Portside

Amid rising labor militancy over the past few years, one group of workers has gone under the radar: medical residents. Also known as resident physicians or housestaff, medical residents are doctors who have finished medical school and are working in hospitals as apprentices on the path to getting independently licensed. They are the patient-facing backbone of hospital operations, working extremely long hours under stressful conditions for mediocre pay.

Over the past few years, from California to New England, medical residents have been unionizing and striking by the thousands. They’ve composed some of the largest new units to unionize in the United States. They labor in the strategic sector of health care, which intersects with multiple struggles around social justice and corporate power. They have the potential to work in coalition with others to address public health and other issues. Thousands of newly unionized medical residents will bring their union consciousness into the rest of their careers.

What do medical residents do? What’s behind their rising unionization? What challenges do they face at work? How do their struggles connect with larger struggles in society and the labor movement? To discuss these questions and more, Truthout spoke with two union medical residents who represent a cross-section of this growing part of the labor movement.

Dr. Mahima Iyengar is a chief resident of internal medicine and pediatrics at Los Angeles General Medical Center. She is the secretary-treasurer of the Committee of Interns and Residents (CIR), a local of the Service Employees International Union (SEIU). CIR/SEIU is the largest housestaff union in the U.S., representing over 40,000 resident physicians and fellows. The union has existed for decades, but has recently seen an influx of thousands of new unionized members.

Dr. Armin Tadayyon was an anesthesiology resident at the University at Buffalo’s affiliated hospitals who helped lead a successful 2023 union drive and 2024 strike of UB residents, which resulted in their first contract. Buffalo residents are affiliated with the Union of American Physicians and Dentists. Tadayyon graduated from his residency this summer. The two interviews were conducted separately and have been edited into a roundtable format. The following transcript has also been lightly edited for length and clarity.

Armin Tadayyon: A medical resident is essentially a medical school graduate who is doing further training to become licensed and eventually board certified to work independently in their specialty. It’s akin to vocational training.

Medical residents are monumental to the care that patients receive. Our labor holds the hospital afloat. Most of the direct patient contact is with residents. If residents don’t show up to work, the hospitals are in crisis mode.

Your first-year resident, fresh out of medical school, is called an intern. Your level of responsibility and independence grows as you progress through residency, from a junior resident to a senior resident. Once you graduate residency, you are a licensed physician, and you pursue board certification in your specialty. Once you are board certified, you are an attending physician, and can operate independently without any supervision. Some attending physicians pursue further training, and they’re called fellows.

Hospital operations are structured into hierarchies where attending physicians oversee many medical residents who are on the front line caring for patients. Medical residents really determine the quality of care that patients receive.

Mahima Iyengar: In many hospitals you visit, the residents will be the people taking care of you. They’re the backbone of whatever hospital they’re working at.

We pretty much do everything, depending on the specialty. We’re usually in the hospital before 6:00 am. We do multiple rounds a day with patients. We order medications, call families for information, consent patients for surgeries, perform surgery under supervision, talk to nurses, explain treatment plans, and much more. Almost all this day-to-day work is done by interns, residents, and fellows.

Why do you think there’s been an uptick in resident unionization over the past few years?

Iyengar: Resident physicians have been overworked and underpaid for decades as we’ve seen the consolidation and corporatization of health care. We’ve been taught over generations to just push through and ignore our working conditions.

But things started changing during COVID-19. We were working 80-hour weeks and 14- or 16-hour days. In some hospitals, residents didn’t have access to vaccines even though they were first in line to see patients.

Our working conditions and the exploitation of our labor really came to light during that period. There was a collective 

realization that hospitals are completely dependent on our labor and these mega-corporations that own hospitals are not valuing how much we do and how necessary we are to patient care.

Tadayyon: Residents work very hard to get through medical school. They have a lot on the line when they get into residency, and hospitals know that. They know that residents need the hospital’s approval to become licensed and graduate. This creates an environment where residents are exploited. It creates cheap labor for the hospitals and a negative experience for medical residents.

Unionization has been the way for residents to fight back against this exploitation and ensure a fair and just workplace. That’s why residents across the nation, without any geographical bias, are unionizing.

During the pandemic, residents were forced into situations where they didn’t have any input. They had to take the shifts that nobody wanted. Stanford medical residents protested during the height of the pandemic after being left off the COVID vaccine list. That made many people angry and shed light on how residents are treated.

“There are many ways we can use our numbers — and, honestly, our privilege, being doctors with white coats — to speak up for our patients and the broader issues that, in the end, are health issues.”

What are the big issues and challenges facing medical residents that have led them to organize?

Iyengar: The cost of living is the number one thing we hear residents talk about. Wages haven’t kept up with inflation and haven’t matched cost-of-living adjustments in most places. When I first started residency, I was making $55,000 a year. It’s very hard to afford to live in Los Angeles on that amount.

Child care is a huge issue for many residents, and also fertility benefits. We’re in an age range where these things are really important. If you have a child, it’s hard to find a daycare with hours that work for our jobs, and paying for child care on our salary is prohibitive. Depending on the city, we’ve been working in coalition with community groups and other unions to advance affordable and accessible child care.

