Physicians and medicine. (Credit: Online Marketing/Unsplash)
The group of physicians are from Children’s Hospital of Pennsylvania, Thomas Jefferson University Hospitals, Temple University Hospital, and Einstein Healthcare Network.
Following in Penn Medicine’s footsteps, over 3,000 residents and fellows from four major hospital systems in Philadelphia announced their plans to unionize last week.
The energized crowd of white coats struck a defiant tone on the steps of the now empty Hahnemman University Hospital, the former teaching hospital of Drexel University. Alongside lawmakers from the region, they chanted “union strong.”
A cardboard cutout of Philadelphia’s Gritty, complete with his own lab coat, stood beside them.
The 2019 closure of Hahnemman in the northeast section of the city displaced more than 570 residents and reduced health care access to the majority low-income and minority population that it served.
After being sold to the for-profit American Academic Health System, the hospital wasn’t able to bring in enough revenue to keep its doors open.
The group of physicians from Children’s Hospital of Pennsylvania, Thomas Jefferson University Hospitals, Temple University Hospital, and Einstein Healthcare Network, stood with leadership from the Committee of Interns and Residents, an affiliate of the Service Employees International Union.
Dr. Taylor Walker, president of the committee, described Philadelphia as “the poorest big city in the country,” with “deeply entrenched” inequities. Accessing health care is out of reach for many, and when patients from these neighborhoods do come for treatment, medical providers are stretched too thin.
“This means that Black and brown communities have been especially devastated by health care profiteers who prioritize profit over patients,” she said.
The committee has over 34,000 members across the U.S., a figure that has more than doubled over the past three years. In May 2023, roughly 1,400 residents and fellows at Penn Medicine became the first in the state to unionize.
Some organizers see the movement's growth as reflecting increased diversity in the medical field, spurring development with new perspectives and demands.
“The residents and fellows who steward our world class institutions deserve world class wages and world class contracts,” said Philadelphia Councilmember Jamie Gauthier. She stood alongside several other politicians supporting the initiative, including state Rep. Rick Krajewski, D-Philadelphia.
A common theme underscored was an inability to influence working conditions while being asked to complete work outside the scope of a physician. Several reported working 80-hour weeks made up of shifts exceeding 24 hours and covering a dozen or more patients, giving them little space to attend to their own needs.
“Residents and fellows serve as cheap labor because we know that we cannot do the job we’ve trained for the past ten years to do unless we finish residency,” Walker said.
For some, the burden is too much to bear. Dr. Matt Nguyen, an internal medicine physician at Einstein described learning of the death of one of his colleagues by suicide, an occurrence that claims the lives of as many as 400 doctors annually in the United States.
“She deserved a place where she felt safe to express her needs, her struggles, and her fears, where she had the support she needed to thrive during residency,” he said. “This system failed her, and this system needs to change.”
Mental health care is a particularly touchy issue within the medical community. Many fear that seeking it out could jeopardize their future and even impact their ability to receive licensure in certain states.
The hope is that once in place, unions at these institutions can negotiate better contracts. In a conversation with The Center Square, Annie Della Fera of the committee said that the shop at Penn had won an incredible first contract, creating momentum workers from hospitals across the country hope to continue.
“The most important thing we are asking for is a seat at the table,” said one psychiatric resident at Jefferson in conversation with The Center Square. “The process of a match is unlike any other job in that an algorithm puts us in a binding and non-negotiable contract.”
According to the committee, one strategy employers use to dissuade workers from organizing is to mislead them about what union contracts really are, leaving many unaware that the workers themselves negotiate the terms.
In a statement to multiple media outlets, a Jefferson Health spokesperson said residents have access to competitive wages and benefits and “exceptional training.”
“While we respect our residents' right to explore unionization, we believe that a direct working relationship between our health system's team members and our leaders results in the most empowered and productive teams,” the statement said.
Critics argue that unionization will only increase costs for the roughly 3 million residents enrolled in Medicaid. In 2022, the Department of Human Services, in consultation with SEIU, drafted new agreements for the HealthChoices Medicaid Managed Care that, absent a collective bargaining agreement, would exclude from the approved care network providers with work stoppages that had occurred within five years.
At the time, the Hospital and Healthsystem Association of Pennsylvania, which represents 240 facilities across the state, expressed concern that the contracts would “improperly inject a subsidiary policy goal – mandating health care unionization – into a program that is designed to provide access to care to vulnerable and low-income Pennsylvanians.”
The department dropped the language from its Medicaid contracts in May 2022.
