Medical residents and fellows at the state’s largest health system are preparing to unionize, frustrated that their salaries have not kept pace with the rising costs of housing and child care. If successful, the effort would create one of the largest unions of medical residents and fellows in the country, part of a wave of such unionizations.
More than 2,500 residents and fellows at multiple Mass General Brigham hospitals would join the Committee of Interns and Residents, or CIR, at the Service Employees International Union, including trainees at Massachusetts General Hospital, Brigham and Women’s Hospital, Mass Eye and Ear, Newton-Wellesley Hospital, Salem Hospital, and Spaulding Rehabilitation Hospital Boston.
Organizers say they hope to file paperwork and hold an election to solidify the union before the end of the academic year in June.
Representatives from CIR-SEIU said its membership has ballooned by more than 50 percent since 2020, to 25,000 members, as the pandemic put unprecedented strain on hospital staff. The union added 4,700 members in the last 11 months alone. Membership currently includes Stanford Health Care, University of California, San Francisco Medical Center, Montefiore Medical Center in New York, and Children’s National Medical Center in Washington, D.C.
In Massachusetts, Boston Medical Center and Cambridge Health Alliance have been unionized for several years.
“We were happy to step up in the context of the pandemic to care for patients, to go above and beyond and practice outside our usual areas of practice,” said Dr. Kayty Himmelstein, a second-year infectious disease fellow at both MGH and the Brigham. “What we expected was to be treated with dignity and compensated fairly and haven’t always had that experience.”
The health system has pushed back against unionization, saying it offers competitive salaries and robust benefits. Residents and fellows also report that program directors have held individual meetings with them to discourage the effort.
In a statement, Dr. Paul Anderson, interim chief academic officer of Mass General Brigham, said, “Mass General Brigham is home to some of the top-ranked and highest-paid residency programs in the country. … Though health care is facing unprecedented challenges, Mass General Brigham remains committed to the lifelong advancement of our medical trainees and working directly together to continuously improve our educational programs.”
The unionization would focus on doctors in the post-medical school training period, which includes an initial residency that lasts between three and seven years, depending on specialty. A fellowship follows residency for some doctors and lasts from one to about three years.
The work is grueling, with hours that stretch to 80 a week, and some residents say they are sometimes pressured to underreport their hours and work even more. The first formal residency programs required trainees to live in the hospital, which is how the term “resident” was coined. Given that history and their long hours, residents and fellows are collectively referred to as “house staff.”
Some say training for doctors has become even longer, as more choose to sub-specialize in certain fields, including within surgery. And the work itself has become more taxing, some residents say, due to the demands of more intensive documentation for billing purposes and dealing with sicker and more complicated patients.
COVID-19 exacerbated stress levels for many, pushing trainees onto the front lines of the pandemic, sometimes in areas with little relevance to their specialty.
“They didn’t have a lot of power in their employment relationship,” said Annie Della Fera, lead communications coordinator with CIR-SEIU. “These are ongoing issues, but during COVID, they realized the impact that it had on their lives and how little control they had.”
Other issues, too, have become magnified, organizers said. Because residents and fellows must work such long hours, they often have to live close to the hospital. Those costs in one of the country’s most expensive cities for renters have become untenable.
“House staff struggle to make ends meet,” Himmelstein said. “I know colleagues who at the end of the month rely on free hospital snacks to make it to their next paycheck.”
Child care costs are also a concern, residents say, given the need to find up to 80 hours a week of such services. Many delay having children because of the costs, but the health system does not provide robust fertility preservation benefits or supports for adoption or surrogacy, Himmelstein said. The baseline costs mean that staff must have the means or support outside of work in order to focus on their training, creating an equity issue.
The health system recently announced it would provide 10 percent raises and $10,000 stipends to residents and fellows to accommodate the rising costs of living. The system said the increase was part of larger salary adjustments it began last year.
However union organizers say that such increases only came months after the health system initially proposed a 2.5 percent raise and were a result of the unionization campaign.
MGB has also said it provides a parental leave policy that goes beyond state requirements and noted the recent stipend was intended to assist with child care costs.
Mass General Brigham says the average salary for residents in their first, second, or third years is more than $80,000 — which hospital officials have noted is higher than many other Boston hospitals as well as those in such expensive cities as San Francisco and New York. Yet residents say those figures are misleading, because the system did not compare salaries at all institutions for the same year and did not factor in benefits such as retirement matches.
Staff also say they have concerns about working conditions, due to their uncompromising hours. Himmelstein said she’s known colleagues who have required thousands of dollars of dental work at the end of their training, because they were not able to take time off even for teeth cleanings. Pregnant colleagues have missed prenatal appointments, unable to find someone to cover their shifts.
“In order for us to take good care of our patients, we also need to be in good health,” she said.
The health system has pointed out that trainees receive four weeks of vacation per year.
Dr. Pietro Miozzo, a third-year pediatrics resident physician at Massachusetts General Hospital, said before the unionization work, the hospital did not contribute to retirement benefits. Even now it only contributes 2 percent of a resident’s salary toward retirement, but some want the hospital to give more by matching doctors’ own contributions. Others have voiced a desire for patient-care funds that doctors can use to help their patients afford devices like hearing aids.
House staff at MGB have been whispering about unionization for years, a difficult task as residents and fellows rely on their program directors for letters of recommendation and jobs.
Organizers say program directors have started holding individual meetings with residents and fellows to discourage the union, with some suggesting that doctors could lose funding for protective equipment under a union, such as lead gowns to protect against radiation.
Residents and fellows also recently received an “open letter” signed by dozens of department chairs at the two flagship hospitals, Mass. General and Brigham and Women’s, celebrating the recent pay increases and suggesting that the groups “move beyond” questions about unionization to “focus all our available energy on our educational programs and see what more we can achieve by working together.”
The health system contends it is sharing factual information so residents and fellows know what a union can and cannot guarantee. System spokespeople added that the organization has worked to better coordinate program needs for its doctors-in-training, forming a system last year to bring together different parts of their work and to focus on trainees’ well-being.
Residents and fellows suggest that the responses are exactly why a union is needed.
“To get a message like this, to say they want to hear our questions, after feeling like we haven’t been listened to or had those questions answered makes me feel even more that [a union] is the answer and way to advocate for our needs,” said Miozzo.
Miozzo said he hopes a successful unionization campaign inspires others.
Unionizing “would set a powerful precedent for other programs in other places, and maybe other employees throughout MGB,” he said.