Penn Medicine residents and fellows want a union, citing grueling workloads and 80-hour workweeks

Resident physicians and fellows at University of Pennsylvania Health System have launched a unionizing effort, joining thousands of training doctors across the country who have organized in pursuit of better working conditions since the onset of COVID-19.

More than 1,400 residents and fellows work for Penn Medicine, and more than two-thirds of them have agreed to be represented by the Committee of Interns and Residents (CIR). CIR officials presented a letter to the hospital system on Friday on their behalf, asking the health system to recognize the union.

If successful, they would be the first group of such doctors — known in the industry as house staff — in Pennsylvania to organize with CIR, which is part of the Service Employees International Union. The union has seen an uptick in organizing at teaching hospitals, with 3,500 residents and fellows joining CIR in the past year, according to a spokesperson.

Organizing committee members were driven in part by grueling conditions they faced during the pandemic, they said. They were expected to pick up extra shifts without any additional pay because they are salaried. Even outside periods of peak COVID-19 spread, an 80-hour workweek isn’t uncommon in many departments, organizing committee members said.

“Residency is always hard. We all came into this knowing we were going to work really hard and learn a lot and take excellent care of our patients,” said Chantal Tapé, a third-year resident in family medicine at Penn and member of the organizing committee. But “not everyone is aware how often residency is a very exploitative part in your working life.”

Recent cost cuts at Penn also fueled the organizers’ motivation. The university gave no raises in 2021 and announced an end to subsidized parking benefits last year, they said.

“We believe that our trainees will best be served by working directly with UPHS administration through our existing Graduate Medical Education Committee structure, which will continue its commitment to a collaborative, flexible approach which ensures strong human resources support for house staff,” a Penn Medicine spokesperson said in a statement Friday.

Resident and fellow salaries last year started at about $65,000 for doctors in their first year post-medical school, up to about $89,000 for doctors in their ninth year of postgraduate work. In July, the pay scale will be adjusted so salaries are between $69,000 and $94,000.

If a first-year resident works a 40-hour week, that would come out to roughly $33 per hour. But in an 80-hour week, it’s more like $16.50 per hour — and that’s without factoring time-and-a-half pay, which would be required for hours in excess of 40 per week if workers are paid by the hour.

For many, their take-home pay is quickly reduced by student loan payments. The average doctor has about $200,000 in medical school debt, and that doesn’t include any loans they took on for undergraduate education.

“That makes this pathway accessible to only a certain subset of people … who are socioeconomically able to do that,” said Jackson Steinkamp, a third-year internal medicine resident. He considers himself lucky because he took out only federal loans. Since 2020, federal borrowers were able to delay their payments as part of a COVID-19 relief program, but that is set to end this year.

In the last three years, private loan payments were still coming due. Madison Sharp, a third-year OB/GYN resident at Penn, currently spends over $500 monthly to repay private loans, which she used to fund about half of her education. Soon, she will begin having to pay off her federal loans as well, increasing the monthly expense. “That’s a real financial barrier for most residents and fellows,” Sharp said.

Other areas of concern among organizing members include heath-care benefits, parental leave, and child-care support. Residents in each department have certain other items they would like to negotiate, committee members said, but the unifying theme is that they want to break down silos between specialties and win a seat at the table to help decide how the health system operates. This includes decisions on how doctors care for patients.

“House staff are normally forced to advocate for ourselves and our patients separately because of our specialties,” Sharp said. “We’re really at the whim of departmental policies.”

Asked about the issues raised by unionizing residents, Penn Medicine’s spokesperson noted that the health system has made investments to stay competitive in the field, including increased salaries and benefits such as employer contributions to retirement, tuition reimbursement, and public transit subsidies.

”Residents and fellows are a crucial part of our health system, as both employees and learners, and we highly value their daily contributions to patient care across each of our training programs,” the Penn Medicine spokesperson said. “We are proud of the ways in which we have sought to continually improve resident life and wellness, including during the unprecedented clinical and financial pressures brought by the COVID-19 global health emergency.”

Residents at a hospital have completed medical school and work directly with patients under the supervision of attending physicians to continue their training. First-year residents are sometimes called interns, but the Accreditation Council for Graduate Medical Education (ACGME) no longer uses that term.

The postgraduate working education varies in length depending on specialty. Afterward, doctors can begin working in that specialty outside of the training atmosphere, or they may pursue a subspecialty as a fellow. Once doctors finish residencies and fellowships and become attending physicians, salaries increase dramatically.

Residents across the U.S. used to routinely work more than 80 hours a week, some even racking up more than 100 hours weekly on a regular basis. ACGME implemented an 80-hour workweek limit two decades ago and continues to evaluate limits on resident work hours in the name of patient care quality and resident well-being.

The residents who agreed to unionize work at the Hospital of the University of Pennsylvania in West Philadelphia and Pennsylvania Hospital in Society Hill, according to CIR.

In addition to annual compensation, resident benefits at Penn currently include four weeks of paid vacation and three personal days per academic year; six weeks of paid parental leave and up to six more weeks unpaid through the Family Medical Leave Act; health coverage for the resident and their family, as well as malpractice insurance, disability insurance, and life insurance.

While the organizing members of Penn’s residency programs hope to improve their own working conditions, they are also looking to set precedents to help future medical professionals.

“A lot of people who would be great doctors either burn out during the process or who are deterred from going through the process to begin with because of what it asks of people during the residency and fellowship period,” Steinkamp said.

Steinkamp, Sharp, Tapé and many of their colleagues on the organizing committee are in their final year of residency. But they said they’re excited about the efforts they’re making now, in hopes that it will create a foundation for future residents to advocate for themselves and their patients.

“The most important thing for me is having the union as a mechanism to make it so that not just current residents, but residents 10 years from now, have a space and a voice,” said Tapé. “Supporting us and taking care of us helps us to take care of our patients. It’s a win for everyone involved.”