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The Hospital of the University of Pennsylvania - Pavilion on Jan. 30. Credit: Abhiram Juvvadi

Residents and fellows at the University of Pennsylvania Health System are working to unionize, citing "fundamental concerns" about their experience.

On Feb. 17, the Committee of Interns and Residents sent a letter to the Health System demanding that the hospital system recognize the unionization efforts of their residents and fellows. Over two-thirds of the over 1,400 residents and fellows who work at Penn Medicine are represented by CIR, the largest housestaff union in the United States, which is directing the unionization effort. 

The University did not confirm the CIR’s request for voluntary recognition of the union by the Feb. 21 deadline given in the letter. In response, the Penn Med residents and fellows filed for an election with the National Labor Relations Board to gain recognition with the CIR, according to a press release sent to the DP.

“This historic move makes the Philadelphia doctors the first housestaff to organize with CIR in Pennsylvania, a state without any unionized residency programs,” the CIR press release said.

A Penn Med spokesperson wrote on Feb. 17 that residents are a "crucial part" of Penn's health system.

“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 housestaff," a Penn Med spokesperson wrote to the DP.

The spokesperson pointed to efforts to improve resident life and wellness, such as a raise to resident salaries effective in July 2023 that will increase first-year salaries by nearly 7%, with subsequent increases ranging from 7% to 11% as residents move through the program. 

The spokesperson also said there are a number of other benefits that residents receive, including retirement employer contributions, subsidized public transportation and tuition, national testing, and medical license reimbursement.

By unionizing, organizers told The Daily Pennsylvanian that they hope to achieve more representation and better work conditions. 

Madison Sharp, a third-year OB/GYN resident and member of the organizing committee, said that the letter from Penn Med residents and fellows marks a milestone in an ongoing unionization effort that began in fall 2020. Sharp said that a surge of COVID-19 in January 2021 drew more attention to the issue across all housestaff.

Chantal Tapé, a third-year resident in family medicine and organizing committee member, told the DP that the COVID-19 pandemic was a wake-up call.

“For many of us, the pandemic was an awakening in recognizing that the work we do is really essential to the health care system and that our concerns as residents aren’t prioritized in the ways they need to be,” Tapé said.

The organizers said that their movement is not focused on any one issue, but rather on “having a seat at the table” and a say in hospital policies that directly impact them. They hope to enact change that will allow all future residents to be actively involved in conversations about them.

The organizers said that one driving factor in organizing the movement is resident salaries. The residency program salaries at Penn Med currently range from $61,000 to $70,000, and resident physicians often work up to 80 hours per week — which amounts to a maximum hourly wage of $16.50 for a first-year resident, the organizers said. In addition to living expenses, residents have an average of $200,000 of medical school debt to pay off.

Medical students are placed in residency programs through the National Residency Matching Program, which requires them to accept the contracts offered to them. Residents cannot leave their programs for a more lucrative offer, which means hospitals have little incentive to raise wages, the organizers said.

“We came to work hard, learn and take great care of our patients,” Tapé said. “We’re not opposed to putting in the work, but it doesn’t feel like the salary and benefits we receive reflect the great care that we provide our patients and the revenue we bring to the hospital.” 

Recent cost reduction efforts were another driving factor for residents. Tapé said that they received no salary increase in the 2020-21 academic year. In addition, a recent announcement informed residents that subsidized parking will be ending in June, which impacts those who work at multiple hospital sites or opt to live in more affordable areas farther from the hospital. 

“[The parking loss] made us feel like even the benefits that we do have could be taken away at a moment’s notice,” Tapé said. “There was very little openness to resident concern about that.”

The GME Program — which the Penn Med spokesperson pointed to as a place for trainees to seek human resources support — has a House Staff Governing Council consisting of housestaff who advocate for resident and fellow needs, working with GME leadership to improve patient care and quality of life. Sharp and Tapé, who have both been involved with the council, said that it has failed to make substantive progress.

“It’s incredibly frustrating to have our concerns brushed aside,” Sharp, a former president of the council, said. “After struggling to advocate for my colleagues and not being listened to, it became clear that we really need a union. We’re at the whim of hospital and departmental policies that are subject to change, and we need to be able to better advocate for ourselves.”

The organizing committee plans to continue discussing the benefits of unionizing with other housestaff while continuing to advocate for their right to unionize.

“We hope that Penn will voluntarily recognize our union given that we have a supermajority of residents and fellows who want one,” Sharp said. “But given the response, that seems unlikely, in which case we will move forward with our campaign to compel them to come to the negotiation table.”