Join us! How to start a CIR chapter at your hospital

Interested in making changes at your hospital and considering becoming unionized? You’ve come to the right place!

Why join CIR?

When we come together as housestaff, we have a unified voice for safe working conditions and better patient outcomes. This pandemic has demonstrated that having workplace representation is urgent and necessary. Thousands of residents across the country have organized union chapters and have won historic improvements for housestaff and patients through collective bargaining agreements.

Lorenzo Gonzalez
President:
Lorenzo González, MD, MPL
Harbor UCLA, Family Medicine

As residents and fellows raise their voices louder each day, we are committed to advocating for housestaff and our patients across the nation by challenging how medicine and health are engendered in our society.

La unión hace la fuerza, pero la participación hace la diferencia. | Unity is power, but participation makes the difference.

Lorenzo González, President
Yariana Rodriguez
Executive Vice President:
Yariana Rodríguez Ortiz, MD
Houston Methodist Hospital – (formerly Wyckoff) Nephrology Fellowship

“Through CIR, residents, and fellows nationwide can come together to build a better educational environment by advocating for healthcare workers and patients. I am privileged to be part of the leaders that support equity, justice, and wellness through the resources provided by our union. I have seen what organizing can do at my own hospital and as Executive Vice-President, I am committed to working with all our union leaders to improve our medical education and healthcare system.”

Yariana Rodríguez Ortiz, MD – Executive Vice President

Frequently Asked Questions

What is a union?

A union is an organized group of coworkers advocating to improve their working conditions through contract negotiations and collective actions. Forming a union is the only way to negotiate a legally binding contract with hospital management that ensures housestaff have a voice in the process. The Committee of Interns and Residents (CIR) is the largest housestaff union in the United States, representing over 20,000 resident physicians and fellows who are dedicated to improving residency training and education, advancing patient care, and expanding healthcare access for our communities. CIR is a union run by residents – for residents.

What are dues and what are they used for?

CIR dues are 1.6% of base pay and cover the cost of organizing, negotiating and enforcing your contract, such as legal and staff support. No one pays dues until there is a ratified contract in place approved by (and voted for) by the membership. CIR contracts always add economic gains that far offset annual dues.

Will I experience retaliation for supporting a union?

You may be worried that supporting a union will cause you to be unfairly singled out, leading to negative consequences for your career, professional relationships, or visa status. But, voting to affiliate with a union is legal, confidential, and will not jeopardize your visa. When residents come together as a union, we are a majority acting together and our strength is in our numbers, so no one can be singled out. CIR represents thousands of housestaff on H1-B and J-1 visas. Besides, it is illegal to retaliate against anyone for participating in a union.

We have a GME office and chief residents who already represent our interests to program directors and the administration. Why rock the boat with a union?

GME can be a great ally, but their responsibility is ultimately to the institution. Plus, GME can’t make decisions to improve things like salary or benefits. When residents have a unified voice, it can actually empower GME and the Chiefs to better advocate for changes otherwise unseen by hospital administrators. CIR chapters are supported by knowledgeable union staff experienced in organizing, bargaining and contract enforcement. Your union is a collective voice for advocating for improvements with the people in power above your program directors

What are the benefits of forming a union?

As healthcare workers, we see issues every day that impact us, our patients, and our colleagues. While we often have great ideas for improving patient care or resident working conditions, it can be difficult to have our voices heard as individuals. When we come together to form a union, our employer has to meet with us to negotiate a union contract that ensures adequate wages, benefits, safe working conditions, and a real voice in patient care issues.

What can my coresidents and I do to start the process of unionizing?

The first thing you can do is start talking to trusted coworkers about issues you’re experiencing at work. The process of forming a union may differ based on your employer and location. For more information about how to organize and build resident power in your context, schedule a conversation with a CIR organizer.

What are my rights?

  • You have the right to form, or attempt to form, a union in your workplace
  • You have the right to discuss improving your working conditions with your coworkers
  • You have the right to organize without retaliation from your employer
By law, employers are prohibited from doing the following (click to open)
Understanding S.P.I.T.
What are the benefits of forming a union?

