Version 02 revision 1 (February 5, 2000)
Ron Risley, M.D.
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This FAQ is maintained by Ron Risley, M.D., PGY-4 in the combined family practice/psychiatry program at the University of California, Davis Medical Center (UCDMC) in Sacramento, California.
This FAQ has no direct affiliation with UCDMC, CIR, CAIR, or any other bureaucracy; it is produced on my own time, with my own computers, and distributed using my own servers (though it may be mirrored or linked by official sites). I probably stole any good ideas from someone else. The fault for mistakes is all mine.
Anyone with information on or questions about the housestaff union is welcome to contribute. I anticipate that the majority of contributions will come from firstname.lastname@example.org, the email discussion list about the housestaff union at UCDMC.
I reserve the right to edit contributions arbitrarily and capriciously. Contributed material will be identified by the contributor's initials in [brackets]. Paragraphs without attribution are mine. Contributors thus far are:
The FAQ gets posted regularly to email@example.com. If there are changes since the previous posting, it gets a new version number. When changes occur between postings, the online edition will be updated rapidly (as my schedule allows) and given a revision number.
*Paragraphs that are new or changed since the last posted version are marked by a *, and are in green in the HTML edition.
There is an HTML (World Wide Web) version available on line. It has a table of contents with live links. It is also updated more frequently than the text version:
You can send a polite correction directly to me. Better yet, join the union-list email discussion list and get your correction sent immediately to all the interested parties. Still feeling like fire and brimstone? I have a special address just for flames.
Check my website. If you want to be sent updates as they occur, as well as participate in discussions about the FAQ and other aspects of the housestaff union, subscribe to the union-list email discussion list either by web form or by email.
Time was, there was a collegial atmosphere at many teaching hospitals. Nobody ever admits to having more money than they need, but at no time in the past have there been economic pressures rivaling those that face teaching hospitals today.
Nurses, clerks, ancillary staff, even the groundskeepers have the protection of state and federal labor laws -- and they all have unions to back them up. Housestaff have no such protections.
Perhaps that's why the Department of Family and Community Medicine recently made several policy changes against the nearly unanimous objections of attending physicians and housestaff. Without question, the changes diminished patient care and increased providers' work loads and frustration. But they saved having to pay overtime to a couple of low-wage employees. In another era, such a tactic would have been unthinkable. Now, it's just a cost-saving measure.
We need a union because the relentless pressure to cut costs will increasingly shift the work load to the lowest-paid, least-empowered employees of the hospital. Right now, that's you and me.
That's what I thought, until the hospital administration sought input from residents about the health plan -- and then ignored the overwhelming support the residents expressed for the Blue Shield plan in favor of their own WHA HMO.
I didn't think we needed a union until I was addressing some serious procedural problems on the hospital floor, and witnessed my warnings being ignored by the Medical Director, the Nursing Supervisor, Risk Management, the Clinical Quality Improvement committee, and my own department chair. One of my patients died as a direct result. The issue? The hospital was unwilling to pay for eight straight hours of a minimum-wage employee's time.
When events like that are greeted with such disinterest, it makes it shockingly clear that residents' voices carry no weight with the Health System. Organizing appears to be the only viable option for making ourselves heard.
When I was a fresh-off-the-boat intern, I heard we had a housestaff union. A meeting was announced, but I was unable to attend. I never heard anything else about it.
That union was the University of California Association of Interns and Residents (UCAIR). It was a union by and for UC housestaff. There were two problems that I know of.
First, UCAIR was run entirely by residents. Residents lack the time, experience, expertise, and money to set up a union -- especially when there really weren't any key issues at the time. Second, the California Public Employee Relations Board (PERB) had not yet decided that residents were employees with a right to collective bargaining, so UCAIR's authority (and hence its attractiveness to residents) was limited. UCAIR petitioned PERB for that authority in 1996.
UCAIR has since combined with the California Association of Interns and Residents (CAIR), which is the Northern California unit of CIR (see 3.3.2 Who is CAIR?). PERB has decided that we work for a living, and aren't just students on the public dole. So now we have people with the time, expertise, experience, and finances to make the union an effective player at the bargaining table, and PERB has given us the potential authority to be represented by them.
*[UP] You had a housestaff organization, but you cannot say it was a union. Without the power to collectively bargain, it isn't a union.
*When PERB decided to recognize interns and residents as employees, they acknowledged that we were eligible for collective bargaining. Since we already have a union (or "housestaff organization") in place, there needs to be an election to certify that housestaff wishes to be represented by that union.
The election is conducted by PERB, using a mail ballot. If a simple majority of ballots cast support the union, then they become our representative.
