From the Group | Motivations for unionization amongst Stanford resident and fellow physicians

My title is Philip Sossenheimer, and I’m one of many resident physicians who has been organizing with the Stanford Housestaff Union for the previous two years.

The Stanford housestaff organizing committee was invited to current to the School Senate in April to share our motivations round unionization, and likewise to reaffirm our dedication to the connection between housestaff and college. This was a part of a sequence of shows meant to tell the School Senate on this matter, and to that finish Dr. Laurence Katznelson, Affiliate Dean of Graduate Medical Schooling, introduced Stanford Well being Care (SHC) administration’s place on the Senate’s final assembly.

Sadly, solely every week earlier than we have been scheduled to talk, our invitation was rescinded.

Whereas I’m disillusioned within the determination by the School Senate to rescind our invitation, I can’t say that I’m stunned by it. And to a sure diploma I may even perceive it. The Housestaff Union is new to Stanford, and I acknowledge there could also be concern and uncertainty round what meaning for the connection between housestaff and college. I need to be clear that each one of us with the housestaff bargaining committee are dedicated to transparency and ongoing dialogue round these points. We consider school have the best to know our perspective and that by way of this dialog we are able to maintain the Stanford that we love.

To that finish I need to make obtainable the message that we have been planning on sharing on the School Senate, in order that any school member who desires to know our place has the chance to take action.


To grasp our motivations for unionization I feel it’s useful to recollect the origins of our motion. In the course of the vaccine rollout in Dec. 2020 there have been points with the COVID vaccine allocation algorithm. This meant that solely a handful of housestaff have been included within the first wave of vaccinations — regardless of residents carrying a considerable portion of COVID-19 surge burden — and experiencing a few of the most high-risk exposures together with different frontline workers.

From the place we sit now, vaccinated with a number of boosters and with the masks mandate having ended, it could possibly be simple to overlook how excessive the stakes felt on the time, however for these of us engaged on the entrance traces through the surge, being systematically excluded from safety in opposition to the pandemic was exceptionally distressing. No different technology of physicians has skilled in a pandemic to this scale, and our coaching is without end imprinted with the experiences of residing and dealing as trainees in an unprecedented public well being disaster. To say this time interval has been tough for residents and their households doesn’t absolutely encapsulate the stress and pressure of the realities of our collective expertise.

However there have been moments of hope through the pandemic as properly. As a resident physique, we noticed in actual time the ability of collective motion in response to the vaccine rollout. A gaggle of residents organized a lunchtime unity break and by standing collectively in solidarity we have been capable of persuade SHC to reverse course and provide all frontline housestaff vaccinations within the first wave. After that have many residents and fellows started to marvel how else collective motion might enhance working situations and elevate care supply. Inside a 12 months we had launched a unionization marketing campaign and received an election with a super-majority of assist from residents throughout from SHC.

Whereas the vaccine rollout was a catalyst for this effort, it was under no circumstances the principle driver behind unionization. As a substitute, for many people, the rollout was a illustration of the character of medical coaching. It represented the shortage of management we have now over our working situations, our private security and our elevated vulnerability to exploitation.

Workers in different sectors have the power to depart an unsafe work setting. They’ll apply for a brand new job, and so they can leverage their expertise and coaching to barter for a greater contract. For housestaff, that’s not an possibility — we by no means get the chance to individually negotiate our contracts, and if we depart our coaching positions we could by no means have the ability to observe medication. For us, the authorized proper to contract negotiation that unionization affords is likely one of the solely methods we are able to have a voice in our employment situations.

So, why unionize? We unionized as a result of we need to foster a tradition inside medication that empowers people as an alternative of burning them out to maintain physicians within the workforce, a tradition that holds advocacy and self-improvement as an expert worth, as an alternative of prioritizing traditionalism and sociopolitical inertness. We aren’t right here as a result of we dislike our jobs and need to work much less; we’re right here as a result of we love our jobs and wish them to nurture us and foster profession longevity.

We’re unionizing as a result of we care deeply about our applications and need to empower housestaff to profit from their coaching. Burnout amongst resident and fellow physicians continues to be a big challenge, and analysis exhibits that the standard of our working situations can have an effect on the care that our sufferers obtain — even the very best medical doctors don’t carry out as properly when they’re overburdened and fatigued. That’s the reason our union is bargaining for a brand new contract that may assist deal with the basis points that housestaff face. We really feel strongly that residents mustn’t have to routinely sneak meals residence from conferences as a result of their grocery finances is tight. That housestaff ought to have entry to protected transportation residence if they’re too fatigued to drive safely. We consider that housestaff with disabilities ought to have equal entry to name rooms. That lactating moms who’re selecting to come back to work as an alternative of spending time with their newborns ought to have clear areas near their work websites in order that they’ll pump breast milk.