When we come together as housestaff, we have a unified voice for safe working conditions and better patient outcomes. This pandemic has demonstrated that having workplace representation is urgent and necessary. Thousands of residents across the country have organized union chapters and have won historic improvements for housestaff and patients through collective bargaining agreements.

What’s legal? What’s not?

The laws vary from state to state as well as the type of employer you are paid by – private or public.Generally, however, most laws give employees the right to act together to try and improve their working conditions, with or without a union.It is illegal for employees to be fired, suspended, or otherwise penalized for taking part in protected group activity.

Generally, it is illegal for employers to S.P.I.T.:

(Document any activity that may look like this)

Surveil

Administration and department leadership may not conduct unlawful surveillance of employees’ union activity. Identifying, tracking and surveillance of employee discussions about the union or union meetings is illegal.

Examples:

Supervisors cannot inquire about what goes on at union meetings, ask which employees attend the meeting, or even give the impression of such surveillance.

Promise

Administration and department leadership must not directly or indirectly promise any benefits or reward employees for refusing to sign a union card, or for voting against your union. They may not promise a wage increase or give preferential treatment in exchange for refraining from union activity. Encouraging employees to withdraw or repudiate union authorization cards is also unlawful. They may not solicit grievances about working conditions while expressly or impliedly promising corrections if residents do not form a union.

Examples:

“I can get you a job here or give you a good recommendation letter if you don’t get involved.”

Reminder: There is nothing holding management accountable to any promises they make and they do not have to follow through.

Interrogate

Administration and department leadership should not interrogate, or ask, any employee whether or not he or she favors the union, has signed a union card, or has gone to a union meeting.

You can always say you’re not comfortable answering their questions. Remember to ask whether they’ve talked to others, whether they know if they’re allowed to ask, and if they have concerns about residents forming a union and what they are.

Questions they may ask:

Have you heard of a union being formed? Are you involved? Have you been asked to sign a card? Do any of your colleagues have interest in forming a union? Who have you heard union talk from? Do you think you’ll join?

Threaten

Administration and program leadership must not threaten employees with harm or reprisals (economic or otherwise) if they decide to get involved with the union or sign a union card.

Examples:

Administration may not threaten to take away residency spots or current department benefits if the residents decide to form or join a union.

What can we do to protect ourselves?

Despite being generally protected, it is always a good idea to be extra careful:

  • Remember to be discrete and never seek advice or reveal to management/administration that you are considering unionizing
  • Refrain from using hospital property – both physical (printers, computers, phones) – and intellectual (email, paging/messaging systems) – in communicating regarding union matters
  • Be mindful of where and when you discuss unionization with your colleagues – being overheard talking about unions in the hospital “on company time” can be considered “solicitation,” so exercise caution and discretion
  • As long as you are using personal means of communication such as personal phones, emails, and only talking to other interns, residents, or fellows, the hospital cannot discipline you

Reminder: Forming a union is 100% our legal right and our vote is anonymous.

What is union busting and what does it look like?

Know how to diagnose union-busting tactics:

Are one or more of the following symptoms present?

  • Incentives: Is your employer suddenly addressing long-standing issues, or making improvements to your wages and benefits? Suddenly your employer is ready to listen when you and your coworkers start coming together.
  • Intimidation: Are your bosses telling you there might be negative consequences for unionizing? They are trying to create an atmosphere of fear.
  • Misinformation and dissuasion: Is management telling you outright that it is in residents’ best interest to oppose unionization? Employers will often stretch the truth or even lie in order to dissuade you.

Then you’re looking at a case of union busting.

What’s the treatment?
You and your coworkers should ask yourselves some questions:

  • Why do you think your employer would work so hard to stop you and your coworkers from forming a union?
  • Why does your hospital not want housestaff to have more power?
  • What’s so threatening about a unified resident voice in your workplace?

Union busting tactics are successful when they create division, confusion and fear.

But if you and your coworkers have decided you are ready for more power and a stronger voice, you can stand together against these tactics. Solidarity is the best medicine.

