The Labor Movement in Medicine: Lessons for Organizers

Kevin Hu (he/him) , MS2, Infrastructure Committee

Thomas Statchen (he/him), MS2 UChicago SNaHP President

Community Agreements

• All of you belong here
• Speak your truth in ways that respect the truth of others
• Assume positive intent
• Conflict with civility
• Suspend assumptions and turn to wonder
• Make space/Take space

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This is a space for SNaHP members, PNHP members are welcome to observe but don’t take space from SNaHP members

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Learning Objectives

1. Learn about what a union is and the labor movement in medicine.
2. Learn the difference between different theories of change: organizing vs. advocacy.
3. Practice some skills that you can use to organize at your school, and that you will use in residency as a labor organizer.

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Agenda

• A Brief History of the Labor Movement
• Union 101
• Theory of Change and Organizing Skills Workshop

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A (Hopefully) Brief History of Labor

The Origins of Labor

“The essential conditions for the existence and for the sway of the bourgeois class is the formation and augmentation of capital; the condition for capital is wage-labour. Wage-labour rests exclusively on competition between the labourers. The advance of industry, whose involuntary promoter is the bourgeoisie, replaces the isolation of the labourers, due to competition, by the revolutionary combination, due to association. The development of Modern Industry, therefore, cuts from under its feet the very foundation on which the bourgeoisie produces and appropriates products. What the bourgeoisie therefore produces, above all, are its own grave-diggers. Its fall and the victory of the proletariat are equally inevitable. “

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• Karl Marx, The Communist Manifesto 1848

The Specificity of American Labor

• The impact of settler-colonialism
• Genocide of indigenous communities
• Slavery
• Immigration
• Progress and Conservatism
• Workers Rights
• Business Unionism
• Racial Exclusion

The Decline and Resurgence (?) of American Labor

• Deindustrialization
• Offshoring
• Anti-Unionism

The Decline and Resurgence (?) of American Labor

• The share of workers has been decreasing but the total number has increased (+200,000)
• 53% increase in union election petitions from 2021-2022
• Work stoppages increased by 280% in 2023

The Context for Medical Resident Unionizing

The Context for Medical Resident Unionizing

“The bourgeoisie has stripped of its halo every occupation hitherto honoured and looked up to with reverent awe. It has converted the physician, the lawyer, the priest, the poet, the man of science, into its paid wage labourers.”

- Karl Marx, 1848

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Unions 101

Good News for Medical Residents

2017:

15,000 unionized residents

2024:

35,000 unionized residents (22% of all housestaff in CIR)

History of Resident Unions

• 1934 - First resident unions appear in New York to advocate for compensation
• 1957 - Committee of Interns and Residents (CIR) forms
• 1975 - Residents in New York, LA, and Chicago go on strike
• 1976 - National Labor Relations Board (NLRB) rule that interns and residents are students not workers
• 1999 - Reversal of NLRB decision

What is a Union?

• A group of workers that promotes their common interest through collective action
• Legal entities (501(c)5 non-profit corporations) that negotiate a contract with employers

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A union is it’s members!

Why Unionize?

Collective Power to

1. Improve pay and benefits
2. Improve working conditions
3. “Bargain for the common good”
4. Enforce existing regulations
5. Politicize and radicalize your coworkers

COPE: Committee on Political Education

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Bargaining for the Common Good: Patient Care Funds

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Process of Unionization

The Opposition to Unionizing

Common Arguments Against Unions

Myth

• The union is a third-party that will only complicate matters between administrators and residents

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• The union will ruin your relationship with your program director

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• This could threaten your future fellowship or make it harder to get a job in the future

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Reality

→ The union is only its members acting as a collective

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→ Program directors can appreciate the role that unions play in advocating for residents and attracting competitive applicants

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→ Everything has some risk, but you must consider if it is important for you to go to a program that supports your interests. Additionally, there is safety in numbers!

Organizing Skills Workshop

Theory of Change: Advocacy? Organizing?

Advocacy

• Individualized action
• Appeal to the reason of authority figures

Organizing

• Collective action
• Leveraging collective power rooted in the structural position of the group

An Example: Letter of Support Campaign at UChicago

• Effort to support ongoing unionization election at UChicago
• 280 signatures out of 400 total medical students

An Example: Treatment not Trauma in Chicago

• Movement to re-open public mental health centers in Chicago
• Decade long fight from the time of the last closures
• Became major issue in mayoral race, now re-opening two centers with plans for more
• Led by clinicians and community members

Organization and Leaders Already Exist

• All workplaces/institutions already have forms of organization
• How do we interface with it?
• Informal/formal leaders already exist!
• Who do people look to for guidance?
• Who do people listen to?

Forming the Organizing Committee

Forming the Organizing Committee

Example: UC Letter of Support Organizing Committee

Tools:

1. Lists
1. Literally list out everyone who you know at your institution/workplace
2. Mapping
• Visually map social groups, leaders, location where people hang out, and people with common problems

Activity!!!

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Think about a campaign you might run at your school

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OR

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Imagine trying to get a majority of your school to sign a petition in favor of single-payer.

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Process

1. Map out how people connect
1. Identify groups, leaders, and issue support
2. Identify Groups
• Who hangs out during class? Outside of it? What student organizations do people participate in?
3. Identifying Support
• Leaders
1. Who is participating? Who has helped in the past?
• Supporters
• Who has participated in the past?

Questions?

Email: hu.kevin.y@gmail.com

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Interested In Labor?

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Medical Students 4 Labor →

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