From the Community | Motivations for unionization among Stanford resident and fellow physicians

April 27, 2023, 1:24 a.m.

My name is Philip Sossenheimer, and I am one of the resident physicians who has been organizing with the Stanford Housestaff Union for the past two years.

The Stanford housestaff organizing committee was invited to present to the Faculty Senate in April to share our motivations around unionization, and also to reaffirm our commitment to the relationship between housestaff and faculty. This was part of a series of presentations meant to inform the Faculty Senate on this topic, and to that end Dr. Laurence Katznelson, Associate Dean of Graduate Medical Education, presented Stanford Health Care (SHC) management’s position at the Senate’s last meeting.

Unfortunately, only a week before we were scheduled to speak, our invitation was rescinded.

While I am disappointed in the decision by the Faculty Senate to rescind our invitation, I can’t say that I am surprised by it. And to a certain degree I can even understand it. The Housestaff Union is new to Stanford, and I recognize there may be fear and uncertainty around what that means for the relationship between housestaff and faculty. I want to be clear that all of us with the housestaff bargaining committee are committed to transparency and ongoing dialogue around these issues. We believe faculty have the right to understand our perspective and that through this conversation we can sustain the Stanford that we love.

To that end I want to make available the message that we were planning on sharing at the Faculty Senate, so that any faculty member who wants to understand our position has the opportunity to do so.


To understand our motivations for unionization I think it’s helpful to remember the origins of our movement. During the vaccine rollout in Dec. 2020 there were issues with the COVID vaccine allocation algorithm. This meant that only a handful of housestaff were included in the first wave of vaccinations — despite residents carrying a substantial portion of COVID-19 surge burden — and experiencing some of the most high-risk exposures along with other frontline staff.

From where we sit now, vaccinated with multiple boosters and with the mask mandate having ended, it could be easy to forget how high the stakes felt at the time, but for those of us working on the front lines during the surge, being systematically excluded from protection against the pandemic was exceptionally distressing. No other generation of physicians has trained in a pandemic to this scale, and our training is forever imprinted with the experiences of living and working as trainees in an unprecedented public health crisis. To say this time period has been difficult for residents and their families does not fully encapsulate the stress and strain of the realities of our collective experience.

But there were moments of hope during the pandemic as well. As a resident body, we saw in real time the power of collective action in response to the vaccine rollout. A group of residents organized a lunchtime unity break and by standing together in solidarity we were able to convince SHC to reverse course and offer all frontline housestaff vaccinations in the first wave. After that experience many residents and fellows began to wonder how else collective action could improve working conditions and elevate care delivery. Within a year we had launched a unionization campaign and won an election with a super-majority of support from residents across from SHC.

While the vaccine rollout was a catalyst for this effort, it was by no means the main driver behind unionization. Instead, for many of us, the rollout was a representation of the nature of medical training. It represented the lack of control we have over our working conditions, our personal safety and our increased vulnerability to exploitation.

Employees in other sectors have the ability to leave an unsafe work environment. They can apply for a new job, and they can leverage their experience and training to negotiate for a better contract. For housestaff, that’s not an option — we never get the opportunity to individually negotiate our contracts, and if we leave our training positions we may never be able to practice medicine. For us, the legal right to contract negotiation that unionization affords is one of the only ways we can have a voice in our employment conditions.

So, why unionize? We unionized because we want to foster a culture within medicine that empowers individuals instead of burning them out to keep physicians in the workforce, a culture that holds advocacy and self-improvement as a professional value, instead of prioritizing traditionalism and sociopolitical inertness. We are not here because we dislike our jobs and want to work less; we are here because we love our jobs and want them to nurture us and foster career longevity.

We are unionizing because we care deeply about our programs and want to empower housestaff to make the most of their training. Burnout among resident and fellow physicians continues to be a significant issue, and research shows that the quality of our working conditions can have an impact on the care that our patients receive — even the best doctors do not perform as well when they are overburdened and fatigued. That is why our union is bargaining for a new contract that can help address the root issues that housestaff face. We feel strongly that residents should not need to routinely sneak food home from conferences because their grocery budget is tight. That housestaff should have access to safe transportation home if they are too fatigued to drive safely. We believe that housestaff with disabilities should have equal access to call rooms. That lactating mothers who are choosing to come to work instead of spending time with their newborns should have clean spaces close to their work sites so that they can pump breast milk.

