Medical associations are good for your health

To move between hospital buildings and see her patients, Dr. Carmen Kilpatrick had to be pushed around in a wheelchair by her colleagues. Kilpatrick, a second-year psychiatry resident at UC San Francisco and a first-time mother-to-be, was expecting twins. The twins’ position put Kilpatrick at risk for premature labor, and her obstetrician advised against standing 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 is absolutely not enough time.’ I was very, very worried,” Kilpatrick recalled. So she turned to her union at UCSF for help.

Working long hours with few benefits and little pay has long been the standard for doctors in training. These include interns, residents and fellows, who are called “house staff” in 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 put up 28-hour shifts caring for patients, only to find respite for a few hours in a small apartment that costs most of their income. The average starting salary for housekeepers is $60,942 nationally, and they can spend up to a decade out of medical school in these conditions. Over 60 per cent of the house’s employees experience burnout related to working conditions, and several have committed suicide.

Tired and horrified, especially after the Covid-19 pandemic, domestic workers across the US are now banding together to collectively bargain for greater benefits. In the past two years, at least nine hospitals have joined, with California and New York leading the way. The largest domestic worker union in the country, the Committee of Interns and Residents (CIR), has grown in membership by over 40 percent since the start of the pandemic in 2019, representing over 24,000 domestic workers.

Can employee unions be effective?

Simply forming a trade union is no easy task. Unionization laws vary by US state and whether a hospital is public or private. In some states, it is illegal for domestic workers to form a union. Where legal, most hospitals do not recognize unions when they are first formed. Domestic workers’ unions must then appeal to the National Labor Relations Board for a formal election. This was the case at Montefiore Medical Center, which held its election at the end of February this year, and voted overwhelmingly for unionization. House staff at the University of Pennsylvania recently called for an election.

Even after a union is formed, change is by no means guaranteed. The union must still negotiate productively with the hospital to achieve gains codified in a contract. Hospitals can avoid negotiations, share feelings described by Dr. Jordan J. Cohen in New England Journal of Medicine. President of the Association of American Medical Colleges at the time of writing, Cohen argued against house staff unions, feeling they were unnecessary because house staff can communicate feedback to hospitals in other ways. In fact, he wrote, unions are harmful because they can create strife between house staff and the hospital that can erode trust in the population.

So many are asking: Can the current growth in domestic worker unions lead to meaningful changes in the health care system?

The answer is yes. At a time when business incentives from large hospital systems increasingly dictate how medical care is practiced, unions can give a voice to the house staff who actually provide that care. An examination of the concrete changes achieved by one of the more active unions in the house at UCSF, where I am a fellow, shows exactly how.

Staff Unions and the Success at UCSF

Historically, the success of domestic worker unions in the United States has been in line 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 out of the Great Depression. Following the passage of the National Labor Relations Act, private sector employees earned the right to unionize. A group of medical interns in their first year of clinical training lobbied for many of the same requests made by House staff today: reasonable 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 formed in 1957 and negotiated the country’s first collective agreement for domestic workers in New York City. Since then, the union has expanded to represent approximately 15 percent of House employees across the country. Now is a fervent time for unionization across labor sectors, from Amazon warehouse workers to Starbucks baristas, with 71 percent of Americans supporting unions. Domestic workers’ unions are no exception to this national trend.

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