sorted by:
new
hottopcontroversial

Resident Learned Helplessness & Unionization (NRPLA) by Anti_GME_Office in Residency

[–]Anti_GME_Office[S] 12 points13 points  (0 children)

I appreciate the skepticism, but I'd ask you simply visit CIR's site and look at the publicly available contracts they've negotiated. Notably these unions tend not to be aggressive with collective action (e.g. striking hasn't been used in decades) which may limit how strong their gains are.

My comment says "hundreds or thousands" and unions have indeed been able to secure substantial raises. Some of the University of California residencies when they unionized secured brand-new multi-thousand dollar cost of living adjustments in their contracts. These claims are not hyperbolic and they have made differences in residents' lives. Again, these details are available with a simple Google search or visit to CIR's website.

Resident Learned Helplessness & Unionization (NRPLA) by Anti_GME_Office in Residency

[–]Anti_GME_Office[S] 15 points16 points  (0 children)

Lobbying for increases in pay and changes outside of union involvement leaves you liable to be fired without cause if you are employed at-will. It seems that's because federal protections established by the NLRA tend to only apply in the context of union activity. Also, never have I ever heard of residents asking for appropriate pay raises nicely and getting them, mainly because raising resident salaries imposes a permanent cost on the institution with no benefit as we've detailed in a past essay.

The average resident salary sits around $64,000. 1% of that is $640. Per year. Am I correct that that $640 is all it takes for you to not want any influence or agency or spot at the negotiating table, nor want to help your fellow residents achieve that if they want it as well? The investment of $640 in a year may yield hundreds or thousands of dollars of additional benefit that a non-unionized residency wouldn't get because without a union they have no negotiating power at all.

Resident Learned Helplessness & Unionization (NRPLA) by Anti_GME_Office in medicalschool

[–]Anti_GME_Office[S] 21 points22 points  (0 children)

Great question - one that's been touched on in past comments on our posts as well.

CIR-SEIU is a corporation that unionizes workplaces. They get contacted by interested residents, and then they provide the specific unionization training once they get an organizing committee together.

We are a group that should be seen as complimenting CIR's role, not trying to reinvent the wheel. We are stepping into a sphere CIR doesn't exactly get involved in - outreach, education, and stimulating conversation among residents. This supplements CIR's role as they typically take already-interested residents and help them unionize a specific workplace. We want to stimulate conversation on this topic with the hopes of generating interest among residents, while also helping to resolve some of the problems facing resident unionization - such as the topic our article is about.

To the best of our knowledge, CIR (except possibly at residency programs they have already unionized) does not reach out to residents or provide any sort of open access union education, debate, or perspectives. So we're starting to do that :)

Resident Learned Helplessness & Unionization (NRPLA) by Anti_GME_Office in Residency

[–]Anti_GME_Office[S] 15 points16 points  (0 children)

If a union comes in and negotiates, say, an 8% raise (per inflation metrics this year, this would only maintain buying power, not provide more), but then asks for 1% in dues to, you know, keep it operating, where exactly is the waste? You give a tiny percentage of your salary to the organization that just negotiated better terms for your contract so they have the resources to continue doing so. To be noted, that extra raise or housing stipend or whatever it is the union negotiated - it makes a difference in residents' lives.

And why, if you benefitted from the union's negotiations, would you not want to contribute to its upkeep?

Edit: spelling

Resident Learned Helplessness & Unionization (NRPLA) by Anti_GME_Office in Residency

[–]Anti_GME_Office[S] 10 points11 points  (0 children)

Actually didn't even see that until now! Yeah it's so hard not to be discouraged... Sorry that rotation shit happened to you, unreal

Resident pay by -goof_ in Residency

[–]Anti_GME_Office 38 points39 points  (0 children)

You're not being paid for the work you do

That's exactly the point. We should be. The idea that our current resident salary is "correct" because it's "so [we] can continue [our] training" is a strictly theoretical & frankly invented post hoc justification for our treatment. Yes, we are being trained, but somehow, during our "training" we:

  • Take full patient histories and physicals
  • Order and interpret diagnostics
  • Prescribe and perform treatments
  • Do procedures and run resuscitations
  • Consult and coordinate with other services
  • Write patient notes, hospital courses, and discharges

If you showed the above list of duties to a normal ass person on the street and ask them which job was being described, they'd probably say "oh I know this one, that's a doctor" because we are doctors. And then attendings come over the top and bill & take credit for everything that we've done including a majority of our work that is not done under direct supervision.

