Why Residents and Fellows Have Been Organizing

The Labor Movement is experiencing a resurgence. Unions have again become part of the national conversation with organizing, contract negotiations, and strikes targeting companies that produce services and products many Americans use daily: Starbucks, Amazon, Detroit’s Big Three, FedEx, UPS and others. This may explain, in part, why Americans’ approval of unions is near an all-time high. 

Medical residents and fellows have become a growing part of this activity, and two major unions focused on residents have experienced nearly a 100-percent election win rate over the past five years. With these odds, Graduate Medical Education (GME) programs need to implement changes now to foster a positive learning and work environment and make sure resident voices are heard and respected – before the union tries to sway their residents and fellows.

The Why Behind Unionization

 While every group of residents and fellows have their own reasons for engaging with the union, there are common themes across many organizing campaigns. Some of the issues are more “traditional” demands that are generally made by employees no matter the field: the perception that their pay is too low or not commensurate to the amount of work required; a need for increased benefits, especially as inflation undercuts pay; a desire for increased respect and a real voice in the system; and burnout or even a sense of helplessness. 

However, residents and fellows looking to organize also raise other issues, such as a desire to reshape medical education, access to healthy food options around the clock, or access to on-site childcare since residents may be starting or have young families during this point in life.  

Burnout also feels different for residents and fellows. Because they need to complete their residencies and fellowships to fulfill their professional goals, they – unlike other health care workers – simply do not have the option to quit. Some share they feel bullied by nurses, advanced practice providers, or attending physicians in their day-to-day work.

The structure of many GME programs can contribute to these frustrations. Residents and fellows are straddling the line between trainee and employee, and disconnects between residents and fellows, nursing, attending physicians, Human Resources (HR), and even senior leadership can leave residents and fellows feeling unsure of their role in the healthcare system. Some believe senior leadership doesn’t value their contributions to the organization or listen to their needs.

When you put these pieces together, residents and fellows are outwardly rejecting the traditional systems they believe have led to a culture of institutionalized hazing, which can take the form of overworking them, undervaluing them, disrespecting them or even overt bullying. When met with the argument of “it’s always been this way” or “we all went through it, so you must too,” they are rebelling and turning to unions to not only to address their immediate grievances, but in theory, to leave a better legacy for those who will come after them.

Be Strategic and Think Ahead

Trying to address all of these issues may seem daunting, but GME programs should invest now in making sure their residents and fellows feel respected, valued, and heard. This can be as simple as turning more attention to distributing timely, accessible communications on issues important to residents and fellows, and as complex as determining how healthcare system leadership can proactively consider the GME community when making operational decisions.

GME programs can be proactive in thinking about how they work with their residents and fellows, and how they connect with other departments in the system to leverage support.

Start by following this simple five-point strategy:

1. Recognize that a “this is how we’ve always done it” approach will not lead to positive engagement, particularly with the newer generations entering the workforce who want a different relationship with their employers that involves more flexibility, a healthier work-life balance, and a greater voice in decisions affecting their lives.
2. Involve residents, fellows, and program directors and faculty in discussions about major changes being contemplated related to issues important to their work and solicit feedback. Engagement and transparency may result in alternative solutions and will provide affected parties with a voice in the conversation even if they don’t like the final decision.
3. Reciprocate communications. It’s not enough to provide one-way communications with residents and fellows. Program directors, faculty, and other leaders (whether formal or informal leaders) need to have information to engage with their residents and fellows and have the ability to impact change when they receive feedback from them.
4. Celebrate the unique and diverse people who make your program great. Even a small bit of recognition can go a long way. 
5. Strengthen a rewarding educational and work environment through ongoing feedback, purposeful engagement, and trusted communications. Candid feedback should always be welcomed and never brushed off. Leaders may need coaching about how to be receptive to this type of feedback and what to do with it.

From a tactical perspective, consider including these messages in your newsletters, external or internal websites, and social media or texting campaigns. Social media tactics are especially relevant as they allow you to meet your community where they already are online to quickly share timely program information and thought leadership, as well as boost community engagement.

If you aren’t already, you need to host regular town hall meetings with relevant leaders from the GME office and across the system, so residents and fellows feel informed about the overall health care system and develop a sense of how decisions around quality, patient experience, finances, IT, and operations are made. And these meetings should provide ample opportunity for your audience to ask questions, raise concerns, and feel involved rather than being talked to.

Finally, considering building or strengthening the connection between the GME program and HR. Every employee, including residents and fellows, deserves to have an HR resource they feel comfortable going to whether to address benefits questions or share a concern. Because residents and fellows are often considered learners, they may fall through crack between education (GME) and work (HR).

Ultimately, by including residents in your engagements, from rounding to communications, you ensure they are treated like other employees, helping to bridge the gap between GME and the hospital and/or system.

The IRI team is well versed in every aspect of labor relations, from issue identification and employee engagement to labor contract negotiations strategy and communications. We’ve worked extensively with GME programs and their HR counterparts. The best way to maintain a positive work environment is to directly engage with employees.

At IRI, we empower organizations to navigate workplace challenges, improve employee engagement and productivity, manage labor relations, and implement effective communication strategies to achieve their business and advocacy goals. We believe every business is different, and each requires its own holistic and customized approach to communications and employee engagement. Whether you need an internal communications or engagement assessment, guidance in developing your internal communications or engagement strategy or social media strategy, digital media intelligence, crisis communications services, media relations, or media training, we have expert communications and engagement consultants who can quickly provide a specialized solution. Contact us using the chat on the right to discuss the next steps, or give us a call at (313) 965-0350.