The place for unions in professions that cannot unionize
We are witnessing a wave of union drives among medical residents, despite not being able to form unions after becoming fully licensed.
One of the things that I was both surprised and not surprised to learn when I took a labour law course in my second year of law school was that professionals, such as lawyers and doctors, are not allowed to form unions in Canada, and many other countries, including the United States. While I was surprised that there was a specific prohibition, it seemed inherently logical.
Lawyers, for example, have a tremendous amount of control over their working environments. They set their own work hours, conditions, and rates. Doctors, while possessing somewhat less flexibility, are still in a position to exercise tremendous agency over much of their professional environment. The same cannot be said of medical residents, the doctors completing their apprenticeship years between school and licensure who fill so many hospital shifts. They lack control over the locations they are sent, hours they work, and are frequently compensated at a rate below minimum wage when considering the ratio of hours worked to salary received. This situation has prompted a wave of union votes by medical residents at hospitals across the United States.
Medical residents fall into a bit of a strange place when it comes to their student and employment status. Professional students, like medical and law students, are not graduate students. These programs are instead included under the wider umbrella of undergraduate education. This means that medical students and residents fall beyond the parameters of the graduate student workers’ unions that have formed at several American universities. Medical residents, though they are, by definition doctors, have not yet met the mandatory requirements to be licensed to practice independently, which would put them into the category of professionals who are not permitted to form a union. Instead, medical residents are both students who pay tuition to the university where they are affiliated, and members of staff who work full time in hospitals and clinics as salaried employees.
This situation is one that is unfortunately frequently exploited by hospitals, a prominent example being the events leading to a successful union drive at Stanford Medicine which included omitting medical residents from the Covid-19 vaccination plan for hospital staff. Or the events leading to the organization of a union drive among medical residents at Penn Medicine that included removing parking benefits (costing residents an average $200 a month); dirty call rooms, some containing cockroaches; and salaries that have not kept pace with the rising cost of living.
Unionizing does not inherently guarantee that all of these problems will be fixed. Just because a union vote is successful does not mean that the collective bargaining agreement will include terms that substantially alter the working conditions for medical residents. It also does not necessarily mean that future negotiations of updated collective bargaining agreements will include sufficiently inflation adjusted pay increases. However, it would certainly make it easier to, at the very least, have these issues called to attention. Without a form of collective representation, it is very difficult if not impossible for medical residents who rely on their place in residency programs to complete a necessary component of their licensing process, to advocate strongly for better pay and working conditions.
One of the unique features of medical resident unions is the short duration during which an individual can be a member. In most fields where unions are common, including postal workers, teachers, or the various industries covered by labour unions, workers join at the beginning of their career with the intention of remaining a member until retirement. Medical residents will be members of their respective unions for a mere 2-5 years while they are completing residency program. This differs even from graduate workers’ unions, as these commonly feed into unionized academic positions. Instead, medical residents will transition from being represented by a college bargaining agreement to a situation where they do not have the opportunity to form a union.
Could the increase in successful union drives result in a push to allow licensed professionals such as doctors to form unions? It’s unlikely. Many of the situations which give rise to a desire to form a union during residency will no longer be at issue once young doctors graduate into the role of attending physician. Furthermore, the guiding principles that prevent licensed professionals, like attending physicians, are not altered by the presence of unions at the post-graduate medical residency level.