Medical residents and fellows at Montefiore Medical Center in the Bronx are trying to form a union, citing the need to fight overwork and understaffing that’s endangering patients. Jacobin spoke with unionizing doctors about their organizing drive.
A mural honoring health care workers at Montefiore Medical Center in the Bronx is seen on the side of a building in Midtown Manhattan, May 11, 2020. (Timothy A. Clary / AFP via Getty Images)
In early November, medical residents and fellows at Montefiore Medical Center in the Bronx announced that they were seeking to unionize with the Service Employees International Union Committee of Interns and Residents (SEIU CIR). Montefiore is a safety-net hospital, serving lower-income residents of the Bronx; it is also one of the country’s premier training hospitals for new doctors. If the organizing drive is successful, the Montefiore bargaining unit will represent over one thousand doctors.
The doctors who are attempting to unionize Montefiore complain of dangerous overwork and understaffing that is undermining patient care; the hospital has refused to voluntarily recognize the union. Jacobin’s Sara Wexler interviewed Montefiore family medicine resident Noa Nessim and psychiatry resident Aubrey Vinh on Friday, November 18, about why doctors are pushing for unionization and what organizing efforts have been like so far.
What made you all decide to unionize?
It’s been a long time coming. There’s a very clear need for health care workers who are on the ground every day, seeing how awfully health care can be delivered in this current health care system, to have more power in the decisions that are made about how health care gets delivered and how resources get distributed. That’s at the core of what’s driving a lot of us to unionize — feeling like we need to have more say in our workplace.
Something I noticed when I was on the interview trail was that programs that are unionized are so proud of it and have really substantive infrastructure to back what unions bring, not just to residents but also to patient populations and your ability to advocate for patients. So, I had already come to Montefiore knowing that I wanted to be part of the unionizing effort, which I had heard whispers about from talking to current residents.
We’re seeing a lot of labor organization right now and seeing that unionizing is a very powerful tool for advocating within these capitalist [health care] systems.
Before you got here, there was already talk of unionizing. It’s been going on for a bit?
Yeah. Aubrey started in July of this year; I started my residency in July 2020. At that time, there had already been conversations about it among residents. It was that year, 2020 to 2021, that we started seriously trying to organize a union. And the Committee of Interns and Residents (CIR) came on board to support our efforts around January 2021.
What were the main drivers that convinced you and other residents to take on this battle? Was it the hours, pay, and working conditions in general or seeing other residency programs having a union?
It was a combination of all those things. Something that I heard of prior to arriving at Montefiore was that the inequities and lack of support for residents revealed by the pandemic got the ball rolling. In terms of an organizing effort, people were speaking out about personal protective equipment (PPE) and about access to vaccinations. That was a tipping point
It’s known among the residents that you have to put in a lot of extra effort to make sure that patient care gets done. It’s a pretty easy starting point when somebody has been on the phone trying to get a patient down for imaging for the better half of a day. You can turn to them and say, “If we had more staffing, this would be different. And that’s something that we would advocate for if we had a union.” Everybody is on board with that.
When somebody has been trying to get a patient down for imaging for the better half of a day, you can turn to them and say, ‘If we had more staffing, this would be different.’
Also, residency is an inherently coercive system: we all sign a contract that we’re matched to without much chance to advocate for better benefits. Knowing that as a baseline about the residency system, unionizing is pretty intuitive to most people in residency and fellowship programs.
Having had conversations across different departments at Montefiore, one of the main problems that comes up over and over again is staffing. It’s not even staffing of residents and fellows, although that is also a problem; it’s staffing of phlebotomists, nurses, CNAs, EKG techs, transport — all of the support systems and all of the workers in the hospital that get things done and carry out the care that we are, in some ways, dictating as doctors.
Without enough staffing of folks that actually make the care happen, it becomes incredibly frustrating and labor-intensive to do our jobs. That’s been, I think, the number-one issue that comes up most consistently. And while I agree that it can be intuitive for a lot of people once the question is asked, I do think that, for a lot of people, the question has not yet been asked.
The way capitalism makes so many workers believe that the way that their job is defined and carried out is normal and ok . . . residents think that working eighty hours a week is normal and not having breaks is normal. But once you raise the question, “Do you think it really has to be like this? What if we could say, ‘We need x number of staff’? What if we say we need to get paid when we get called in to work a shift that someone else was supposed to work but they got sick?” Once you ask that question, it can become very, very clear.
How has organizing been so far?
We have extremely strong support for the union among residents and fellows and even attending physicians that we work with; the nurses also have buttons in solidarity with us. That said, we work so many hours a day, it’s hard to mobilize when people consistently think so much about patient care and their duty to their patients and also the hours they are obligated to work. It is really hard to get people to find one moment in their schedule that aligns.
Also, we’re disparately organized across different residency programs and hospitals. So much of this has required one-on-one outreach. All of that is an enormous burden on our already quite taxing schedules. We’re lucky to have CIR staff making sure that we push things forward. But inherently, it’s the things that make residency difficult that make organizing within residency difficult.
