From the Neighborhood | 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.

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

Sadly, solely per week earlier than we had been scheduled to talk, our invitation was rescinded.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 shocked 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 worry and uncertainty round what meaning for the connection between housestaff and college. I need to be clear that every one of us with the housestaff bargaining committee are dedicated to transparency and ongoing dialogue round these points. We imagine college have the correct to know our perspective and that by this dialog we will maintain the Stanford that we love.

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

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To grasp our motivations for unionization I believe 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 had been included within the first wave of vaccinations — regardless of residents carrying a considerable portion of COVID-19 surge burden — and experiencing a number of the most high-risk exposures together with different frontline employees.

From the place we sit now, vaccinated with a number of boosters and with the masks mandate having ended, it might be straightforward to neglect how excessive the stakes felt on the time, however for these of us engaged on the entrance traces throughout the surge, being systematically excluded from safety towards the pandemic was exceptionally distressing. No different era of physicians has educated in a pandemic to this scale, and our coaching is eternally imprinted with the experiences of residing and dealing as trainees in an unprecedented public well being disaster. To say this time interval has been troublesome for residents and their households doesn’t totally encapsulate the stress and pressure of the realities of our collective expertise.

However there have been moments of hope throughout the pandemic as effectively. As a resident physique, we noticed in actual time the ability of collective motion in response to the vaccine rollout. A bunch of residents organized a lunchtime unity break and by standing collectively in solidarity we had 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 circumstances and elevate care supply. Inside a 12 months we had launched a unionization marketing campaign and gained an election with a super-majority of help 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 dearth of management now we have over our working circumstances, our private security and our elevated vulnerability to exploitation.

Staff in different sectors have the flexibility to depart an unsafe work surroundings. 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 be capable to apply medication. For us, the authorized proper to contract negotiation that unionization affords is among the solely methods we will have a voice in our employment circumstances.

So, why unionize? We unionized as a result of we need to foster a tradition inside medication that empowers people as a substitute of burning them out to maintain physicians within the workforce, a tradition that holds advocacy and self-improvement as an expert worth, as a substitute of prioritizing traditionalism and sociopolitical inertness. We’re not 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 need 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 take advantage of their coaching. Burnout amongst resident and fellow physicians continues to be a major challenge, and analysis reveals that the standard of our working circumstances can have an effect on the care that our sufferers obtain — even one of the best medical doctors don’t carry out as effectively when they’re overburdened and fatigued. That’s the reason our union is bargaining for a brand new contract that may assist tackle the basis points that housestaff face. We really feel strongly that residents shouldn’t must routinely sneak meals dwelling from conferences as a result of their grocery funds is tight. That housestaff ought to have entry to protected transportation dwelling if they’re too fatigued to drive safely. We imagine that housestaff with disabilities ought to have equal entry to name rooms. That lactating moms who’re selecting to come back to work as a substitute of spending time with their newborns ought to have clear areas near their work websites in order that they’ll pump breast milk.

Basically: we imagine that individuals who dedicate the overwhelming majority of their time to SHC ought to have a voice in what their contract appears 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 enjoying discipline 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. Effectively-cared-for residents make everybody’s jobs simpler. In my very own program I’ve witnessed the battle to scale back the caps on our providers to make it simpler for residents to attend instructional 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 affect 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 flexibility of program management to advocate for residents and fellows.

I think about there was numerous dialogue amongst program management across the challenge of “establishment protections” so I need to tackle these immediately. Established order refers to a provision within the Nationwide Labor Relations Act which bars an employer from unilaterally altering the phrases and circumstances of employment which might be necessary 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 supposed to profit housestaff and serve affected person care. If any program leaders need to implement modifications to enhance working circumstances for housestaff — we’ll help 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 at all times make issues higher.

The Stanford Housestaff Union is pushed by housestaff, and never by a 3rd occasion. We’ve got partnered with the Committee of Interns and Residents (CIR) to assist symbolize us as a result of they’ve the data and expertise to assist us cut price 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 america, 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 relating to selections made at Stanford, these selections are made by Stanford residents and fellows. So who’re we?

Effectively, we’re the residents and fellows you’re employed with each day! We’ve got representatives from throughout the spectrum of specialties, and now we have the help 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 college to alter due to this union.

I need to finish by reflecting on the way forward for our career extra broadly, and the way we will shield the function of physicians as leaders inside healthcare. Over the previous decade, and particularly over the previous three years, now we have seen an enormous 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 at the moment are staff of hospitals or different company entities. Stanford’s personal Dr. Kevin Schulman has written about this challenge, and poses the query of how we will, 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 imagine that doctor unions, together with resident unions, are a useful 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 imagine physicians must 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 instrument in our instrument field, however it’s an efficient intervention for coaching physician-leaders whereas additionally enhancing their very own working circumstances.

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 imagine the Housestaff Union and program leaders can discover progressive methods to enhance the working circumstances of housestaff and the care that we ship. Our objective is to make Stanford the premier establishment to coach at and to perch it on the prime of ranked lists nationwide.

Thanks all a lot for studying.

Philip Sossenheimer is a 3rd 12 months inside medication resident at Stanford Hospital, and shall 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.