Hear from CIR Members on the value of the union:

Michael Zingman
Secretary-Treasurer:
Michael Zingman, MD, MPH
NYU Langone Health/Bellevue Hospital, Psychiatry

The impacts I’ve seen on the well-being of residents and fellows as well as their patients when housestaff unite together should not be understated. The more residents organize, the more we engage new individuals in advocating for themselves and their communities and, therefore, the more power we have. Together, we can win strong contracts, raise the standards of residency, and protect ourselves and our patients.

Michael Zingman, MD, MPH – Secretary-Treasurer:

What We’ve Won


Family Benefits

Boston Medical Center

House Officers who do not qualify for Family and Medical Leave are entitled to 12 weeks of unpaid parental leave if they are the primary caregiver or 8 weeks of unpaid leave if they are a non-primary caregiver. They are not required to make up missed on-calls after returning from parental leave.

Children’s Hospital & Research Center at Oakland

The hospital provides health insurance coverage for up to 3 months of approved unpaid maternity leave. Prospective fathers, adoptive parents, and domestic partners are entitled to 3 months of unpaid leave and the hospital provides health insurance coverage for up to 3 months of approved leave.

Jackson Memorial Hospital

CIR members [will] have access to a percentage of slots in daycare or other childcare services proportional to their ratio in the overall staff population.

LA County

Residents who are on authorized pregnancy leave may use sick leave benefits in addition to vacation, holiday, or compensation time. There is no contractual limit to the amount of leave she can use. Residents who are pregnant or one month post-partum may submit a request to her program director to be assigned rotations appropriate to her health and her child’s well-being.

NYC Health + Hospitals

Residents with children 13 years old or younger are eligible to receive childcare reimbursements of up to $3,500 per household per year.

Pregnant residents may use paid sick and vacation leave, as well as request unpaid leave. They may be entitled to rescheduling to less-taxing rotations and relief from some amount of night call. There is no contractual limit to the number of paid sick days they may use.

New York Methodist

HSOs are given 2 paid working days for paternity leave. At no time shall any HSO exercising a contractual right to use leave time be required to arrange for alternate coverage.

UCLA Medical Center

Residents have access to a Flexible Spending Account for dependent care expenses and are able to participate in UCLA’s emergency childcare service.

Residents have continuous health insurance coverage while on Family and Medical Leave. New parents (including foster or adoptive) are entitled to 4 weeks of paid parental leave. Pregnant residents are eligible for up to 28 weeks of leave through a combination of Pregnancy Disability Leave (i.e. partially paid short-term disability leave) and FML.

UCSF Medical Center

New parents receive 4 workweeks of paid parental leave. This was an increase from 2 workweeks in the first year of the contract and 3 workweeks in the second year. Residents and Fellows can also use their paid sick or vacation leave or use FML to extend their parental leave up to 12 weeks.


Education Benefits

Boston Medical Center

House Officers receive an annual professional education allowance of $1,150 – to be increased by $50 each year. The allowance may be used for conference-related expenses, textbooks, journals, exam review courses and materials, board fees, licensing fees, medical equipment, computer equipment, or professional association membership.

Children’s Hospital & Research Center at Oakland

Interns and residents are reimbursed for approved medical education expenses each year up to $1,000 for interns, $1,500 for PGY2, and $1,200 for PGY3 and up. All bargaining unit members have the option to purchase a laptop or tablet with the education fund once during their residency at CHO. Medical license renewal costs are eligible for reimbursement during PGY3. The hospital will pay for the HSO’s annual membership to the American Academy of Pediatrics, their California Medical License and DEA fee during PGY2, and one USMLE Step III exam fee prior to December of PGY1.

Jackson Memorial Hospital

Each HSO receives a $2,000 allowance per academic year to be used for professional or educational expenses. They receive the allowance on the first full pay period in September. If they begin employment after September, they will receive the allowance by the 8th pay period from the start of employment.

NYC Health + Hospitals

As part of the Professional Education Plan (PEP), residents are eligible to receive reimbursements of up to $750 per year to pay for exam fees, medical equipment, license fees, books, scrubs, and more. Any unused portion of this benefit can be carried over into the next year. PEP is provided by the CIR Benefits Fund.