Patient care is an issue that really galvanizes people and is driving unionization. We want to provide the best care for patients, but the system is set up against this. Unionization has helped residents advocate for better patient care and get funds for equipment and supplies that patients need.

Mental health is also a major issue. Suicide is one of the leading causes of death for medical residents. Many unions are fighting for better mental health coverage in their contracts.

During my intern year, I worked 28-hour shifts in the neonatal intensive care unit. Every few hours I would be at another delivery trying to make sure that baby was born OK. I can’t imagine being a patient on the other end of that. Would you want your doctor coming to your delivery to have been awake for 24 hours?

Work hours are a little harder to address because they’re mandated through a separate body. We have an 80-hour workweek averaged over the course of four weeks. You could work 120 hours one week and 60 hours the next week. Residents talk about work hours a lot, but that requires a higher push, from a federal level even.

Tadayyon: The rising cost of living is a huge issue. Our salaries didn’t increase when inflation went up. Residents in Buffalo were taking out personal loans just to stay afloat. Health insurance was also a big issue in Buffalo and a reason for unionizing. One sign during our strike was “I can’t even afford the health care I provide.” 

Residents are always given the shifts that nobody else wants. I’ve worked every single holiday over the last three and a half years. We negotiated 10 holidays into our contract. Holidays must still get covered, but now residents get a comp day if they work a major holiday.

We’re here because we love our patients and we want to provide the best care we can. But that doesn’t mean the employers should be allowed to exploit us.

How are the struggles of medical residents connected to larger struggles in our society and also to patient care?

Iyengar: Most residents weren’t in a union prior to joining a unionized residency program, and many people won’t be in a union after this. We have a unique moment to engage residents in thinking of themselves as workers who are part of a bigger struggle and who have power to make changes outside of just the exam room.

A lot of what we’re actually treating when we treat patients are social determinants of health. There’s much more that goes into why a person is sick than what’s directly in front of you. We address transportation issues, food security issues, housing security issues. As a labor union, we have the ability to connect these struggles for our members and help them see that bigger picture.

We’ve supported legislation that prioritizes the needs of the communities and patients that we’re serving. There are many ways we can use our numbers — and, honestly, our privilege, being doctors with white coats — to speak up for our patients and the broader issues that, in the end, are health issues.

Since the 1970s, we’ve also had a patient care fund in Los Angeles County that’s funded by residents forgoing a part of their raise. We’ve bought things like sleeper couches and new ultrasound machines when the hospital won’t buy them. A bunch of hospitals across the country have patient care funds because of the union.

Tadayyon: Our resident unions fight for patient care. Just one resident used to transport even critically ill patients, pushing the bed and managing the drips and bagging the patient. That’s just not safe. Now we have a minimum of two residents with a division of responsibilities helping with transport. Unionization has let residents bargain over bringing more safety to patients, and we have better outcomes.

How do you see medical resident unions in relation to the larger labor movement?

Iyengar: We’ve added thousands of new residents to the labor movement over the past few years. I’m always meeting people who are wondering how to join the union. I think we’ve really energized labor organizing in the health care sector because we’ve been growing so rapidly.

We’re also workers, and we’re fighting for the same things as everyone else, like child care, better public transportation, more affordable housing, and addressing the rising cost of living. We help connect these fights for people.

Every new union residency program adds people to the labor movement. The more members we have means the more power we have to achieve victories for us and our patients. I don’t see this slowing down anytime soon, because residents have now seen what unions can do for us.

Finally, what keeps you energized and hopeful for this movement?

Tadayyon: When you compare morale today among Buffalo medical residents to before we unionized, it’s huge. Before, we felt like we weren’t being heard. Fast-forward to today, and residency is still hard, but there’s less burnout and less stress over whether you can pay rent. After a long shift, we now have clean call rooms with clean sheets to rest on.

What inspired me to join our organizing committee and help win our union was that residents were not being treated right. I love looking at junior residents today and seeing that, instead of stressing about rent or groceries, they’re worried about questions like, “Did that patient do well?” “How should I follow up with that patient?” “Did I provide the best care possible?” That’s how residency should be.

Iyengar: I get to interview the next set of residents that come to our program, and I’ve noticed a huge shift. A few years ago, nobody was asking about the union. Now people always ask about this. They want a unionized program. It’s been really energizing to see this new generation of doctors who know their worth and are willing to fight, and who know the union is the path to being able to take better care of themselves and their patients.

I’m also seeing a huge wave of people who see the union as a powerful tool for advocating for patients in ways that intersect with health care but aren’t specifically health care. People are using the power of the union to fight for immigrants and trans kids. That’s really kept me energized.

I’m not going to be a resident for much longer. I’m really hopeful that in the next year, we can harness all this energy of younger, newer doctors that are so excited to be part of the labor movement and use that energy in coalition with others. I think that’s the next frontier for us.

DEREK SEIDMAN

Derek Seidman is a writer, researcher and historian living in Buffalo, New York. He is a regular contributor for Truthout and a contributing writer for LittleSis.