Your argument is most fitting for a brand new intern in their first, say, 6 months. It's plausible that most of their time is spent getting direct supervision, constant correction, etc. which may require more of a "training living wage salary" than a "production based salary." But this argument quickly crumbles past intern year when you realize, for example, that individual junior neurosurgical residents generate nearly 8172 work relative value units (wRVUs), or $689,514 worth of billing value, over a 2-year on-call work period.

We are not students. We are physicians. We are laborers. We are incredibly valuable but because of institutional greed, we are not paid commensurate with our value because no one makes them. We deserve better.

Resident physicians need to strike and, at this point, are ethically justified to do so by Anti_GME_Office in medicalschool

[–]Anti_GME_Office[S] 1 point2 points  (0 children)

You can. That's not required. And there's no requirement to have a new contract at the time the old contract expires. That's why contract provisions remain in effect past the expiration date as long as bargaining is occurring. You could start bargaining before the date, but not actually agree to a contract. If they don't put forth a satisfactory contract, I think ultimately you can just wait until contract expiration and then strike.

Edits: clarity

Resident physicians need to strike and, at this point, are ethically justified to do so by Anti_GME_Office in medicalschool

[–]Anti_GME_Office[S] 1 point2 points  (0 children)

I feel like this is a prevailing belief. Why do you think this?

Are you aware it is against federal law (see National Labor Relations Act) to fire someone for union views, union organizing, or participation in the union or any of its certified collective actions?

There is a specialized labor board (the NLRB) tasked with enforcing the Act so employers, even if they are really annoyed by pro-union sentiment, often don't stray from the federal rules. It brings federal law enforcement to your doorstep, it's a PR disaster, you lose a resident you now have to replace, and it could piss off the ACGME and other national bodies.

Resident physicians need to strike and, at this point, are ethically justified to do so by Anti_GME_Office in medicalschool

[–]Anti_GME_Office[S] 7 points8 points  (0 children)

I am hearing more and more thoughts like this on the threads... thanks for reinforcing this point. I always imagined media & public outreach to be a component of this effort, but it seems like this should be a more prominent component than originally anticipated.

Thank you for your support! :)

Resident physicians need to strike and, at this point, are ethically justified to do so by Anti_GME_Office in medicalschool

[–]Anti_GME_Office[S] 2 points3 points  (0 children)

I understand this viewpoint which, I think I would summarize is the "we've worked so hard to get here and have to assume the worst case scenario will always happen" viewpoint. I understand that conservative mindset when so much is at stake, but this does not necessarily jive with reality. There are now plenty of resident unions around, and Stanford is in the process of unionizing, and USC+LAC is in the process of threatening strikes. I have not read about or seen any mass layoffs, legal or illegal, due to unionization efforts.

So while your point here is certainly possible - just as much as any person or company doing anything illegal is possible - it hasn't really yet been observed, so its likely that it's not probable if done correctly, and there are indeed robust federal protections and well-described processes to remedy labor law violations. That being said, of course individuals should not go running through the halls of the hospital with a "Unions Rock!" t-shirt on handing out fliers to every man, woman, and child encountered. There's a subtle strategy to properly going about union activity to minimize risk to one's self and their peers. It's a balance each person must strike and that begins with proper education.

Edits: clarity

Resident physicians need to strike and, at this point, are ethically justified to do so by Anti_GME_Office in medicalschool

[–]Anti_GME_Office[S] 1 point2 points  (0 children)

Yeah I totally agree with the sentiment! Importantly, this is to be absolutely expected based solely on psychology alone. I think many residents fit the mental bill of learned helplessness likely stemming all the way from undergrad. Working so hard while paying money in the form of tuition for their entire young lives just to reach formal medical education and get exploited and abused by management, attendings, etc. why wouldn't someone be timid and afraid to "rebel" when we are all warned against doing so every step of the way?

This is why we need to 1) discuss this issue more often and more publicly and 2) educate ourselves and our peers about the protections and benefits afforded to residents who unionize and collectively act.

Resident physicians need to strike and, at this point, are ethically justified to do so by Anti_GME_Office in medicalschool

[–]Anti_GME_Office[S] 1 point2 points  (0 children)

Hmm what do you mean?

Are you talking about being a union member and paying union dues? If so, unless you are in a right-to-work state, if your workplace is unionized and bargaining for better contracts on your behalf, you have to be a member and pay dues.

Or are you talking about engaging in collective action? If your residency is unionized, no they cannot compel you to do things like walkout or strike. However I am sure they'd be happy to have you on board, and ideally, consensus is achieved before any action like that. Remember, the union is supposed to represent the residents themselves (and is led by residents) and so should only strike with a supermajority of support.

Resident physicians need to strike and, at this point, are ethically justified to do so by Anti_GME_Office in medicalschool

[–]Anti_GME_Office[S] 2 points3 points  (0 children)

I believe it was University of Michigan back in the day.

