what I'm seeing to people who have power to make those decisions," Sejal Shah, a second-year primary care and social medicine resident at Montefiore Medical Center, told Axios.

  • Physician inquiries to the Committee of Interns and Residents have risen to double or triple the rate before the pandemic, Sunyata Altenor, communications director of the committee, told Axios.
  • Residents like Isuree Katugampala, a third-year pediatrics resident at Montefiore Medical Center, had to help with the COVID response during the pandemic due to the surge of patients and staffing shortages.
  • Difficulties securing protective gear and vaccines during the pandemic underscored the need for more formal organizing, the Bronx-based residents said.

Zoom out: Physicians who aren't in supervisory roles have the right to bargain collectively — and experts say the pandemic experience and business conditions will encourage more activity.

  • "I believe doctors will find a way to unionize," John August, director of health care labor relations at Cornell School of Labor and Industrial Relations told Axios.
  • Antitrust laws prevent most clinicians from unionizing if they are independent practitioners, but August thinks that like resident physicians, providers will likely begin to organize in the coming years.
  • Resident physician unions are unique in that members will cycle through only for the duration of their residencies.
  • "I probably will not see the benefits of this union, and I am fully okay with that knowing I contributed and tried to play a part, with my colleagues, that will be better for us and our patients in the long run," Katugampala said.

The bottom line: As health systems move beyond COVID-19 and rely less on traveling and temporary staff, relations with doctors will become a pivotal business barometer.

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