To move between hospital buildings and see her patients, Dr. Carmen Kilpatrick had to be pushed in a wheelchair by her colleagues. Kilpatrick, a second-year psychiatry student at UC San Francisco and first-time mom-to-be, was expecting twins. The position of the twins put Kilpatrick at risk of premature labor, and her obstetrician advised her not to stand for more than a few minutes. The risk eventually became so high that she started her four weeks of paid maternity leave early.
“I thought to myself, ‘This time is absolutely not enough.’ I was very, very worried,” Kilpatrick recalled. So she reached out to her union at UCSF for help.
Working long hours with few benefits and little pay has long been the norm for trainee doctors. These include interns, residents and fellows, who are called “house staff” at the hospital. These are the doctors who, in many hospitals, are the first to meet you and spend the most time at your bedside. They regularly stay up for 28-hour shifts caring for patients, only to find respite for a few hours in a small apartment that costs most of their earnings. The average starting salary for house staff is $60,942 nationally, and they can spend up to a decade out of medical school under these circumstances. Over 60 percent of home staff experience burnout due to working conditions and several have committed suicide.
Tired and frustrated, especially after the Covid-19 pandemic, house staff across the United States are now unionizing to collectively bargain for greater benefits. In the past two years, at least nine hospitals have unionized, with California and New York leading the way. The largest home staff union in the country, the Committee of Practices and Residents (CIR), has grown in membership by over 40 percent since the start of the pandemic in 2019 and represents over 24,000 home staff members.
Can staff unions be effective?
Simply creating a union is not an easy task. Unionization laws vary by state in the US and by whether a hospital is public or private. In some states, it is illegal for house staff to even form a union. Where legal, most hospitals do not recognize unions when they are first established. Corps staff unions must then appeal to the National Labor Relations Board for a formal election. This is what happened at Montefiore Medical Center, which held its election in late February of this year, voting overwhelmingly in favor of unionization. The house staff at the University of Pennsylvania recently called for an election.
Even after a union is created, change is by no means guaranteed. The union still needs to negotiate productively with the hospital to win any profits codified in the contract. Hospitals can avoid negotiations, sharing sentiments described by Dr. Jordan J. Cohen in The New England Journal of Medicine. The President of the Association of American Medical Colleges at the time of writing, Cohen argued against housestaff unions, arguing that they were unnecessary because housestaff can communicate feedback to hospitals in other ways. In fact, he wrote, unions are harmful because they can create strife between home and hospital staff that can erode public trust.
So many are wondering: Can the current growth of house staff unions bring about meaningful changes in health care?
The answer is yes. At a time when the business incentives of large hospital systems increasingly dictate how medical care is delivered, unions can give a voice to the front-of-house staff who actually provide that care. An examination of the tangible changes achieved by one of the most active staff unions at UCSF, where I am a fellow, shows just how.
Staff Unions and Success at UCSF
Historically, the success of domestic worker unions in the US has closely aligned with the country’s fluctuating politics and economy. The first domestic workers’ union was formed in the early 1930s, when US President Franklin D. Roosevelt enacted the New Deal to stimulate the economy from the Great Depression. After the passage of the National Labor Relations Act, private sector workers won the right to unionize. A group of interns in their first year of clinical training lobbied for many of the same demands of house staff today: reasonable work hours, more educational conferences, and the elimination of discriminatory practices in medical education.
But in the early 1950s, in the more conservative political climate marked by McCarthyism, the organization disbanded amid allegations of subversive communist ties. CIR was founded in 1957 and negotiated the nation’s first collective bargaining agreement for domestic workers in New York. Since then, the union has expanded to represent about 15 percent of home staff nationwide. Now is a fervent time for unionization across all labor sectors, from Amazon warehouse workers to Starbucks baristas, with 71 percent of Americans supporting labor unions. Housekeeping unions are no exception to this national trend.