Resident physicians work long hours for relatively low pay. They have little ability to determine their schedule and are generally locked into their positions for a number of years. Those factors are among the reasons some residency programs across the country are turning toward unionization.

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Anna Yap, MD
Anna Yap, MD

In recent months, physicians at a number of residency programs have voted to unionize. Anna Yap, MD, is an emergency medicine resident at the University of California, Los Angeles, (UCLA), Olive-View Medical Center, and was part of an effort to unionize at UCLA in 2019.

For Dr. Yap, the reasons that residents consider unions  are similar to most other  workers that opt to organize.

“A union is the only real way to make sure you have protections as an employee and have better working conditions,” she argued. “The gains you  gainfrom becoming unionized far outweigh any negatives.”

The AMA has policy on unions in graduate medical education that “strongly advocates for the separation of academic issues from terms of employment in determining negotiable items for labor organizations representing resident physicians.”

Unions, the policy says, should follow the AMA Principles of Medical Ethics, which prohibit “such organizations or any of its members from engaging in any strike by the withholding of essential medical services from patients.”

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Giving residents a voice

Dr. Yap entered residency in 2018. As a member of the AMA House of Delegates, she saw participation in the union as an extension of her work in organized medicine. The importance of union representation was solidified by the COVID-19 experience, she said, noting that residents have been on the front lines of care but were not first to have access to personal protective equipment or lifesaving vaccines.

“When the pandemic hit, we—as residents—felt like we were being exploited,” Dr. Yap said. “It’s damaging when residents can’t speak up or even know how to speak up to leadership and tell them what’s happening and that they don’t feel safe.”

Dr. Yap and her fellow interns at UCLA won benefits when they reached an agreement with the administration, facilitated by the Committee of Interns and Residents, the largest housestaff union in the U.S. and a local of the Service Employees International Union. Those benefits included wage and housing stipend increases.

The Committee of Interns and Residents says it represents more than 20,000 residents and fellows, roughly 15% of physicians in graduate medical education training positions.

Dr. Yap said the resident union movement will keep growing out of necessity.

“We do see residents across the country continuing to collect those signatures [to certify for a union] and say we are going to come together and unionize,” she said.

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“As more residents are unionizing, they are telling their friends and peers,” she added. “That’s the best way to get it done, on that one-to-one level. It’s been amazing to see how active it has been over the past few years.” For her part, Dr. Yap didn’t see any sort of retaliation or retribution associated with joining the union. “Most of the time, it is your big hospital system executives who are against a union,” she said. “It’s not your program director. Your program director’s goal is to make sure you become a good physician and are taken care of in the process. And you are going to make good physicians when you have happy residents, and you are going to have happy residents when they are paid more and cared for more.”

Learn more about the AMA Resident and Fellow Section, which gives voice to—and advocates for—issues that affect resident and fellow physicians.

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