Resident and fellow physicians at San Francisco-based California Pacific Medical Center (CPMC) hospitals announced plans to unionize Tuesday, citing grueling shifts and a culture of overwork exacerbated by pandemic conditions and a local opioid crisis.
“Residents are seen as this unlimited resource that hospitals can tap for whatever they need,” said Dani Golomb, a second-year psychiatry resident. “We don't really have any say, in terms of how we work, where we work and what that's going to look like—even though we are essential to the hospital running.”
Golomb says that she and her peers are organizing in order to gain more representation and bargaining power, as they seek to negotiate better pay, benefits and more flexible work arrangements—all with the goal of improving physician well-being and patient care.
Residents and fellows are newly minted physicians who work at teaching hospitals for anywhere from three to seven years, sometimes more depending on their specialty. Referred to as the hospital “house staff,” they often make less $18 an hour despite taking on a disproportionate share of work.
CPMC residents say they’re frequently asked to work 80-hour weeks, compromising their own health and well-being, as well as the safety and care for patients at some of SF’s oldest medical centers.
Resident physicians started organizing in May last year, and the hospital system’s roughly 120-member house staff reached a supermajority vote to formally unionize this month. The union will include residents and fellows at Sutter Health’s four SF CPMC hospitals, all located in the city’s downtown corridor.
CPMC union members will join the Committee of Interns and Residents (CIR/SEIU), the largest house-staff union in the nation representing 22,000 resident and fellow physicians.
Demanding Increased Representation, Change in Culture
While forming a union will help CPMC residents and fellows continue to negotiate for better pay and benefits, organizers say the overarching goal of their efforts is to give resident physicians a space at the table to voice concerns and gain better representation.
“It’s a lot about dignity in the workplace and having a say in the conditions that you work in,” said Eric Kalis, a first-year psychiatry resident on the union’s organizing committee. “Particularly for a lot of those medical residents, we don't get a whole lot of say in where we go for residency or on your working conditions.”
It’s not just the pandemic or the local opioid crisis that have caused exhausting work conditions; residents say that the medical field has long fostered a culture of overwork that defended long shifts and tough work conditions as a necessary part of the job.
Until 2003, there was no cap on the number of hours resident physicians could work in a week, nor a limit to how long a shift could last. An entire generation of physicians was raised under these circumstances, which CPMC residents say is part of why many older medical professionals may have been reluctant to unionize or recognize the need for one today.
“There's this idea that you kind of just have to put up with the way things are, just because that's how they were,” Kalis said. “The culture of medicine is like, it's supposed to be awful—but it really doesn't have to be that way. We should all advocate for ourselves, and then the people after us will have an improved quality of life. At the end of the day, isn't that what a lot of us got into medicine in the first place? To improve the quality of life for others?”
Now, national regulations require teaching hospitals to cap work weeks at 80 hours, with no single shift extending past 24 hours. The problem with this? CPMC residents frequently hit the 80-hour weekly cap, and rarely ever work a week with less than 50 hours on the clock. Pandemic conditions have only extended shifts and spread hospital staff thin, heightening the intensity and trauma of providing nonstop patient care.
It’s not just physician well-being that’s affected by overwork conditions; numerous studies have found that long hours and sleep deprivation can adversely effect patient care.
“We care about our patients, we love working with them, but we can do our best when we're feeling well-rested and well-supported,” Golomb said. “This really is about everyone being more supported and getting better care, whether you're a patient, whether you're a resident, whether you're an attending physician. It's really just about improving conditions for everybody.”
On average, medical residents make $60,942 per year, according to 2022 Association of American Medical Colleges estimates. Though post-residency salaries are cushy, many medical residents are saddled with hundreds of thousands of dollars of medical school debt. Low residency salaries can make it particularly difficult and prohibitive for low-income or first-generation physicians, who may not have as many financial resources to afford the long road of medical training.
Last summer, CPMC residents received a small raise and increased benefits from Sutter Health, in an effort by the hospital to recognize the increased toll the pandemic had on house-staff working conditions. Organizers say they hope they can continue to work with Sutter Health to prioritize physician well-being.
"We believe that working directly with our employees, without the involvement of a labor union, creates the best relationship with our team members as we work together to care for our patients," wrote a Sutter spokesperson in a statement. "If employees seek representation by a union, we will respect their right to choose in a secret ballot election, share our perspectives and hope they will vote to continue working directly with management.”
A Rising Medical Residency Labor Movement
CPMC’s union is the latest to join a growing labor movement among house staff at hospitals across the country.
“There's been this resurgence of the labor movement in the past few years, and one of the places where that's been happening is in residency programs across the country,” said Golomb. “Residents at CPMC have wanted to unionize for a long time, but we were kind of unable to do so during the Trump Administration because of the unfriendliness of the labor board.”
More than 3,500 residents and fellows chose to join CIR/SEIU within the last eight months, including house staff at Stanford Health Care. Residents at UCSF Medical Center are already unionized under CIR/SEIU, and over 200 nurses at Sutter Health hospitals protested outside the CPMC Van Ness hospital last April, demanding better safety protections.
Though many residents and first-year interns at CPMC may only be at the hospitals for a few short years, organizers hope that by forming this union they can help improve conditions for future physicians—and for the patients they serve.
“A lot of people see the institution of medicine as this very well-formed, hearty beast that can't be moved,” Golomb said. “Our generation is really excited about the possibility of making things better for those who come after us. And I think that that's really exciting, being able to influence change in a positive direction for medical training.”