Essentially: we consider that individuals who dedicate the overwhelming majority of their time to SHC ought to have a voice in what their contract seems to be like.

For me personally, the rationale I’ve devoted my very own free time to unionize is as a result of it creates this dialog. Earlier than the union, there was no channel for housestaff to talk immediately with hospital management on an equal footing. Unionization has helped stage the taking part in area between SHC administration and the residents and fellows who’re an integral a part of the SHC enterprise. It’s my honest hope that our union will profit not solely residents and fellows, but additionally program management and departmental management. Nicely-cared-for residents make everybody’s jobs simpler. In my very own program I’ve witnessed the battle to cut back the caps on our companies to make it simpler for residents to attend academic conferences. I can’t assist however marvel how a lot simpler that marketing campaign may need been if there had been a robust housestaff union in place to marketing campaign alongside our program director.

I acknowledge that there could be anxiousness about how it will impression the connection between housestaff and program management. Our union is dedicated to sustaining these relationships. We hope that the presence of a union will strengthen the power of program management to advocate for residents and fellows.

I think about there was numerous dialogue amongst program management across the challenge of “established order protections” so I need to deal with these immediately. Established order refers to a provision within the Nationwide Labor Relations Act which bars an employer from unilaterally altering the phrases and situations of employment which might be obligatory topics of bargaining. The important thing phrase right here is “unilaterally.” Let me be clear: our union unequivocally helps any programmatic modifications which might be meant to profit housestaff and serve affected person care. If any program leaders need to implement modifications to enhance working situations for housestaff — we are going to assist them. Our intention is to not stand in the way in which of progress. The established order simply implies that the hospital can’t make issues more durable or worse; they’ll all the time make issues higher.

The Stanford Housestaff Union is pushed by housestaff, and never by a 3rd get together. We now have partnered with the Committee of Interns and Residents (CIR) to assist signify us as a result of they’ve the information and expertise to assist us discount with a really well-resourced hospital administrative workforce whereas we concurrently proceed to supply affected person care. So let me contact briefly on what CIR is. CIR is the most important housestaff union in the US, representing over 24,000 residents and fellows throughout the nation. It’s a democratically run group, with management composed of elected housestaff from throughout the nation. However in terms of choices made at Stanford, these choices are made by Stanford residents and fellows. So who’re we?

Nicely, we’re the residents and fellows you’re employed with each day! We now have representatives from throughout the spectrum of specialties, and we have now the assist of a supermajority of all housestaff. We’re surgeons, pediatricians and researchers. We’re the primary physicians that sufferers see after they come to this hospital and the final ones they see as they stroll out the door. None of us need our relationship with our school to vary due to this union.

I need to finish by reflecting on the way forward for our career extra broadly, and the way we are able to shield the function of physicians as leaders inside healthcare. Over the previous decade, and particularly over the previous three years, we have now seen a large shift within the relationship between physicians and the well being system we work in. The place physicians used to largely be unbiased, a majority of physicians are actually workers of hospitals or different company entities. Stanford’s personal Dr. Kevin Schulman has written about this challenge, and poses the query of how we are able to, as a career, preserve our skilled independence as we lose our financial independence. These are points that all of us share — residents, fellows, attendings — and I consider that doctor unions, together with resident unions, are a worthwhile a part of the answer. Traditionally physicians have been a reasonably apolitical class, however with the change within the distribution of energy between varied stakeholders in medication I consider physicians have to elevate our political consciousness and stand collectively as a career to advocate for our pursuits and the pursuits of our sufferers. Unionization is just not the one software in our software field, however it’s an efficient intervention for coaching physician-leaders whereas additionally bettering their very own working situations.

So, whereas I’m disillusioned by the Senate eradicating our invitation to talk, I need to decide to persevering with these conversations and stay open to anyone who has questions. I consider the Housestaff Union and program leaders can discover modern methods to enhance the working situations of housestaff and the care that we ship. Our aim is to make Stanford the premier establishment to coach at and to perch it on the high of ranked lists nationwide.

Thanks all a lot for studying.

Philip Sossenheimer is a third-year inner medication resident at Stanford Hospital, and will likely be staying on at Stanford as a fellow in palliative medication. He has been concerned as an organizer for the Stanford Housestaff Union, which is at present negotiating its first contract.