Stanford Health Care FAQ (Yes to Voluntary Recognition!)

What is a housestaff union?
Do I have to pay dues?
Why are we unionizing?
What have other resident unions accomplished?
Why do we need a union anyway?
How can our union improve patient care?
What can a union do to help support the needs of a diverse housestaff?
What does collective action look like?
Does this mean I have to strike?
What is better about a union versus existing GME committees and programs?
Can my program retaliate against me for supporting the union?
What is an “Unfair Labor Practice”?
What do we expect to happen now that the union effort is public?
We had a supermajority (65%+) of cards. Why are we moving to an election?
Can we lose current benefits?
If there is a union, do residents have a choice of being in it?
I’m an international graduate and don’t want to jeopardize my position. Why should I sign up?
We filed for voluntary recognition. Then what happens?
How is a union won?
How do I get more involved?
I’m graduating. What does this mean for me?

What is a union?
A union is a group of workers who use their collective strength/voice to bargain for better working conditions. A union gives us more power and leverage to effect changes on everything we want—from better pay and benefits to improving patient care and more—than we would have if we negotiate as individuals.

What is a CIR?
The Committee of Interns and Residents (CIR) is the largest resident union in the US, representing over 20,000 housestaff. CIR has over 60 chapters throughout the country and represents over a majority of housestaff in California including all housestaff in the UC system (e.g. UCSF, UCLA, UCI), Santa Clara Valley, Highland Hospital, and more. Given their expertise, we (the housestaff organizers) reached out to CIR for support/guidance in our effort to empower the Stanford housestaff voice.

How much does a union cost? Do I have to pay dues?
No one pays dues until the union membership has voted to ratify a contract. Resident unions have never ratified a contract with benefits that do not outweigh the cost of dues. CIR dues are 1.6% of base pay (= $1100 PGY-1, $1400 PGY-5) and are used to support the infrastructure of collective bargaining (e.g. pay for things like contract negotiations, PR/media support, and legal representation). Common negotiations include salary increases (e.g. UCSD won a 6% salary increase) or housing stipends (UCLA has a $12,000/year stipend) or even improved meal stipends ($3000/year at UCLA) which would already far outweigh the cost of dues.

Why are we unionizing?
We are unionizing to have a stronger voice and federally protected right to bargain about issues that matter to us, our colleagues, and our patients. The individual issues are up to us – what do you feel strongly enough about that you would fight for it? More workplace protections? Better benefits? Improved parental leave? Speaking up against the exploitation of housestaff labor? Patient care funds to improve the quality of care?

What are we trying to accomplish/win?
In the worst of circumstances, we saw what housestaff can accomplish with one day of collective action following the vaccine rollout debacle. In the subsequent year, housestaff won long sought-after retirement benefits (albeit only 40% of what every other employee gets) and limited fertility benefits. Now, imagine what continued, sustained collective action can win – full retirement benefits, better parental leave/childcare policies, moonlighting, affordable housing, educational protections… Ultimately, unions are democratic organizations, and what we accomplish depends on what is important to you.

What have other residency unions accomplished?

Residency is supposed to be hard. Shouldn’t we just suck it up?
Resident salaries have been consistently falling over the last 40+ years in terms of cost of living – residents today have 29% less disposable income after correcting for inflation than residents in 1970, despite continuing increases in educational debt. Additionally, training conditions may not be the same in all programs, and may not always stay the same. All of the benefits we receive could be taken away because they do not have the protections of a union contract. Having a union will help us maintain good working conditions and advocate for ourselves (e.g. vaccine roll-out, COVID hazard pay). The best time to form a union is now, not only for all current residents and fellows but also for future housestaff. We need to be at the table when decisions are made about us. Check this out: “Change the culture” – Dr. Glaucomflecken

How can a union help improve patient care?
A key part of many housestaff union contracts is dedicated patient care funds to direct towards needs identified by housestaff. For instance, LA County housestaff won more than $2 million per year for community engagement projects and patient care equipment, and NYC Health System residents won $1 million for equipment and training programs that improve patient care. In our role on the front line of the hospital, we see firsthand the disparities that exist in the care we provide. This is our opportunity to reshape how Stanford Health Care serves our community.