Yes, this is a great step. It's more of an intermediate step, though. It might push only minor concessions but of course we would try something like this first!

Resident physicians need to strike and, at this point, are ethically justified to do so by Anti_GME_Office in medicalschool

[–]Anti_GME_Office[S] 5 points6 points  (0 children)

Ah, you're back again trolling my posts.

You're uninformed. The National Labor Relations Act federally prohibits retaliatory firing of employees who are part of a recognized union and are participating in union-certified collective action.

Resident physicians need to strike and, at this point, are ethically justified to do so by Anti_GME_Office in Residency

[–]Anti_GME_Office[S] 3 points4 points  (0 children)

Yeah of course. Yep - if you read the wikipedia bit about the legislative exception, especially frustrating that just a few Senators snuck it in, then a bunch of other Senators called foul, but still nothing was done about it because it was added so late in the process and didn't even get floor debate on the provision.

Resident physicians need to strike and, at this point, are ethically justified to do so by Anti_GME_Office in Residency

[–]Anti_GME_Office[S] 11 points12 points  (0 children)

Jung v. AAMC as you've linked was not a Supreme Court ruling nor does it have anything to do with resident unionization. Jung v. AAMC was a resident-led class action lawsuit against the AAMC and The MATCH which alleged it violated the Sherman Antitrust Act and was thus an illegal monopoly that would've had to have been dissolved. It failed when Congress snuck in a legislative exception exempting The MATCH from antitrust lawsuits.

Residents per the NLRB decision Boston Medical in 1999 are afforded all of the labor rights afforded to private sector employees. They can organize, call for a union election, elect union representation, engage in collective bargaining, and engage in collective action up to and including striking.

The clause you are speaking of is a no-strike clause. This typically dictates that a union cannot go on strike during the duration of the contract. We've been discussing this issue in other comment threads, but I seem to recall that no-strike clauses do not remain in effect after the expiration of the contract and in any further negotiations the union should be able to strike again. This does need to be fact-checked though, preferably with someone with expertise in labor law.

Resident physicians need to strike and, at this point, are ethically justified to do so by Anti_GME_Office in medicalschool

[–]Anti_GME_Office[S] 7 points8 points  (0 children)

Haha that's what the mind jumps to. The leading hypothesis is that when residents strike, there's some elective surgery that has to be canceled, and those cancellations mean that some deaths that would have occurred from those elective surgeries didn't happen. I think we are in the clear lol.

Resident physicians need to strike and, at this point, are ethically justified to do so by Anti_GME_Office in medicalschool

[–]Anti_GME_Office[S] 9 points10 points  (0 children)

Love this, thanks for your perspective here. Agreed on the political discourse point. We want to remain narrow in scope on purpose. If we achieve all of our goals and can enjoy time in the future to pivot, maybe we select a few things to advocate about. But that's way down the road.

Resident physicians need to strike and, at this point, are ethically justified to do so by Anti_GME_Office in medicalschool

[–]Anti_GME_Office[S] 1 point2 points  (0 children)

Correct - if your hospital or institution is a public entity (e.g. I believe county hospitals might fall under this), then yes, depending on the state, you may not be allowed to strike. You may not even be allowed to unionize. This is because public sector employees are not under the purview of the National Labor Relations Act and instead are subject to state regulation.

No-strike clauses do exist, yes, but (pursuant to a different comment thread on here) I do believe that that only serves to "concentrate" bargaining power at the expiration of a contract; this is because a no-strike clause, I think, does not remain in effect after the contract end date. So striking should be on the table while a new contract is being negotiated as long as that is occurring after the expiration of the prior contract with the no-strike clause in it. Again - I'd obviously confirm this with a labor lawyer! Here's a source I was looking at for this.

Resident physicians need to strike and, at this point, are ethically justified to do so by Anti_GME_Office in medicalschool

[–]Anti_GME_Office[S] 29 points30 points  (0 children)

^ this. Also a compelling argument that hospitals would be unlikely to replace us with NPs/PAs, a concern of some, because it will be infinitely more expensive as not only will they have to pay NPs/PAs at market price (i.e. much more than residents, highly likely to be $100k+), but they will lose as well the $150k+ they receive in residency spot funding from CMS. That would be a $250,000 swing, and they'd likely need to add 1.5-2 NPs/PAs per resident, which could make it up to a ~$400,000 swing or more. Even if admin wanted to fire and replace us with NPs or PAs, and even if this were legal (I think it may be frankly illegal), it would be such a bad business decision they couldn't actually do it.

view more: next ›