I also think it’s hard for some doctors to think of themselves as workers who could be in a union. That has been a challenging narrative to confront, and part of that is because we know that, as attendings, we will make more money, and we will have a better quality of life, so this residency time and fellowship time are billed as a temporary, you-pay-your-dues situation, and then you go on to have the life that you actually signed up for.
Enough [doctors] are concerned about the health care that they’re delivering to question whether we should have more power and more say.
A lot of people are hesitant to fight back and take any risk when they know that life is around the corner. So, that is a challenging narrative to confront. But enough people are concerned about the health care that they’re delivering to be able to question our material reality and question whether, in fact, we should have some more power and more say or voice.
Within the medical community, there’s this narrative: this is your calling, this is your passion, and therefore you are expected to sacrifice. You’re expected to work really abusive hours, and you’re expected to give because this is what you’re meant to do.
I agree with that on some level — that’s why I chose medicine. But a lot of that is just us gaslighting ourselves or being gaslit by a program that has profited off of resident labor, and truly could not function without residents. So, I would add to what Noa is saying, that it’s difficult to organize when so many people have that narrative at the forefront of their minds, as supportive of the union as they are.
What are your demands?
A seat at the table is a huge one — just a say in how things happen in our workplace. Safe staffing is another one.
Support for parents and families and then fair compensation. Another demand is making sure that Montefiore invests in the Bronx, continues to support the clinics there, and makes sure that resources are not funneled elsewhere. Also, increased commitment to resident and fellow training and education, which is part of what residency is allegedly for.
I work at the Family Health Center, which is a primary care clinic in the Fordham area of the Bronx. It’s one of the two training sites for family medicine residents. It’s also a clinic for fourteen thousand patients. And Montefiore just decided to shut down the Grand Concourse internal medicine and pediatric clinic that is a couple blocks away, push all of those patients and providers into the Family Health Center space, and then move almost all of the providers from the Family Health Center — including nearly the entire residency — into the other family medicine clinic, Williamsbridge. That is around two miles away; you would have to take two buses to get from one to the other.
It’s leaving thousands of patients without primary care providers. It’s also significantly disrupting our residency training. It was at the recommendation of McKinsey consultants that Montefiore made that change. At the same time, we’re seeing that Montefiore is opening up this concierge primary care clinic in Hudson Yards.
If we haven’t been given protected time for a break, for a nap, for a meal, then we’re making life-and-death decisions for our patients at 3:00 a.m., and we haven’t slept.
So, we’re seeing Montefiore actively divesting from the Bronx, trying to save money from its expenditures there on this lease that it was paying for the Grand Concourse clinic, and investing money elsewhere in places where presumably it will make more profits. That’s why [keeping Montefiore invested in the Bronx] is one of our timely demands.
What role do you see the union playing in your workplace going forward?
Having a seat at the table isn’t even something we have access to currently. As I mentioned, we got matched into this residency program and are automatically signed on to the contract without even having seen the most current iteration of it. Because of that system, you don’t have much ability to advocate for yourself, for the things that you want.
Through unionizing, we would have better access to that. I also think it creates an infrastructure to work with the nurses’ union, the New York State Nurses Association (NYSNA), to be much more vocal in making demands of the institution that we work for, to better advocate for ourselves and our patients.
The main thing, in terms of the role that it would play in the hospital, is having a structure and an organization to move forward. All the things that we know will make our patient care better and make our lives better alongside the nurses’ union and the support staff union, 1199SEIU.
So, there’s a way to view this as a way to bring us together with the other exploited categories of workers in the hospital so we can make the changes we know are needed.
Do you see your struggle as connected to the issues your patients face? If so, how?
Absolutely. A great example is the consolidation of health care, carried out by Montefiore, that just happened with the primary care clinics in the Bronx, without our input and without the input of the patients. There’s a community advisory board for the clinic, and Montefiore didn’t even consult the community board’s report, for example. That decision impacts our training, and it impacts patient care. That’s just one example.
But also, we’re the doctors who are up overnight in the hospital, and oftentimes we’re up overnight because we’re working twenty-four- or twenty-six-hour shifts. If we haven’t been given protected time for a break, for a nap, for a meal, then we’re making life-and-death decisions for our patients at 3:00 a.m., and we haven’t slept. We’re miserable and suffering, and also our patients are having their life-and-death decisions being made by someone who’s underslept. They’re intrinsically related. Our patient care is only going to be as good as our treatment of the workers in the hospital.
Something that I came to Montefiore expecting to do was to advocate for patients. I recognize that we have made it through med school, we have benefited from a lot of incredibly privileged systems, and after we’re done with residency, we will make attending salaries, and we’re very privileged in that way.
You must advocate for yourself to be able to advocate for your patients. We can’t do this work if we’re burnt out.
But I came to Monte recognizing that a lot of the work would also be advocating for patients. I think internalizing that — that thought of advocating for patients really passionately — if you internalize it properly, you recognize that you must also advocate for yourself to then be able to advocate for your patients. We can’t do this work if we’re burnt out.
We as workers and patients are all subject to the same forces of capitalism and white supremacy, and that is what’s making our jobs worse. That’s what’s making our patients’ health worse. We are all suffering under the same systems.Original post