CHOP resident physicians have voted against joining a union

Resident physicians and fellows at Children’s Hospital of Philadelphia have voted against forming a union, a month after more than 3,000 medical residents from around the region announced plans to unionize.

In late December, 178 CHOP residents voted in favor of a union and 195 voted against joining — a 17-vote margin, said Natalie LaBossier, a second-year pediatrics resident at CHOP who worked to organize the vote. The residents had sought to join the Committee of Interns and Residents, a division of the Service Employees International Union.

In a statement, a CHOP spokesperson said that the hospital believes “the best employee experience is achieved by direct, two-way communication and collaboration and will continue to partner with our residents and fellows to find ways to improve or strengthen that experience.”

“We remain committed to developing positive and productive relationships with all of our workforce members regardless of union status,” the spokesperson said.

In November, CHOP residents joined resident physicians at Temple University Hospital, Thomas Jefferson University Hospitals, Jefferson’s Einstein Healthcare Network, and the Delaware-based ChristianaCare to announce plans to unionize. The organizing residents said intense hours, burnout, and a lack of support from higher-ups at their hospitals had spurred them to form unions.

CHOP was the first hospital in that cadre to hold a union vote. Residents at the other hospitals are set to vote in mid-January, said Melissa Uribe, a CIR spokesperson. Another group of residents at the University of Pennsylvania health system, which is affiliated with CHOP, successfully voted to unionize in 2023.

“Ultimately, at CHOP, when the residents are ready to try again, we’ll be here for them,” Uribe said.

Matt Eiman, a second-year resident in pediatrics at ChristianaCare, said that he had been surprised by the CHOP vote and felt for residents there who “deserve a say in their contract and work-life balance.”

Still, he said, he felt confident about the upcoming vote at his hospital.

“It’s given me some urgency [about] having as wide a reach as possible. Our numbers have shown us this is a very popular cause, and there are a lot of residents and fellows that are in favor of it,” he said. “But these elections aren’t guaranteed and we’re making sure to do everything we can to get the vote out.”

Uribe said that CHOP officials had engaged in “anti-union tactics” ahead of the vote but did not clarify what those tactics were. LaBossier said that votes are private, so it’s difficult to know exactly what swayed some residents and fellows toward voting against the union, but said that “some of the language” employed by CHOP during the campaign “was more focused on discouraging fellows from voting ‘yes.’”

Fellows are doctors who have completed residency, the initial portion of a doctor’s training, and are undergoing additional training in a specific medical specialty, like pediatric endocrinology.

“Pediatrics is in a difficult time in general due to government disinvestment,” LaBossier said, “and CHOP really capitalized on trainees’ fears about future employability in order to discourage unionizing.”

LaBossier said that while she was disappointed in the outcome of the vote, she said residents who want to unionize will continue to organize.

“Even since the election result, I’ve spoken to several people who feel even more motivated to get involved with our effort,” she said. “I’ve had some conversations with people who were disappointed in themselves, and who asked me when can we try again.”

The union drive had taken place relatively quickly. The process can typically take years, though some residents had been working towards formally proposing joining a union for some time. At CHOP, LaBossier said, residents organized for “well over a year” before announcing their plans last fall.

Union officials said in November that they wanted to hold union votes at the organizing Philadelphia hospitals before Republicans take control of the White House.

CIR president A. Taylor Walker said officials were concerned about President-Elect Donald Trump’s attitude toward unionizing graduate students, including medical residents. In 2019, Trump’s National Labor Relations Board, presidential appointees who enforce the country’s labor law, proposed that graduate students should not be considered employees.

That would mean that graduate students would lose the legal right to unionize, and universities would be free to allow or reject a graduate student union outright without involving the NLRB.

In 2021, the NLRB — though it was still operating with a majority of Republican appointees — announced that it would withdraw the proposal. Currently, the board has two Democratic appointees and one Republican appointee.

“You’ll see Republican presidents install a board that is more pro-management, and you’ll see Democratic presidents install a board that is more pro-worker. And I think our pro-worker policies over the last four years is why we have been able to double in size at CIR,” Walker, who is also the chief resident in family medicine at Massachusetts’ Cambridge Health Alliance, said in November.

Still, Uribe said, “it’s not accurate that the Trump administration is in any way going to hinder our efforts” to organize residents, including those at CHOP.

“It’s no secret what’s at stake with the NLRB,” she said. “But we’re going to move forward regardless of who’s in office.”

More and more residents around the country have begun to join unions in recent years, and about 20% are currently in a union, despite entering a profession that has historically not been part of organized labor.

But residents in particular have cited grueling working conditions and relatively low pay in their efforts to unionize. In residency, the final phase of a doctor’s training, physicians can work up to 80 hours a week for, on average, about $61,000 a year. That’s less than other professionals who require special training, like flight attendants and electricians, the New England Journal of Medicine’s Resident 360 website reported.

Even outside of residency, most doctors are now employed at health systems instead of running their own practices, making collective bargaining more attractive to some — including in the Philadelphia region.

ChristianaCare attending physicians last year became the region’s first group of unionized doctors who have completed their training.

Residents at Penn and the Rutgers University health system finalized their first contracts with their health systems this fall. Those successful efforts galvanized residents at CHOP and other health systems, the group said in November.