In hopes of gaining power and pay, medical residents at an increasing number of Chicago-area hospitals are unionizing.
Thousands of residents and fellows in the Chicago area have voted to unionize in the last year — at University of Chicago Medicine in May, Northwestern Medicine in January and West Suburban Medical Center in Oak Park in November 2023. University of Illinois at Chicago residents and fellows unionized in 2021.
Residents have long had to work many hours for relatively low pay, as they train to become specific types of physicians after medical school. Traditionally, residents have been expected to put their heads down and grind, for years, as they gain on-the-job experience and progress toward more lucrative, prominent careers.
Attitude is shifting
But residents say that attitude is shifting amid changes in the business of health care, frustrations that arose out of the pandemic and growing unionization across many industries.
“Hospitals rely on us, but we have not been able to rely on them to guarantee fair working conditions,” said Dr. Anis Adnani, chief resident for the University of Illinois at Chicago emergency medicine residency program. “At some point we decided to become self-reliant and demand fair working conditions not only for ourselves, but for what we see every day in terms of taking care of patients.”
Before the union at the University of Illinois at Chicago reached its first contract last year, first-year residents were making a little less than $60,000 a year for up to an average of 80 hours a week of work — an income that’s about minimum wage, if broken down hourly, Adnani said. Under the contract, residents were able to secure an 18.5% raise over four years and establish a committee focused on resident well-being, among other gains, he said.
“Any entity that relies so much on a pool of labor to operate should ensure their labor force is well taken care of,” Adnani said.
Residents at Northwestern, UCMedicine and West Suburban have not reached contracts with their respective hospitals, having unionized more recently.
They say they were inspired to unionize partly by the success at UIC and other institutions across the country.
Unionization has been growing
In general, unionization has been growing across industries in recent years, and enjoying strong support. About 67% of Americans surveyed in 2023 said they approved of labor unions, up from a long-term average of 62%, according to Gallup — an environment that has helped residents’ unions flourish.
The Committee of Interns and Residents — which represents doctors at Northwestern, UIC and UCMedicine — has seen its membership nearly double to more than 33,000 doctors nationwide since 2020. The committee is part of the Service Employees International Union and also represents doctors in California, Massachusetts, New Jersey and New York, among other places.
“There’s been a huge upswing,” said Dr. Philip Sossenheimer, a palliative medicine fellow at Stanford Health Care, who was on the organizing committee for the unionization campaign at Stanford.
In the past, doctors at hospitals on the East Coast were more likely to be unionized than those in other areas of the country, and it was more common at public sector hospitals, he said. For example, residents at Stroger Hospital in Chicago, which is a public hospital, unionized in affiliation with a different group, the National Union of Hospital & Health Care Employees, in 1974. The union at West Suburban is now part of that same group.
Now, residents at an increasing number of large, academic medical centers across the country are getting in on the action, including in Illinois, which has more union-friendly laws.
“There has been an appetite for this for a long time,” Sossenheimer said. “(Older doctors) all talked about similar dissatisfaction they had back in their day, but I think there are a few things that have changed.”
Residents are no longer mostly white men
For one, residents are no longer mostly white men with stay-at-home wives. About 48% of active, U.S. citizen residents with MDs in 2022 were white, and about 48% of residents and fellows were women in 2022, according to the Association of American Medical Colleges.
Residents are concerned about benefits such as parental leave, or freezing their eggs if they want to have children after their residencies, which can sometimes last as long as seven years, Sossenheimersaid.
There’s also been upheaval when it comes to the business of health care. In the past, doctors often practiced independently. In recent decades, that has shifted. In 2022, about 47% of doctors worked in private practice, compared with about 60% a decade earlier, according to the American Medical Association — a change that stems from the economic, administrative and regulatory burdens that can face doctors in private practice, according to the association.
“The generation that preceded us as physicians did not conceive of unionization as a thing because they weren’t employees,” Sossenheimer said. “They owned their own practices. That’s changed drastically in the last 15 years.”
That new reality means doctors must now contend with employers that are watching their bottom lines and often involved in mergers and acquisitions. They feel more uncertainty about their futures.
“What changed is these interns really began to think about themselves as employees … and maybe that long-term medical professional career might take longer to get,” said Robert Bruno, a professor of labor and employment relations at the University of Illinois at Urbana-Champaign. “The industry is changing, they might find themselves in a different labor market situation.”
Residents also say that COVID-19 was a catalyst for organizing. It was a stressful period for everyone in health care and, for many residents, highlighted their lack of power and standing at their institutions, residents say.
'Little protection'
“In COVID, when residents were certainly on the front lines in many places, they realized how little protection they had as residents,” said Dr. Mugdha Mokashi, who is finishing her second year of residency at Northwestern Memorial Hospital.
A big reason that Mokashi, who is on the bargaining committee for her union, wanted to unionize was to give residents more power when it comes to how the hospital functions. As a resident at Northwestern, Mokashi spends half her time at Northwestern Memorial and the other half at Stroger.
“We are caring for patients with the least amount of support, the least amount of resources, and despite that, we also have the smallest voice in how the health care system works,” Mokashi said. “We don’t have any say in how finances are allocated to the department. I think the people on the front lines should have an active voice in how funds are allocated and why.”
Vanessa VanDruff, a third-year resident at UChicago Medicine, said she wanted to unionize not because she dislikes her workplace, but because she cares so much about it. Residents want the power to help improve their hospitals, she said.
University of Chicago Medical Center said in a statement it “remains committed to continuing to foster an exceptional learning and care environment for our 1,040 residents and fellows.”
VanDruff said she believes the unionizations at UChicago Medicine, Northwestern, UIC and West Suburban are just the beginning.
“I think unionization of residents is going to spread to almost every institution,” VanDruff said. “I think it’s that important.”