Members receive reimbursement for conference expenses through the House Staff Benefits Plan. Residents receive up to $1,500 over 3 years and Fellows receive $1,500 every year.

New York Methodist

All HSOs are eligible for reimbursement of $1,300 each academic year for purchasing medical devices, board review courses, licensure and board exams, elective conference tuition and registration fees, etc. Approval for reimbursement shall not be unreasonably denied. The Hospital shall reimburse HSOs within 45 days of submission of receipts. A $3,500 Library Fund shall be provided for the House Staff, who provide a list of requested books and journals to be purchased by this Fund.

Fellows, chief residents, and residents in their last year of basic residency are granted 1 week of paid conference leave in their specialty with approval of the Chairperson. Eligible residents attending an approved conference will receive a reasonable educational allowance of at least $500. All other residents may be provided at least 2 days of paid education leave to attend a conference, depending on the availability of funds and staff coverage. These residents will receive a reasonable educational leave allowance to cover registration fees, etc. as long as funds are available.

San Francisco General

Up to $105,319 of the Patient Care Fund may be used each year to pay for medical books and journals, exams, projects and training, and conference-related costs.

UCLA Medical Center

Residents and Fellows are eligible for reimbursement of $1,000 per year and interns are eligible for $500 per year for expenses including: medical equipment, computer equipment, exam review courses or materials, board fees, textbooks or journals, conferences, or professional association membership.

Residents and Fellows are eligible for reimbursement of conference-related expenses when presenting on behalf of UCLA, with no cap on the number of conferences they can be reimbursed for. They are entitled to reimbursement for lodging and food the day prior, day of, and the day after the presentation. For conferences they are attending, but not on behalf of UCLA, residents and fellows are eligible for reimbursement of $1,000 per year and interns are eligible for $500 per year for conference-related expenses. Funds not used can be rolled over to the following year.

University of New Mexico

House staff are eligible to receive reimbursement for courses that further their medical academic education at UNM up to 8 credit hours per semester or 4 credit hours in the summer. Regular full-time house staff are eligible for reimbursement starting from their date of hire. The hospital will make a good faith effort to provide reimbursement within 30 days.

Westchester Medical Center

The Medical Center will make every effort to procure tuition waivers at Westchester Community College for house staff.


Compensation

Children’s Hospital & Research Center at Oakland

HSOs received a 6% across the board increase in the 1st year of the contract and a 3% increase in each of the 2nd and 3rd contract years. St. Barnabas: Each resident received 2 raises in the first year of the contract: a 4% increase in their base pay in September 2020 in addition to a 3% increase in the following month (October 2020). They also received 3% raises in the 2nd year and the 3rd year of the contract. The chief resident differential increased from $2,122 to $2,350.

LA County

All interns and residents received a 2% across the board increase in salary during the 1st year of the contract, followed by 2.5% increases in the 2nd and 3rd years. Oral and maxillofacial surgery residents in their 5th year of training are paid at the PGY3 level and those in their 6th year of training are paid at the PGY4 level. Chief residents receive a bonus of $300 for each full month served in the position.

NYC Health + Hospitals

Interns receive a salary of approx. $66,000, which increases by more than 2% each year to $87,000 for residents in PGY8. Residents receive large increases in PGY3 (7.9%) and PGY7 (5.1%). The annual pay rate is reduced by $4,365 for those who receive housing from the hospital. Chief Residents receive $4,722 annually – to be paid on a prorated basis.

New York Methodist

Each HSO received 2 raises of 3% each in the second year of the contract and a third raise of 3% in the third year of the contract. Interns receive a salary of $70,799, which increases by approx. 9% each year for PGY2 and PGY3. After PGY3, salary increases are 3% or less and rise to approx. $93,600 for PGY8. Adjustments in wages to be made in accordance with the contract or in compliance with a grievance or disciplinary decision must be made within 30 days on the date they become due.