What about burnout? I can’t take care of patients when I’m exhausted.
28% of residents have fallen asleep at the wheel postcall. 62% of residents have felt so burned out that it has affected their work. These are unsafe working conditions and prevent housestaff from providing high quality care to our patients. A housestaff union can fight for work hour restrictions, COVID/moonlighting pay, protect our access to mental health resources, adequate work space, appropriate staffing, and more. Check out CIR’s well-being page and the CIR Bill of Rights.

What can a union do to help support the needs of a diverse housestaff?
Other CIR chapters have won specific benefits for protecting residents on visas and expanding diversity efforts. For instance, Boston Medical Center residents won an $88,000 budget for their Diversity Committee, and Highland Hospital (Alameda Health Systems) residents won $14,000 specifically for diversity outreach and scholarships.

What does collective action look like?
Look no further than the demonstration following the COVID vaccine rollout debacle. A collective group of committed housestaff can create incredible change, and the hospital administration will respond when we act together. Collective action takes many different forms. It starts with forming a union, which will give our housestaff a legally backed seat at the table to advocate on behalf of our residents and fellows. Visibility in the hospital also makes a difference – pins, masks, flyers, and speaking up in town halls. Describing the challenges of providing quality patient care when burned out in an op ed or with legislators can get our message out to the public. Moreover, these days, we live in an interconnected world and can band together on social media to put pressure on the hospital administration. And of course, we saw what a brief demonstration with media coverage did a year ago – the option to take a unity break is always on the table if our ability to take care of patients is at stake. And we have solidarity with many other unions: CRONA, UHW, and other housestaff unions in California and across the country.

Does this mean I have to strike?
No – strikes are very rare and must be voted on by union members. CIR has not had a strike since the 80s (when USC residents were advocating for a patient care fund). CIR contracts, like most union contracts, generally contain no-strike clauses. There are other tactics that can be used to help our negotiation, such as media pressure or unity breaks.

What is better about a union versus existing GME committees and programs?

 

  • When residents gain concessions from their hospital through their GME residency council or similar bodies, those concessions are not legally binding and can be lost at any point. When an employer negotiates with a union that is the legally recognized representative of their residents, the agreements ultimately reached during those negotiations are legally binding and enforceable. When trainees unionize, they can negotiate for economic improvements (salary, 403b matching, etc,) and for improvements to non-economic conditions (encompassing a wide variety of subjects like parking, childcare, resident representation at leadership levels).
  • After unionizing, UCLA and UCSF negotiated $12k housing stipends. UCI secured increases in meal and education allowances. Other programs obtain improvements to resident lounges/workrooms/call rooms, pay bonuses for working holidays, better parking, and longer parental leave. During the pandemic, residents in New York organized and won hazard pay.

Does this mean that our program leadership will not be able to advocate for us?
No – although this is a common myth spread by hospitals in response to unionization efforts. To the contrary, we can work with program leadership to ensure that our union contract empowers them to better serve residents – e.g. to advocate for space, educational time, or appropriate staffing limits. We will fight to ensure that our union contract serves as the floor for all residents – and that individual programs and departments can continue to support their residents through existing and additional bonuses and benefits. In fact, many residency programs with housestaff unions use the presence of a union in recruitment!

Can my program retaliate against me for supporting the union?
First, the union vote is confidential! You do not have to be a vocal member to support unionization. Additionally, it is illegal (per the National Labor Relations Board) for an employer to retaliate against an employee for union activities. They cannot ask you if you support the union, or threaten any punitive action such as not writing a recommendation letter because you supported the union. In fact, it is easier to retaliate against an individual pushing for change rather than a resident union standing together. A union should not get in the way of existing relationships with faculty; instead, it can protect your interests and rights in case the attitudes or personnel of leadership changes. If you are an international graduate, unionizing will not jeopardize your visa. CIR has legal representation to back us up.

