Surgery residents aren’t supposed to get pregnant.

That’s the (mostly) unspoken message that’s all too common across medical training in the U.S. Though the culture has been changing for decades–largely through physician organizing–residency in the U.S. retains many unfortunate remnants of the system’s origins. Among these: a quiet understanding that the realities of starting a family are just not the hospital’s problem.

But thanks to the diligent, multi-year organizing of a group of parents and prospective parents in the University of California (UC) system, this paradigm is shifting, and not only for pregnant residents and fellows. This winter, a groundbreaking law went into effect in California that ensures millions of workers across the state now have access to fertility benefits through their employer-sponsored health insurance. Crucially, this coverage is inclusive of queer couples.

UCLA surgery resident Dr. Amanda Labora was an early leader in CIR’s UC Family Building Committee, which formed in 2022 when a group of UCLA physicians began discussing issues with their access to fertility benefits. In just a few years, by working across the system, from UC San Diego to UC Davis, the committee and other UC physicians managed to: win groundbreaking family building benefits in their union contracts, dramatically improve lactation rooms at UCLA, and secure statewide legislation that will benefit their patients as well.

“I think surgery residency was not designed to be supportive to building a family regardless of your gender identity, but it’s really stacked against women because of the length of training,” said Dr. Labora. “This bill now changes things for our patients–it’s not just about us, it’s about Californians as a whole.” 

The UC-wide benefits physicians won include support for family building through assisted reproductive technology, fertility preservation, and adoption, as well as postpartum services like continuous labor support from a doula, postpartum visits, and lactation support. Through their organizing, the physicians also pushed the UC administration to improve its lactation policies system-wide, making it easier for doctors to access lactation rooms while on the clock.

Ensuring the physician benefits and the bill were supportive of queer couples was also always a high priority to the committee. 

“What was really special about this bill is that it leaves the definition of infertility in the hands of patients and providers, and is more inclusive of LGBTQ folks because it changes the definition of infertility from one that assumes the patient is going to conceive through sex,” said Dr. Labora. “It allows for more equitable use of fertility care and affirms all types of families, including single individuals.

“It became clear that it was important to have a diversity of stakeholders across specialties with different goals and try to make the committee really inclusive and representative of the CIR community. That was something that was a core emphasis from the beginning.”

Meeting regularly to develop their proposals and organizing strategy, the FBC became a core pillar of the first system-wide CIR negotiations in the UC system. Through collective action, including sticker ups, petition deliveries, and eventual “unity breaks,” UC physicians won contracts in late 2022 and early 2023 that helped lift the standard for residency and fellowship nationwide.

Coming just after another paradigm-shifting event in medical training–the COVID-19 pandemic–these new standards helped encourage the massive, ongoing wave of physician unionization, and especially bolstered organizing aimed at making training more accommodating to parents.

“The pandemic really unmasked a lot of the ways in which the healthcare system is not working in the service of education or patient care but is very profit-driven,” said Dr. Labora. “I had to write up a living will at the beginning of the pandemic and I still had to show up to work every day. It was the union that made those bonuses happen for us.”

The experience of organizing with other physicians continues to have a profound impact on Dr. Labora’s life as a doctor and parent; the latter, of course, is the “best thing” she’s ever done. The FBC has made it possible for Dr. Labora to use accessible, clean lactation rooms while at work, and to advocate to take the parental leave she needed. Crucially, it has also given her consistent community and support both as a resident and mother.

“People are in the shadows but I feel like this group pulled people and their identities out of the shadows and built a community to support one another in this work that’s really hard, but also really important,” said Dr. Labora. “We’re deserving of our humanity and should be allowed to grow as people and build our lives outside of medicine while we take excellent care of patients.”

She says the next phase of this work will include ensuring physicians can access affordable childcare. She doesn’t seem to doubt the power of her union to win–and why would she?

“It’s a new identity for doctors to be part of the labor movement because there was this separation of this is a profession–we’re not labor–but actually those are false boundaries between us and our patients,” said Dr. Labora. “My generation woke up to that truth as a result of COVID and we’re finding our voice and our strength together, because we realized doctors and patients need to be the people defining the priorities in health care.”

“Look what happens when we stand up together.”