Here is CIR's answer to that question:
[UP]We are physicians, like you. CIR has been America's leading voice and largest organization for housestaff. Our membership today includes more than 10,000 interns and residents, including 2,000 resident physicians here in California who are members of CAIR, and its sister organization in Southern California, the Joint Council of Interns and Residents. (JCIR).
[UP]We are a Democratic, Physician-Led Organization. Each CIR hospital elects its own representatives and votes on its own contract. CIR representatives in Northern California meet every month to coordinate their efforts on behalf of CAIR/CIR members in the region. CIR representatives meet every year in a national House of Delegates to chart the direction of the organization, and elect rank and file housestaff to a national Executive Board.
[UP]We are Experienced. CIR builds on over 40 years of experience representing resident physicians. We have learned how to work with management to find solutions to the issues we face, from lack of support staff and excessive hours to meal allowances and clean call rooms. CIR salaries are among the highest in the US for housestaff. We have a proven track record of improving working conditions and enhancing our ability to care for our patients.
More information is available from the CIR website:
*CAIR is the California Association of Interns and Residents, the Northern California affiliate of CIR (see 3.3.1 Who is CIR?). The regional vice-president is a friend from medical school. CIR is doctors and housestaff, not just professional union organizers.
The Service Employees International Union. CIR chose to affiliate with SEIU in order to take advantage of that large union's resources, primarily organizing support, grants, and legal services. SEIU does not run CIR; union dues go directly to CIR. CIR, however, pays SEIU a fraction of dues collected in the form of a "per capita tax."
SEIU is affiliated with the AFL/CIO (the American Federation of Labor/Congress of Industrial Organizations). The relationship between SEIU and AFL/CIO is similar to the affiliation between CIR and SEIU: the larger organization collects some funds and, in turn, provides services that are appropriately rendered by an institution with larger scope.
*This is similar in nature to the relationship between the CMA (California Medical Association) and the AMA (American Medical Association). As you may know, the CMA is often at odds with the AMA (for example CMA endorses CIR, while the AMA is opposed to housestaff unions).
No, union dues go directly to CIR. CIR consists of representatives we elect, and they decide how the money is spent.
A fraction of the dues do go to SEIU, and a fraction of that money goes to the AFL/CIO. I have no idea what relationship, if any, might exist between the AFL/CIO and Jersey mob bosses. I do know that the majority of our dues goes to support local union activities.
We do, but until November 1999 we didn't have the right to be represented by the union at collective bargaining talks. Now we do:
At Santa Clara Valley Hospital, the CAIR contract stipulates a $63 weekly meal allowance. Prior to the union contract, the hospital had effectively eliminated meal allowances. At Highland Hospital, the union contract specifies a $107 weekly meal allowance.
Both contracts specified increases in educational allowance ($400/year at Highland; $750/year at Santa Clara Valley).
Both contracts allow residents to respond to adverse evaluations placed in their personnel files.
The Valley contract also specifies that the hospital will reimburse residents for initial licensing and 50% of license renewals.
Our mileage may vary.
Perhaps more important than any individual contract items is that the union can give housestaff a voice. With a union in place, the hospital can no longer make unilateral changes in residents' salaries, benefits, and working conditions, and can no longer blithely ignore their own policies (generally created to get ACGME certification) that limit working hours and promote healthy working conditions.
Salary increases at Santa Clara Valley amount to 13% over three years. Highland salaries will increase 9% over 15 months.
Our mileage may vary.
At Highland, the negotiated contract specifies a $75,000 fund, the Patient Care Fund, to be allocated by the CIR housestaff committee for purchase of equipment and supplies needed to improve patient care.
Again, however, I think that the real power comes from having a voice. Often, we are our patients' only advocates. If no one listens to us, our patients go unseen and unheard. Part of every organization effort is putting channels of communication in place which give the members a powerful voice that administrators can ignore only at their peril. When we can be heard, our patients' needs can be recognized.
Currently, 1.25% of gross salary collected monthly (usually by payroll deduction).
No. Dues collection begins only after a contract is negotiated.
Joining is optional. BUT (and it's a big one), everybody is represented by the union during collective bargaining talks. You get the advantage of the union-negotiated contract whether you join or not. If you don't join, you don't pay dues per se, but you do have to pay 90% of the amount of the dues as your share of the costs of negotiating the contract. (Looks and quacks like a duck to me.)
*Strikes are unlikely. The State of California Public Employment Relations Board had this to say about UC's argument that having a housestaff union would lead to strikes:
*"The University also argues that permitting collective bargaining for housestaff may lead to strikes. However, it is widely recognized that collective bargaining is an alternative dispute resolution mechanism which diminishes the probability that vital services will be interrupted."
