Penn Medicine residents seeking union may have a fight ahead. Here’s what comes next.

Residents and fellows at the University of Pennsylvania Hospital System (UPHS) asked their employer to recognize their newly formed union Feb. 17 with support from more than two-thirds of the prospective members.

Nearly a week later, the training physicians haven’t gotten that recognition from the university, so organizers filed paperwork with the National Labor Relations Board on Tuesday on behalf of 1,566 employees to move their effort forward.

In announcing their plans to form a union, the residents pointed to the fact that many of them work long hours, up to 80 hours per week routinely, for a flat annual salary. With medical school loans to repay and the costs of living in the Philadelphia area and commuting to Penn, many have found themselves under financial stress, the residents said. Their organizing effort began in earnest more than two years ago, when they were asked to take on additional shifts because of the COVID-19 pandemic.

It is unclear whether UPHS, which includes six hospitals and many more outpatient centers in the Philadelphia area, would support the union’s efforts. Asked about the unionization effort the day it was announced, a spokesperson for the hospital system noted that the salaries for house staff — another term for residents and fellows doing on-the-job training — have grown by 18% over the past five years, and will increase again in July.

“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,” the Penn Medicine spokesperson said in a statement. The health system did not respond to a request for comment on the union’s next steps.

Lack of recognition from the employer doesn’t stop the union in its tracks, but it does lengthen the process. Residents at Montefiore Hospital in the Bronx won a union election on Thursday. They had asked their hospital system to recognize the union in November, and had been drumming up support for a union since the early days of the COVID-19 pandemic, taking issue with lack of protective gear and hazard pay.

At Penn Medicine, “The residents want to move forward quickly,” said Annie Della Fera, a spokesperson for the Committee of Interns and Residents (CIR), a local of the Service Employees International Union. “They want to bargain their first contract.”

Here’s more on what could happen next.

Now that the Penn Medicine residents have filed a petition to be represented by CIR — with support from more than the required 30% of workers — the NLRB will investigate and make sure the proposed union meets the national labor law requirements before holding an election on whether to form the union.

Typically the election process at other CIR units has taken around a month or two, Della Fera said. It can be longer if the hospital system challenges the petition, or argues that certain employees should not be allowed to join the group of workers aiming to win a contract, known as a bargaining unit.

“What we’ve seen across the country in hospitals similar to Penn [is that] employers have a pretty strong response, pretty aggressive antiunion campaigns,” Della Fera said.

Filing a petition with the NLRB, as the Penn Medicine residents did on Tuesday, does not guarantee a union will form. Across industries and regions, 2,072 representation petitions were filed with the NLRB last year, but only 1,363 elections were held, and 1,041 of those elections resulted in a union.

Reaching a first contract between a bargaining unit and their employer usually takes about a year, Della Fera said.

The organizing committee at Penn, which has led efforts to form a union, has aimed to get input from people in different years of residency and in all departments and specialties. They’re planning to do the same if and when they form a bargaining committee to negotiate with the health system on a contract.

Organizing committee members said each department has its own work conditions — for example, working 80-hour weeks is far more common in some specialties than in others. A bargaining unit would want to focus on the issues that everyone can relate to, the organizers said.

“Almost everybody, regardless of what specialty you’re in, feels the pressure of student debt,” said Jackson Steinkamp, an internal medicine resident in his final year. “Things around cost of living adjustments and benefit increases commensurate with inflation are pretty uniting things.”

The votes to unionize Wednesday from close to 1,200 residents and fellows at Montefiore Hospitals-Moses Campus in the Bronx was the result of hundreds of one-on-one conversations among residents already balancing a grueling 80-hour workweek, and despite antiunion messaging from the hospital.

“The nature of medical training is it’s very busy, so it’s hard to do sustained, organized effort,” said Clare Wynne, a pediatric resident and one of the Montefiore labor leaders.

The lack of safety gear during the pandemic catalyzed union organizing, but discussions quickly turned to other problems, she said, including the need for parental leave, allotted time for studying, and more staff so residents, who are doctors, aren’t doing tasks like transporting test results.

University of Pennsylvania’s house staff should be prepared for plenty of resistance, residents with organizing experience elsewhere said. At Montefiore, the hospital system suggested unionizing could erase the unique qualities of each residency program, Wynne said, like morning coffee sessions or conference stipends. She had to convince other residents unionizing wouldn’t affect these perks.

Jessie Ge, a urology resident who helped organize house staff at Stanford Health Care in California, saw her employer make a similar case to residents, she said.

“It’s a lot of fearmongering, and residency is already so fear-based it’s easy to work,” she said.

At Stanford too, the pandemic provided the impetus for unionizing almost 1,500 residents and fellows, Ge said. The hospital excluded many residents from the first round of COVID vaccinations at the hospital even though they were frontline health-care workers.

“Residency is already so fear-based.”

“That got people fired up,” Ge said. “It was the first time hundreds of residents from across specialties were in one place talking about one thing.”

Another Stanford organizer, Philip Sossenheimer, described the difficulty establishing a network among house staff. They weren’t allowed to use their work e-mails to discuss unionizing business, and union lawyers recommended against it as well, he said, so they had to take the extra step of collecting personal contact information from people before getting them involved in the effort, the internal medicine resident said.

The culture of residency worked against unionizing efforts, Sossenheimer and Ge said. Residents’ time is consumed by work, leaving little energy for anything else. Some expressed fear of retaliation, either during their residency or in a subsequent job hunt, for being perceived as troublemakers.

The Stanford house staff successfully unionized in May after a 14-month effort, and retaliation hasn’t materialized.

“I don’t perceive any difference in how I’m treated at work,” Sossenheimer said. “If anything I think it’s benefited me. People admire it.”

The Penn house staff’s unionizing effort has another complicating factor: Residents have a defined end date. Many of the organizing committee members will be done with their residency this summer.

“The transient nature of this time period is really hard,” said Chantal Tapé, a family medicine resident in her final year, who is on the organizing committee. When residents raise concerns about their work conditions without the support of a union, she said, “it’s easy for institutions to rely on the fact that … eventually those residents are going to leave.”

Many of the physicians who helped organize the potential union will be finishing their residency in June and moving on to different jobs, and a new group of first-years will come to Penn and start their postgraduate training.

Since the initial efforts to form a union kicked off, the organizing committee has been reaching out to get newer residents involved and engaged in their efforts, Della Fera said, and that would continue with the next class of first-years.