San Francisco General

Though interns and residents do not have collective bargaining rights when working at SFGH, the city of San Francisco provides Quality Improvement Incentive pay to bargaining unit members at SFGH who do not qualify for the UCSF QI incentive pay provided the target goals set by SFGH leadership are met by their Department. The QI pay will match the amount under the UCSF program. Interns receive approx. $52,000 in wages, which totals to $61,000 with the inclusion of their $8,750 annual housing stipend. Wages increase by 3.6% to 4% each year from PGY1 to PGY6. The annual housing stipend remains the same each year.

UC Irvine

Residents received a 6% across the board increase upon contract ratification, followed by 3% increases in the 1st and 2nd years of the contract. Within 1 month following ratification, all residents received a $2,500 lump sum payment. Chief Residents receive a $50 monthly stipend.

UCSF Medical Center

HSOs received a 3% across the board increase in the 1st year of the contract, a 6% increase in the 2nd year, and a 3% increase in each of the 3rd and 4th years. Clinical Psychology interns receive $31,382 annually and non-physician clinical trainees receive between $47,484 and $60,000. The stipend for chief residents range from $50 to $150 per month.

Westchester Medical Center

Interns receive a salary of approx. $66,000, which increases by more than 2.5% each year to $84,000 for residents in PGY8. Residents receive large increases in PGY2 (5.2%) and PGY3 (4.6%). Chief Residents receive $3,714 annually – to be paid on a prorated basis.


Having a Voice

  • Collective Bargaining gives us a seat at the table with top decision makers
  • All CIR contracts include regular labor/management meetings, the right to renegotiate the contract every few years, and due process rights

Housing

Children’s Hospital & Research Center at Oakland

HSOs receive an annual housing stipend of $9,000 paid in monthly installments of $750 to be paid on the check receipt date closest to the 1st of each month for the life of the agreement.

LA County

The County provides an annual housing allowance of $4,000 per intern/resident, to be allocated on July 1.

New York Methodist

Incoming interns and residents can enter a lottery to license an apartment from the hospital. In any CIR contract year, the percentage increase in rents shall be no higher than the percentage increase in salary scales. Rent may not be increased except under oulined circumstances, and any proposed increase in rent shall be reported to CIR.

San Francisco General

Interns and residents receive annual housing stipend of $8,750, which remains the same regardless of PGY.

The housing allowance is $1,134 per month. It increased by 3% from the previous year and 6% 2 years ago.

UC Irvine

Residents receive a housing allowance of $8,000, which is payable in 12 monthly installments of $667. This allowance is provided until University housing units become available for use by residents, in which case the union can request to begin bargaining on housing issues.

Westchester Medical Center

To the extent available, the hospital provides apartment rentals on the Medical Center campus to house staff on an equitable basis. Rental rates increase by 3% each year. CIR and the hospital formed a Housing Committee of equal parts CIR members and hospital designees to discuss regular maintenance, repairs, security, etc.


Meals

Children’s Hospital & Research Center at Oakland

Residents receive their yearly meal allowance of $2,150 at the beginning of the academic year. They may charge up to $60 per day on their badge. The Hospital is actively considering the option of allowing the carry over of the annual meal allowance to the next residency year.

Jackson Memorial Hospital

All HSOs receive a meal card with a value of $1,375 per academic year. They receive the 25% discount granted to all JHS employees and access to a designated line for meal card holders during peak hours. The hospital shall consider making changes in cafeteria closing hours to accommodate HSOs’ schedules and the Public Health Trust shall make food available for HSO working overnight shifts.

LA County

The County provides 3 fresh meals daily to house staff and makes every reasonable effort to provide meals with consideration to a greater variety of dietary needs. The County prepares sufficient food daily to ensure that healthy night meals are available or provide frozen meals to HSOs assigned to nighttime duty or in-hospital on-call duty. If meals are not provided at host hospitals outside of LA County, the County will reimburse residents up to $25 per day.

NYC Health + Hospitals

Residents receive a meal stipend of up to $3,500 per year, to be increased by $600 per year. This amounts to $135 each biweekly pay period.

New York Methodist

Each HSO receives $1,300 for meals each educational year. The amount is loaded on their ID card within the first week of the new academic year. Coffee, tea and juice, and a light snack shall be delivered to the House Staff Lounges each afternoon. The Hospital agrees to maintain access to at least one outside vendor that is open 24/7 and is reasonably accessible to HSOs.