What is an “Unfair Labor Practice”?
An Unfair Labor Practice (ULP) is any action taken by Stanford Health Care that is in violation of the National Labor Relations Act. Broadly speaking, this includes: (1) interference, coercion, or restraint – e.g. threaten or question housestaff; (2) discriminate based on labor activity – e.g. retaliate against organizers or anyone else for supporting unionization; (3) refuse to bargain – i.e. does not engage in bargaining with housestaff or bargains in bad faith. If Stanford or any individual programs/departments take part in a ULP, we have the right to file these through a formal complaint process to protect our housestaff.

What do we expect to happen now that the union effort is public?
It is a common practice for large employers to hire outside anti-union consulting firms (for example, Stanford has historically employed IRI Consultants and H&H Consulting). These firms often use strategies out of the same playbook, so much so that we’ve created a “Union-Busting Bingo” card. These tactics often rely on vague generalizations, threats, and vague promises that are not enforceable to avoid the risk of being illegal under federal labor laws.

We had a supermajority (65%+) of cards. Why are we moving to an election?
We started by requesting voluntary recognition by Stanford, given that a supermajority of our residents and fellows signed cards stating their support for a housestaff union. By rejecting this request, Stanford is telling us that they don’t believe that we truly have a majority of support and requesting an election to prove these cards are accurate. However, if between our request for recognition and the election, Stanford Health Care engages in conduct that violates federal labor laws, this will help demonstrate that they did not request an election in good faith and we will be ready to file ULP complaints with the NLRB to prove these violations.

Can we lose current benefits?
No – our benefits cannot be taken away due to starting collective bargaining negotiations. When a group of employees unionize, their employer may not make changes to wages, hours, working conditions and other “mandatory subjects of bargaining” without negotiating with the union. Furthermore, employers are also legally prohibited from threatening or changing working conditions in retaliation against their employees seeking to organize a union.

If there is a union, do residents have a choice of being in it?
No one is required to join a union, but resident non-members will still receive the union-negotiated benefits. At a private sector hospital like Stanford, non-members pay an agency fee equal to dues or they would be required to pay a “fair share” fee for costs of representation which is a percentage of dues and is for benefits/services received by non members of the union that are germane to collective bargaining.. However, non-members would not have a vote in any union negotiations or actions, or other member-only rights and benefits.

I’m an international graduate and don’t want to jeopardize my position. Why should I sign up?
CIR/SEIU has numerous foreign medical graduates as members, including many who are here pursuant to an H-1B or J-1 visa. Voting to affiliate with a union is legal, confidential, and will not jeopardize your visa.

We filed for voluntary recognition. Then what happens?
Stanford has the option to recognize us, and then we move to collective bargaining. If they insist they have a good faith reason to doubt our supermajority of cards, we will file with the NLRB, who will conduct an independent election in the next few months. When we win that election with a majority of votes, the NLRB will require Stanford to recognize our union, and we begin our collective bargaining then.

How is a union won?
After cards are submitted, if the employer does not voluntarily recognize us there is an election administered by the NLRB (again, votes are confidential) which is won with a simple majority. However, because the strength of a union comes from its collective voice, supermajority support and solidarity for our fellow housestaff is the backbone of an effective union.

How do I get more involved?
Organizing is built on the collective engagement of the entire housestaff! The organizing committee will be hosting multiple meet & greet events to help answer questions, and are always happy to discuss what getting more involved looks like. Fill out this form and one of us will reach out as soon as we can!

I’m graduating. What does this mean for me?
We need everyone’s support to give future trainees a voice. It also costs nothing to support – you will never have to pay any dues because it will take time to bargain a union contract. Future trainees will be able to decide on their own fate by voting on negotiated contracts or decertifying the union if it is no longer useful to them. Ultimately, this is about paying it forward: residency is hard as it is, but giving housestaff a real voice in their experience is the start of reimagining medical training where we make sure our doctors can be well enough to improve care for our patients and our communities.