Opinion | Residency Is Broken. We’re Unionizing to Fix It.

On its website, UMass Memorial Health states that the hospital system was created to “make health and healthcare available to everyone.” This mission is made possible by the “people of UMass Memorial Health” and their “relentless pursuit of healing in all its forms.”

As frontline resident physicians who work day in and day out to care for patients at UMass Memorial, this mission is also at the core of our values. That’s why we are bargaining for our first union contract: In order to ultimately improve residency for ourselves, those that come after us, and the people of central Massachusetts who need quality healthcare most. But unfortunately, since the bargaining process began this fall, the hospital system’s leaders have not been as responsive to our proposals as we would have hoped.

A Wave of Resident Physician Organizing

While the COVID-19 crisis dramatically exacerbated issues UMass residents face, our struggle to make ends meet and stay well during residency is nothing new. Before the pandemic, we came together and started the process of unionizing with the Committee of Interns and Residents (CIR/SEIU) to gain a voice at the table where we could better advocate for ourselves and our patients. When the pandemic struck, securing better conditions became even more urgent, as the inequities in our healthcare system were laid bare — and in light of the rapid changes that left residents scrambling to keep up within traumatizing and sometimes dangerous practice conditions.

UMass residents are not alone. In just the past few weeks, hundreds of frontline physicians at Stanford University Medical Center, the University of Vermont Medical Center, and the University of Southern California-Keck recently demanded union recognition with a supermajority of support — a landmark residents and fellows celebrated at UMass not too long ago. In labor organizing, this means over 65% of the bargaining unit voted to unionize, but so far, all of these employers have refused to voluntarily recognize their union. This refusal then forces workers to move to an arduous National Labor Relations Board (NLRB) election process, which can draw out for months and creates an array of complications. (Residents at nearby Greater Lawrence Family Health Center recently won their union through an NLRB election).

Importantly, establishing a union is only the first step. Next, the workers who are organizing must prepare to negotiate with management to approve a collective bargaining agreement, which is a contract between the workers and the organization or company that sets pay, benefits, and other conditions over a period of time. Although we have been organizing for years at UMass, our union protections won’t truly be secure until we sign our first contract.

At the Top of Our List of Demands

Among the most important demands in our contract negotiations with management is the pay we need to live and work in an area with an increasing cost of living. Currently, UMass resident physicians are barely making the state minimum wage when our hours are considered. But so far, UMass has denied residents the basic ask of a fair wage. Instead, they’ve made only a meager wage proposal that fails to keep pace with the cost of living in Worcester — where the main UMass Memorial campus is located — while continually refusing to acknowledge several of our proposals. However, this disregard is perhaps unsurprising given how undervalued resident physicians’ labor is nationwide, a fact reflected in everything from our pay and working conditions to the gaps in our labor protections and benefits.

During residency, many of us are working to establish ourselves in a new location, while in some cases starting families or bringing families with us. We must stretch our dollars to cover the cost of essentials, from rent to childcare to gas to groceries. According to RentData.org, the fair market rent for a two-bedroom apartment in Worcester was $1,450 per month in 2021, which is more expensive than 96% of areas the site calculates. At the same time, the average student loan debt for graduating physicians is almost a quarter of a million dollars.

It is disheartening, to say the least, that the hospital system has so far refused to give us what we need after all we’ve sacrificed during this global catastrophe. We have worked sometimes to the point of physical and emotional exhaustion while witnessing far too many patient deaths during multiple COVID-19 surges.

Working Conditions Impact Patient Care and Health Equity

This pandemic has made it clearer than ever that resident physician well-being and patient care are inseparable. UMass Memorial residents are willing to work 80 hours per week because we know exceptional care is critical to community well-being, but we are significantly underpaid for doing so. A meaningful pay increase and adequate health and leave benefits would mean that we would be able to better focus on caring for our patients without burning out or completely neglecting our families and our own well-being.

Fair pay and benefits for residents is also a matter of health equity. Currently, residency at UMass is unaffordable, which limits who can come work and train here. UMass Memorial cannot claim to care about the most vulnerable communities in Massachusetts while helping to entrench inequities during residency. Through our union, we hope to foster a more diverse body of residents within the historically oppressive systems of healthcare — starting with UMass.

Hospitals Must Respect Resident Physicians’ and Fellows’ Labor Power

The surge in resident physician and fellow organizing around the country shows it is long past time for hospitals like UMass Memorial Health to respect the labor power of residents — first by recognizing our unions and then by agreeing to contracts that reflect the importance of our work and patient well-being. Graduate medical education should not be a burden on would-be physicians. At UMass Memorial, we hope to ultimately make residency more sustainable financially and otherwise, so we can continue to provide the highest quality care to our communities without burning out.

We won’t stop fighting until UMass agrees to invest in its future physician workforce and to treat us with the respect and dignity we deserve. Our families can’t wait — and neither can the communities in Massachusetts who need quality healthcare the most.

Dipavo Banerjee, DO, MS, is a first-year psychiatry resident at UMass. Pratiksha Yalakkishettar, MD, is finishing her PGY3 year in family medicine and is staying at UMass Memorial as a preventive medicine fellow.