Is It Time to Unionize?

William G. Wilkoff, MD


February 02, 2023

According to an article in the Wall Street Journal (Mosbergen D. 2023 Jan 16), physicians-in-training in several parts of the country are attempting to unionize. The Committee of Interns and Residents (CIR), a union representing about 15% of the 140,000 residents and fellows in the United States reports that it has been adding chapters at an accelerated rate since the pandemic began.

Most of the 1,400 residents at Palo Alto–based Stanford Medicine recently voted to unionize seeking better compensation and improved working conditions including more accommodations for residents with disabilities or who are breastfeeding. At the University of Illinois at Chicago, house officers are also exploring an association with CIR hoping that collective bargaining might help them get “better pay and working conditions that could alleviate some burnout and stress.”

William G. Wilkoff, MD

Although physicians have been hesitant to organize themselves around workplace concerns, nurses have a more robust history of unionizing and taking action. Recently, the nurses at two of New York’s largest medical centers went on a strike for 3 days that ended after the medical centers agreed to their primary demand of hiring more nurses and committing to set more workable nurse to patient ratios.

In an unusual but historic incident of workplace activism, the residents and interns at the then notoriously decrepit Boston City Hospital staged a “heal-in” in 1967 during which they admitted more patients (all with legitimate conditions for admission) than the hospital could handle. While more pay was included in their demands (interns were being paid $3,600/year and senior residents $7,500/year), the primary complaint of the house officers focused on patient health and safety issues. The crisis this work action triggered finally brought into sharp focus the city’s failure to care for its most needy citizens and over time, changes have been made (TIME Magazine. U.S. edition. Jun 21;91:25).

Having spent some time at the Boston City Hospital as a medical student in the 1960s I can attest to the deplorable conditions. While you might not be washing your hands and instruments in rusty sinks or having to brush flaking paint off your patients’ cribs, you may be experiencing working conditions that are threatening the health and safety of you, your coworkers, and not least of all your patients. Staffing shortages, clunky electronic health record systems that are adding hours of work to your day, screen after screen of data entry tasks that prevent you from meeting your patients eye-to-eye, and piles of prior authorization requests clogging your inbox to name just a few.

Who can you complain to, other than your coworkers? The patients brought their problems to you; it doesn’t seem fair to add to their burden by sharing your own. Maybe it’s time to think about joining a union to strengthen your voice and create some change.

But “union” and “strike” don’t sound very professional and certainly not coming from the mouths of folks who have chosen to be caregivers. However, things have changed. Most of us are employees now. We need to finally accept that role and begin acting like employees working under stressful and unhealthy conditions. Does the word “burnout” make the notion of unionizing any more palatable?

The American Medical Association’s code of ethics wisely discourages physicians from engaging in actions that withhold medical care. However, the Boston City Hospital house officers provided just one example of a work action that can draw attention to the problem while still providing care to the patients in our trust.

Simply, joining our voices can be a powerful force in the war of words and images. Patients don’t like the impersonalization that has come with the current crop of electronic health record systems and the tortuous phone trees they must navigate just to talk to a human voice any more than we do. Instead of complaining to the patients, we should explain to them that the working conditions we must endure have the same roots as the things they don’t like about coming to see us.

I hope your situation still allows you to have an effective voice. If it doesn’t maybe it’s time to consider unionizing. However, if asking for more pay is anywhere near the top of your grievance list, I don’t want to join your union because you are doomed to failure on the public relations battlefield.

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics, including “How to Say No to Your Toddler.” Other than a Littman stethoscope he accepted as a first-year medical student in 1966, Dr. Wilkoff reports having nothing to disclose. Email him at

This article originally appeared on, part of the Medscape Professional Network.

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