Fundamentally: we believe that people who dedicate the vast majority of their time to SHC should have a voice in what their contract looks like.

For me personally, the reason I have dedicated my own free time to unionize is because it creates this conversation. Before the union, there was no channel for housestaff to speak directly with hospital leadership on an equal footing. Unionization has helped level the playing field between SHC management and the residents and fellows who are an integral part of the SHC enterprise. It is my sincere hope that our union will benefit not only residents and fellows, but also program leadership and departmental leadership. Well-cared-for residents make everyone’s jobs easier. In my own program I have witnessed the struggle to reduce the caps on our services to make it easier for residents to attend educational conferences. I can’t help but wonder how much easier that campaign might have been if there had been a strong housestaff union in place to campaign alongside our program director.

I recognize that there might be anxiety about how this will impact the relationship between housestaff and program leadership. Our union is committed to maintaining those relationships. We hope that the presence of a union will strengthen the ability of program leadership to advocate for residents and fellows.

I imagine there has been lots of discussion among program leadership around the issue of “status quo protections” so I want to address those directly. Status quo refers to a provision in the National Labor Relations Act which bars an employer from unilaterally changing the terms and conditions of employment that are mandatory subjects of bargaining. The key word here is “unilaterally.” Let me be clear: our union unequivocally supports any programmatic changes that are intended to benefit housestaff and serve patient care. If any program leaders want to implement changes to improve working conditions for housestaff — we will support them. Our intention is not to stand in the way of progress. The status quo just means that the hospital cannot make things harder or worse; they can always make things better.

The Stanford Housestaff Union is driven by housestaff, and not by a third party. We have partnered with the Committee of Interns and Residents (CIR) to help represent us because they have the knowledge and experience to help us bargain with a very well-resourced hospital administrative team while we simultaneously continue to provide patient care. So let me touch briefly on what CIR is. CIR is the largest housestaff union in the United States, representing over 24,000 residents and fellows across the country. It is a democratically run organization, with leadership composed of elected housestaff from across the country. But when it comes to decisions made at Stanford, those decisions are made by Stanford residents and fellows. So who are we?

Well, we are the residents and fellows you work with every day! We have representatives from across the spectrum of specialties, and we have the support of a supermajority of all housestaff. We are surgeons, pediatricians and researchers. We are the first physicians that patients see when they come to this hospital and the last ones they see as they walk out the door. None of us want our relationship with our faculty to change because of this union.

I want to end by reflecting on the future of our profession more broadly, and how we can protect the role of physicians as leaders within healthcare. Over the past decade, and in particular over the past three years, we have seen a massive shift in the relationship between physicians and the health system we work in. Where physicians used to largely be independent, a majority of physicians are now employees of hospitals or other corporate entities. Stanford’s own Dr. Kevin Schulman has written about this issue, and poses the question of how we can, as a profession, maintain our professional independence as we lose our economic independence. These are issues that we all share — residents, fellows, attendings — and I believe that physician unions, including resident unions, are a valuable part of the solution. Historically physicians have been a fairly apolitical class, but with the change in the distribution of power between various stakeholders in medicine I believe physicians need to elevate our political consciousness and stand together as a profession to advocate for our interests and the interests of our patients. Unionization is not the only tool in our tool box, but it is an effective intervention for training physician-leaders while also improving their own working conditions.

So, while I am disappointed by the Senate removing our invitation to speak, I want to commit to continuing these conversations and remain open to anybody who has questions. I believe the Housestaff Union and program leaders can find innovative ways to improve the working conditions of housestaff and the care that we deliver. Our goal is to make Stanford the premier institution to train at and to perch it at the top of ranked lists nationwide.

Thank you all so much for reading.

Philip Sossenheimer is a third-year internal medicine resident at Stanford Hospital, and will be staying on at Stanford as a fellow in palliative medicine. He has been involved as an organizer for the Stanford Housestaff Union, which is currently negotiating its first contract.

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