When Dr. Ben Raymond-Kolker graduated from medical school, he had his sights set on a medical residency program at Rhode Island Hospital. But it was missing a piece he found interesting in other residency programs: a union.
“I was really excited to be able to train here,” Raymond-Kolker said. “[Unionizing] was something that was on my mind when I was applying to residencies … I had heard really good things about the gains that programs were able to make through unionization.”
Now, after more than three years of organizing, physician residents at some of the state’s largest hospitals have unionized, joining the Service Employees International Union’s Committee of Interns and Residents following votes taken by residents at Brown University Health’s Rhode Island Hospital and Care New England Health System’s Women & Infants Hospital, Kent County Memorial Hospital and Butler Hospital.
Nearly 700 residents and fellows at Rhode Island Hospital and another 230 residents and fellows at the three CNE hospitals will be collectively bargaining for pay and other benefits.
This adds Rhode Island to the growing number of states where physician residents – doctors who have graduated from medical school and are undergoing yearslong specialized training at an affiliated hospital – have formed themselves into bargaining units.
For years, residents have been known for working long hours and getting paid much less than fully licensed physicians. According to figures published by the Department of Surgery at Brown University’s Warren Alpert Medical School, first-year residents at Rhode Island Hospital are paid an annual salary of $69,750. By year four, the salary increases to nearly $81,000.
Union organizers have been demanding better pay and benefits such as a 401(k) matching plan and family and parental leave.
Most observers say it’s too early to determine exactly how unionized medical residents will affect hospital operations and patient care.
“Unionizing represents a significant shift in health care,” said Betty Rambur, professor of nursing at the University of Rhode Island’s College of Nursing.
The Committee of Interns and Residents represents more than 34,000 resident physicians and fellows in several states, including in Massachusetts. Since 2020, the union has more than doubled in size.
The labor drive comes as independent medical practices have been increasingly bought by larger health systems, which some blame for increased workloads, more bureaucracy and an increased focus on profit. Between 2012 and 2022, the number of physicians working in practices fell from 60.1% to 46.7%, according to a 2023 survey by the American Medical Association.
Those trends have motivated doctors in training to band together, Rambur says. At the same time, the COVID-19 pandemic exacerbated flaws in hospital working conditions, adding fuel to unionization efforts.
“We’ve relied on residents to do a lot of work, and they’ve been sort of invisible,” Rambur said.
Indeed, the physicians say they regularly work up to 80 hours a week and have been facing chronic financial stress with little time to focus on their own health.
Raymond-Kolker, a fourth-year internal medicine-pediatrics resident physician at Rhode Island Hospital who was on the union’s organizing committee, says he has had hundreds of conversations with colleagues over the past few years as part of unionization efforts. He says he found that many resident physicians wanted to feel valued for their work.
In separate statements, Brown Health and Care New England say they plan to work in good faith with the unionized residents. “Brown University Health is grateful to our residents, interns, and fellows for their important contributions to delivering high-quality care with empathy and kindness,” Brown Health said.
Negotiations could be a tricky balancing act.
Lessening the number of hours residents work could certainly improve patient care, as the physicians are less likely to burn out, says Robert Hackey, professor of health policy and management at Providence College. Also, if residents are assigned fewer cases, they could spend more time with each patient.
But fewer work hours for residents could lower the number of patients that can be treated, he says.
“Somebody’s got to provide the care,” Hackey said.
While health systems could hire more physicians, that increases hospital expenses, observers say, as does increasing compensation for medical residents.
“We want to provide better conditions, but how does the state pay for that?” Hackey said.
Right now, physician residents in Rhode Island say massive student loan debt combined with rising housing costs have made it more difficult to make ends meet.
Raymond-Kolker, who graduated from Warren Alpert Medical School and has lived in Providence for more than eight years, says he has seen the city’s housing prices skyrocket.
“People felt like they were spending a lot of their income on housing,” Raymond-Kolker said.
Also, residents are looking for better benefits for those who are already parents or looking to start a family. Often, physicians have to postpone or change plans for starting a family because of the time and financial constraints of their work.
Now that the union is formed, the hard part will be negotiating, Hackey says.
Raymond-Kolker expects negotiations to pick up in the coming weeks.
Personally, he is graduating from the residency program in the summer and will no longer be part of the union he helped create. Nevertheless, he and other organizers hope their efforts will benefit future residents in Rhode Island.
“I find it to be immensely hopeful; it’s really exciting that the future physicians of Rhode Island are coming together to say, ‘We care about each other,’ ” Raymond-Kolker said. “We’re making health in Rhode Island even stronger and part of that is taking care of resident fellow physicians.”