There are many kinds of work actions that wouldn't involve denying care to patients. Tactics such as refusing to write ICD-9 codes on lab slips, holding clinic billing documents for a week before turning them in, or gasp insisting on following every University-decreed policy and procedure TO THE LETTER would all get the attention of hospital administrators in a real hurry.
But I believe there is a more fundamental issue. I used to be found squarely in the camp of those who said that it would never be ethical for a doctor to walk out on strike. After 3 1/2 years of witnessing unspeakable horrors perpetrated by accountants practicing medicine, I have realized that our obligation as physicians should go beyond just showing up for work. To continue to enable corrupt health care industries to harm our patients in the name of a better bottom line is to practice the worst kind of hypocrisy. If striking is the only way I can protect my patients, then I will strike.
No. Nothing in the CIR/SEIU affiliation agreement requires that strike for any reason other than our own (collective) decision to do so.
Perhaps. But if the Health System will negotiate a fair and reasonable contract without the threat of a strike, then we will never have to strike. It is unwise to give up a tool of last resort; that simply increases the chances that other means will fail.
Far from it. More and more salaried physicians are joining unions as the health care industry becomes less humanistic and more profit-driven. In fact, the CMA endorses CIR:
The AMA, predictably, is less charitable. They're pushing their own idea of union representation, but it hasn't been very popular thus far (except, perhaps, with health care industry executives).
Individual specialty organizations have been decidedly mixed. It is not surprising that older, more established physicians who have escaped the domination of managed care (so far!) are reluctant to endorse efforts to organize.
Yes, but it's our bureaucracy. That's key. Those who worry that a union could take our money and do unpopular things have a legitimate concern. As with any democratic process, if you don't participate, you get the government you deserve
The union is ours, but only if we take some responsibility for it. If we certify a union, it is imperative that we remain involved.
*This seems to be a common fear, but also seems to be unjustified. I have spoken with residents, faculty, and staff at hospitals with housestaff unions. I have never heard of any cases where having a union interfered with resident-attending relations.
*[UP]The presumption distorts the reality of collective bargaining. Everything in a CIR-Hospital contract must a) also be agreed to by the hospital before it becomes part of a contract; and b) must be agreed to and ratified by the membership of that chapter -- you, the residents. Think about it ... it just doesn't make sense that the fears the administration wants you to believe could be approved by both the hospital and by the residents and put into a mutually agreed contract.
We at UCDMC are in an enviable position right now. CAIR/CIR would very much like to negotiate a favorable union contract at a UC medical center -- it would make other UC housestaff much more interested in the union. By cutting our benefits without discussion, UCDHS has created an environment conducive to organizing efforts. CIR, therefore, is motivated to put extra resources into making things work quickly and smoothly at UCD.
It seems decidedly unlikely that any new contract can be put in place before the next academic year (July 2000). And, of course, there are no guarantees of any kind. We pays our money and we takes our chances.
The best way to stay in touch and up to date is to join our electronic mail discussion list, firstname.lastname@example.org. To join, send any email to "email@example.com" -- the subject and body of the message are irrelevant. You can also join (or leave) by visiting the subscription maintenance page:
The list will have announcements of upcoming events, and you can exchange questions and ideas with other residents, union representatives, and (I hope) representatives of UCDMC.
The only real resource I know of at the moment is the UCDMC staff website:
Among other things, it contains the hospital policies and procedures (there are some real eye openers there!) and many personnel policies. Be sure to ask your friendly hospital administrator why access to this site is restricted to on-campus computer systems.
Another source of entertainment can be found among the 22 pounds or so of papers you were given during orientation. It's called the "Resident Medical Staff Personnel Policy," and contains such gems as "300.2 The maximum scheduled in-house training week for residents will ordinarily be 80 hours per week..." Dig that out during your next Trauma rotation, and see how far it gets you.
There are several CAIR/CIR organizers floating around the campus. I am not certain who fills what role, but these are the folks I know:
The only one I know offhand is Andrea Cervenka, a former medical school classmate of mine who recently finished an internal medicine residency and is now regional vice-president for CAIR. She may not be totally unbiased, but she's very real and she can tell you a lot about what CAIR did for her hospital. (NB: in spite of her union activism while a resident, her hospital hired her to be an attending.)
Andrea Cervenka: firstname.lastname@example.org
I thought you'd never ask. Join the email@example.com discussion list!
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Copyright © 1999-2000 Ron Risley. Permission to redistribute is granted provided the entire document, including this notice, is distributed intact and unaltered.