Responses to GME ‘FAQs’

SHC Says: Consistent with our values, we respect the rights and opinions of all our residents and fellows and believe it is up to each of them to choose whether or not to join a union. It is every resident and fellow’s decision, and, under the National Labor Relations Act, each resident and fellow has the right to express their views on union representation through a secret ballot election conducted by the National Labor Relations Board (NLRB).

We Say: Yes, residents and fellows have a federally protected right to organize, and we appreciate Stanford allowing us to have a free and fair election. Before filing, we had conversations with a supermajority of residents and fellows who have already indicated by signing cards that they would like to be represented by our union.

SHC Says: The success of our residents and fellows’ experiences depends greatly on the direct relationship they have with their program leadership and clinical program departments. We value our ability to have first-hand conversations about how we can improve, what tools or resources are needed, or why we should rethink specific approaches. This direct relationship has allowed us to respond to feedback we receive, find solutions in real time, and work in tandem to design an experience that is meaningful and rewarding for every one of our residents and fellows. 

This direct relationship between our physician trainees and their clinical departments will change should our residents and fellows unionize because that relationship will then be between Stanford Health Care and the union. The customized training experiences that each department has developed, including electives, team structures, resources and stipends, will have to yield to a universal approach, with the union representing the collective voice of residents and fellows.

We Say: We agree that direct conversations are needed between housestaff and their clinical departments. As housestaff, why would we want our union to interfere with productive conversations between housestaff and their departments? A housestaff union will not interfere with these productive conversations. Many program directors at other unionized residencies (e.g. UCSF) have found regularly-scheduled labor management meetings helpful, as both union housestaff representatives and management are present. While solutions successfully negotiated within a department do not need to be brought up to the union, PDs who have run into limits from management have found these meetings as a way to facilitate expeditious resolution. Additionally, the union will be a peer resource for housestaff who do not feel comfortable having certain conversations with their departments.

The union will represent the collective voice of the housestaff, but the voice of the housestaff would not mandate a ‘universal approach’ to electives and team structures, as we recognize that this is not how clinical care is conducted. A contract negotiated by the union would put into place a ‘universal floor’ for each represented resident and fellow, to ensure that everyone is receiving sufficient benefits. However, this is not a ‘ceiling’ – there is nothing inherent to a union contract that would limit additional department-specific resources and stipends from being granted. Holding back those additional benefits would be purely at the discretion of the department and the GME. As an example, UCSF’s union contract states, “Programs may provide funds to Residents and Fellows for educational purposes. It is not the intent of the University to reduce any benefits in place as of the effective date of this Agreement.” Indeed, many other residency union contracts enshrine department-specific benefits into their contracts.

SHC Says: We don’t think so. Here’s why: We believe that when residents and fellows have their own voice and the ability to express their opinions and desires directly to us, it is more powerful and effective for them and our patients. In a union environment, those messages may be factored in with many other potentially competing voices, and then delivered to us by the union through filters. This “indirect method” may not accurately or completely express individual views.

We Say: We as housestaff lead our union, and we understand what works best for our individual programs (and that each program is very different). We believe that housestaff have a stronger voice with a union, as this gives housestaff (and their allied programs) a seat at the table to negotiate directly with hospital management about the issues that matter to them. We have seen both in programs and the GME instances where progress is limited by hospital-level policies that are out of their control. Housestaff will continue to engage with their leadership as normal, but will be empowered by the collective strength of the union.

As it stands, when housestaff “express their opinions and desires directly” to leadership, it is up to leadership to decide whether they take those opinions and desires seriously. Unfortunately, over the past year of advocating for housestaff interests within the existing system our GME representatives have found that our concerns often fall on deaf ears. Unionization and collective action give us an avenue to advocate directly for our interests, and not wait for other people to advocate for us.

SHC Says: Yes. Under a union contract, residents and fellows across departments may find themselves subject to a “one-size-fits-all” situation. The union will become the exclusive bargaining representative for the entire group, making it difficult to consider the unique needs and preferences of all residents and fellows and their departments. This means what may be important to specific training programs may not be on the top priorities of the negotiation committee.

We Say: Our negotiation committee is made up of housestaff, and we are actively seeking broad representation from each and every department so that all voices and interests are adequately represented during bargaining (get involved!). This is not a “one-size-fits-all” agreement, but rather a “no department left behind” agreement (see Q2 response):

The union will represent the collective voice of the housestaff, but the voice of the housestaff would not mandate a ‘universal approach’ to electives and team structures, as we recognize that this is not how clinical care is conducted. A contract negotiated by the union would put into place a ‘universal floor’ for each represented resident and fellow, to ensure that everyone is receiving sufficient benefits. However, this is not a ‘ceiling’ – there is nothing inherent to a union contract that would limit additional department-specific resources and stipends from being granted. Holding back those additional benefits would be purely at the discretion of the department and the GME. As an example, UCSF’s union contract states, “Programs may provide funds to Residents and Fellows for educational purposes. It is not the intent of the University to reduce any benefits in place as of the effective date of this Agreement.” Indeed, many other residency union contracts enshrine department-specific benefits into their contracts.

SHC Says: Our residents and fellows value the relationship they have with their department chairs, program directors and faculty. This direct, trusted relationship is critical to the success of their training experience.

We thank you in advance for:
– helping ensure they have all the facts and information needed to make a fully informed decision about what unionization could mean for them.
– encouraging them to vote so they can express their own perspectives.

Given how vital this decision is, we want to make sure residents and fellows have all the facts and information needed to make a fully informed decision about what unionization could mean for them.

These are important discussions, and we’ll be providing you with additional information to share with residents and fellows that reinforces our commitment to supporting all their training at Stanford Health Care through a highly competitive total compensation and benefits package, and the many ways we have been able to work together and improve the program and hopefully their experience for the better.

We Say: We absolutely agree that residents and fellows need to have all the facts, and we need to have a strong turnout at the election! Please encourage your residents and fellows to vote, and direct them to www.stanfordhousestaffunion.org to read our FAQs. We are happy to speak with any housestaff or faculty to answer questions directly! Housestaff are invited to weekly virtual or in-person happy hours to answer questions.

SHC Says: We want and need our leaders to be effective communicators on issues important to our residents and fellows, including the topic of unionization. Do talk about facts, the law, opinions and experiences. Do discuss the implications unionization will have on your department’s training and education program, and on the direct relationship that residents and fellows have with their respective clinical departments.

You must always respect that all residents and fellows have a legal right to choose to be represented or not by a union. Any actions that threaten, interrogate, make promises, conduct surveillance or discriminate are in violation of the National Labor Relations Act.

We Say: We want to have open and honest communication with both housestaff and faculty regarding the union. We understand that many program directors may have questions about how this will affect their program and interactions with their residents and fellows – it is also a top priority for us to avoid any negative impact on how our programs are run. Please feel free to reach out to any of us to have a conversation! We affirm that the National Labor Relations Act protects employees from employer behavior that threatens, interrogates, makes promises, surveils, or discriminates – however there is nothing prohibiting general conversation!