MMedicine is a vocation. But far too often, trainees—residents and fellows—in hospitals don’t receive the support they need to provide the best clinical care. Overworked, underpaid and undervalued in a time of skyrocketing paperwork demands and historic inflation, interns sometimes struggle to make ends meet, take care of themselves and of their loved ones, and even to find joy in the daily life of learning to be an independent doctor.
In response, many interns are asking for unions, including at Mass General Brigham, where I am currently a third-year orthopedic surgical resident. But while many view unionization as a “yes” or “no” proposition, at this time, I suggest a third option: a pause.
A year’s pause and reevaluation would allow us to sift through the alarmists on both sides of the organizing debate, to consider what has already been done in good faith by Mass General Brigham, and to allow all voices to be heard better.
On the pro-union front, fellow interns argue that concessions recently made by Mass General Brigham — including a 10% pay raise, an additional $10,000 per year stipend, free health insurance and pension contributions 2% annual base – are “just the beginning” of the benefits a union would guarantee. Although attractive, it is false. Nothing in the law requires that a negotiated union contract be better or offer more benefits than the basic “starting point”. In fact, it could even be worse, and compromises are a natural result of union negotiations. While interns from other institutions that have unionized have “earned” some key benefits, none compare to the significant increase in benefits interns at Mass General Brigham have received, which will make us the best residents. paid from the country starting next year.
On the anti-union side, leaders at Mass General Brigham have suggested that unionization could have a negative impact on mentoring between interns and faculty. While the process of organizing can be seen as contradictory, the expectation that the day-to-day relationships between trainees and treating physicians will be negatively impacted may be an extreme view; I could not find any health care literature to support this position. Further, this argument assumes that physicians who have chosen to pursue careers in academic medicine will change their approach to trainee training in response to unionization efforts. I find that hard to believe.
There are many other statements – frankly speculation – made by the camps for or against unionization. People who want more flexibility and specialty-specific changes in their educational programs and leave requests tend not to unionize. Those who prioritize a guaranteed seat at the table lean toward unionization. And the list continues. I hear the arguments made by my fellow trainees and by my fellow leaders of Mass General Brigham. I respect and appreciate both sides, and urge everyone involved to truly assess only the facts, not the hyperbole.
It is undeniable that interns deserve better and for a long time. We arrive early at the clinic or hospital and stay late. We make personal sacrifices, often going the “extra mile” to provide the best care, even when it’s not optimal for us and our families.
But no one knows what a union with Mass General Brigham will or will not accomplish. The only scientific literature on the subject, which was published in JAMA Network Open, demonstrates No improvement in school environment, pay, work hour violations, abuse, burnout, suicidal tendencies, or job satisfaction.
What we all want are actions and solutions that will make a difference in our lives and those of our patients. But whatever the motive behind Mass General Brigham’s recent benefits announcement, we have already accomplished so much without unionization. So while many pro-union interns believe – although there is no clear evidence for this – that recent benefits changes were prompted by Mass General Brigham’s desire that we not unionize , does it even matter? While this may not sit well with some interns, the more important question becomes: can we really do better with a union? Maybe, but any gain will involve trade-offs.
I am not trying to persuade anyone to vote for or against the union and ultimately I think it is essential that all parties speak up and vote. But for now, I just want everyone to do what we do every day in medicine – take a deep breath, look at all the facts, make the best decision possible, and only then act. In my mind, this requires a pause in the current high-speed push and an equally adamant opposition to unionization based on a mixture of emotion and assumption with a “pinch” of fact. We need to see how Mass General Brigham’s new promise of teamwork and leadership benefits positively impact our lives and the lives of our patients over the next year – or not. Without it, I fear the interns will be perceived as vindictive rather than focused on what we can actually achieve for ourselves and our patients and no olive branch – whatever the benefits – of mass general Brigham will would have been enough to appease us.
If I’m to vote now, I’m a ‘no’ to unionization because, in part, interns have already won – we’re now on our way to being the highest earning residents in the United States and we’ll continue to be educated by some of the best and brightest attending physicians in the world.
However, I urge the pause and remind my fellow interns that even if the recent changes were an attempt to stop organizing efforts, then it is clear that any power we wield derives from the legitimate option to unionize and of the ingrained benefit of going on strike in a “worst-case scenario. But I have to admit that doesn’t sit well with me, even though it would be an extraordinarily rare case. I can’t imagine hitting and putting patients at risk.
The best way to think about organizing is that it – and the interns’ ability to jump-start the process if our voices are silenced or our progress is reversed – is the trump card up our sleeve to protect us and our patients.
At least for now, this is not the time to play it.
David N. Bernstein, MD, MBA is a resident physician in the Combined Harvard Orthopedic Residency Program, based at Mass General Brigham.
Read a counterpoint by another third-year resident at Mass General Brigham who votes for the union.