What I wish I knew in residency about collective bargaining

Timothy M. Smith , Contributing News Writer

AMA News Wire

What I wish I knew in residency about collective bargaining

Mar 21, 2024

The question of whether to join a labor union might not be top of mind for many residents, especially if their residency program doesn’t have one, but it’s something that deserves careful consideration. After all, the main purpose of unions—through the process of collective bargaining—is to maintain or improve the conditions of employment, which, in the case of resident physicians, can mean everything from pay and benefits to accessibility of care and patient safety.

Dayna Isaacs, MD, MPH, has a lot to say about collective bargaining. She is a PGY-3 in internal medicine residency program at the University of California, Los Angeles (UCLA), and has been a member of the Committee of Interns and Residents (CIR), the largest housestaff union in the U.S., since her first year. In fact, she joined the bargaining team right away and was later elected to a post as a Southern California regional vice president, representing 30,000-plus members at quarterly in-person national executive board meetings.

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An AMA issue brief (PDF) explores collective bargaining for physicians and physicians-in-training.

“The AMA supports the right of physicians to engage in collective bargaining, and it is AMA policy to work for expansion of the numbers of physicians eligible for that right under federal law,” says the brief. “For example, the AMA supports efforts to narrow the definition of supervisors such that more employed physicians are protected under the National Labor Relations Act.”

In an interview with the AMA, Dr. Isaacs, who also is vice chair of the AMA Resident and Fellow Section’s governing council, detailed what resident physicians should know about the pros and cons of union membership and explained how her residency experience has been affected by collective bargaining.

“The way I got into it was our employment contract was up for renewal,” Dr. Isaacs said. “Right when I started residency, I decided to join the bargaining team, which was made up of 17 residents and fellows who met regularly, about every week or two, with UCLA Health leadership to negotiate a new contract.”

At that point, she and her colleagues were largely trying to build on wins from the previous contract.

Dayna Isaacs, MD, MPH
Dayna Isaacs, MD, MPH

“Things like having your salary keep up with inflation and being able to afford to live in Los Angeles,” she said. “Roughly 50% of my post-tax salary goes just to rent, and even though two and half years later, I’m still paying around this same amount, our new contract allowed me to afford housing near UCLA despite my rent increasing by $700 a month as a result of post-pandemic inflation.”

Pay and benefits are only the most obvious bargaining points. Pretty much anything that affects how valued employees feel is fair game during negotiations.

“That’s where my public health interest comes in because what we do is so vital on a day-to-day basis, and we need to feel valued to provide the best care that we can for our patients,” Dr. Isaacs said, noting that one of the sites where she rotates, Ronald Reagan UCLA Medical Center, has a patient boarding crisis in the emergency department. Another, the West Los Angeles Veterans Affairs (VA) Medical Center, was previously a food desert for resident and fellow physicians working overnight shifts. 

Furthermore, expanding UCLA’s Medi-Cal patient population is of utmost importance for residents and fellows across all departments, and an article aimed at reaching these underserved communities was introduced during bargaining. Through CIR, Dr. Isaacs said, residents and fellows are able to give voice to the biggest and most significant issues impacting their training.

“One of the misconceptions is that if you're active in a union, then you are somehow diametrically opposed to the academic leadership at your hospital. But I’ve found that the union is truly necessary to address some of the structural issues that your program leadership or chief residents cannot,” she said.

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Illustration of resident looking at a diagnostic image

Dr. Isaacs’ union is a local of the Service Employees International Union, which represents about 1.9 million workers in the U.S. and Canada in health care, public services and property services. Residents can join the union at any time, provided their program has a local.

Membership in CIR is 1.5% of Dr. Isaacs’ gross annual salary, which she sees as “an exceptional return on investment.”

“We received a 6% salary increase followed by two years of 5% increases in our latest contract, plus a $1,200 educational stipend per year, so we got much more back than we put in,” Dr. Isaacs noted. “To me, it’s a very wise investment in the greater good. By paying our dues, we're able to achieve a lot for ourselves, our patients and the hospital generally.”

Other recent contract wins by the UCLA CIR local include:

  • $30,000 of coverage for fertility benefits, including surrogacy, with no coinsurance and no deductible.
  • Eight weeks of paid parental leave, up from just four.
  • Affordable campus housing for residents and fellows with families.
  • Full access to Uber Eats at $25 per day and a total of $200 per month at the West L.A. VA Hospital.
  • Expanded access to UCLA Uber Fatigue Mitigation, which now provides unlimited rides to and from the hospital. Rides were previously only available upon completion of a shift.
  • $50,000 per year for the housestaff wellness fund.
  • Arbitration for residents facing discipline.

In addition, Dr. Isaacs said, the benefits tend to grow along with the size of the union.

“When you’re in bargaining for a contract, hospital leadership looks at the union’s membership rate. The larger the membership, the more leverage you have in negotiating,” she said.

“We hold CIR delegate elections for each department on campus, and you can also run for the national board. Plus, we have several local, statewide and national committees throughout the year that work on different issues,” Dr. Isaacs said. “Someone can be as involved as they would like to be. It just depends on where their skills and passions lie.”

Just a few of the roles other than bargaining:

  • Advocacy, including voter registration, lobbying on issues pertinent to trainees, and endorsing candidates.
  • Filing contract grievances.
  • Social media, email communications and leading town hall as well as labor-management meetings.

“CIR has full-time union staff, including organizers, contract negotiators, lawyers, grievance coordinators, political coordinators, accountants, and communications experts, so residents and fellows have a lot of administrative support in running their chapters,” she noted.

The notion of having a role in the union might trigger some anxiety in residents because they spent so many years in school, but they should know that almost everyone is in the same boat, Dr. Isaacs said.

“We encourage as many people to be involved in leadership as possible because we all learn and grow together as we go,” she said. “For instance, I had never negotiated a contract and I didn't know a lot about the labor relations side of medicine, but I jumped into the bargaining team and sharpened my strategic thinking and legal reasoning skills. It was a really rewarding experience.”

In fact, Dr. Isaacs encourages everyone new to residency and new to the union to jump into a leadership role, “because we might not get that opportunity in our attending jobs,” she noted.

Related Coverage

Why more resident physicians are looking to unionize

“The biggest argument I hear for not joining a union is the cost,” Dr. Isaacs said. “Resident salaries are so low, and we're all very worried about money. But I think the dues are such a minuscule amount of money when you look at the grand scheme—in terms of your contract wins and in terms of having a platform to address issues in your hospital at labor management meetings. All those benefits vastly outweigh the cost.”

In addition, “union” is a four-letter word to a sizable chunk of the population.

“Some people are dead set against unions ... and there isn't a whole lot I can say to change their minds,” she said. “I don't hear that a whole lot in Los Angeles, but in other areas of the country that sentiment might be more common. You just have to keep working for what you think is right to collectively change the culture of medicine and provide the best patient care possible.”

To learn more, watch the webinar, “Understanding Collective Bargaining for Physicians: An Expert Perspective,” hosted by the AMA Organized Medical Staff Section, which examines the risks and benefits of collective bargaining for physicians in today's health care environment.