San Francisco General

Interns and residents receive meal cards of $23 per day when working at SFGH. In addition, the hospital delivers 50 meals to the Interns and Residents Lounge every night and includes vegetarian options. The daily meal allotment is adjusted if prices increase in the cafeteria.

University of New Mexico

Meal funds are distributed according to a 4-tier system that is based on the amount of in house overnight call and months at UNMH, which was agreed upon by resident representatives. Tier 1 residents receive $1,350 per year, while Tier 4 residents receive $550 per year.

Westchester Medical Center

Every 6 months, house staff receive preloaded store-specific cards of a combined $350, which may be split in $50 increments of the employee’s choice between the hospital’s cafeteria and another set location.


Diversity

Alameda Health System

The hospital provides $14,000 each year to the CIR Diversity Recruitment Fund to pay for outreach efforts and scholarships for minority resident candidates of up to $4,000.

Boston Medical Center

The Hospital funds a dedicated program manager position to track diversity efforts and produce annual reports. It also funds a program of $88,000 per year for the recruitment and retention of minority House Staff and faculty, which is administered by a Steering Committee composed of equal numbers of Union members and attending staff. The Committee participates in meetings relative to the ranking of applicants for hire as House Officers.

Children’s Hospital & Research Center at Oakland

The hospital designates $7,000 per academic year of the contract for purposes of recruiting and retaining minority housestaff. The Joint Committee will make recommendations for spending this money.

LA County

Diversity recruitment, physician pipeline, and retention into the LA county healthcare network will be discussed at each facility’s communications meetings as requested by CIR or the hospital.

NYC Health + Hospitals

CIR members serve on the Affirmative Action Committee, which has access to data on the recruitment and retention of House Staff Officers and makes recommendations on diversity issues. Surplus funds from the on-call coverage pool may be used to support House Staff and medical students in their affirmative action activities.


Improving Patient Care Conditions

Children’s Hospital & Research Center at Oakland

The Patient Medical Fund for Residents totaled $69,000 in 2014 and the ED Patient Med Fund totaled $25,000.

Jackson Memorial Hospital

CIR receives $175,000 each year from the Public Health Trust (PHT) to work on ways to achieve the shared goals of improving: quality health care for the communities they serve, patient safety, and working conditions. CIR and PHT collaborates on the Quality and Patient Safety Initiatives and PHT agrees to provide requested data to CIR within 72 business hours.

LA Country

The Department of Health Services contributes $300,000 each year to fund Patient Provider and Community Engagement Projects.as well as $2.2 million per year with each department participating in purchasing patient care equipment.

NYC Health + Hospitals

Residents have access to a wide range of funding opportunities through the Patient Care Trust Fund to purchase equipment and fund training programs or research to improve patient care. This fund amounts to approximately $1 million.

New York Methodist

The hospital agreed to provide 3 annual installments of $75,000 toward the Patient Care Fund. The money delegated to the Fund may be transferable to Quality Improvement Initiatives if agreed upon by both parties. The hospital shall purchase equipment or release project funds within 120 days of approval. In addition, the hospital will contribute an aggregate of $150,000 for the term of the CBA to be used by the Hospital’s House Staff Safety Council to assist in engaging HSOs in the Council’s work regarding quality and safety. CIR and the hospital leadership must jointly approve the intended use of the funds.

San Francisco General

The hospital gives $183,000 each year to a Patient Care Fund, with up to $105,000 able to be used for medical books, resident wellness activities, exams, computer and digital equipment, medical software, etc. If there is a rollover balance at the end of the fiscal year, the hospital contributes half of the balance to the next fiscal year in addition to its normal contribution. The hospital will purchase the approved items within 6 months of receiving the completed purchasing request.

University of New Mexico

UNM Hospital contributes $20,000 each year to the Quality Improvement Fund, which provides incentives for residency programs to establish scholarships to attend conferences, bring speakers to UNM, and fund resident-driven projects.

22,000 Members Strong: Building a National Movement

We’d love to talk more with you about starting a CIR chapter!