I am a general internist who just finished my three years of residency training at Montefiore Medical Center a few months ago. (Residency is the high-intensity period of work and training that all practicing physicians in the United States must complete after medical school.) Montefiore is a safety-net hospital for the Bronx, hosting one of the largest training programs for doctors in the country. It’s also a profit center for some extremely wealthy executives. The doctors in training there just announced their intention to unionize, backed by the New York State Nurses Association (NYSNA)—a union with a long history in the fight for safe staffing in the city.
Despite the horrible working conditions of residency (which can include 80 workweeks, 28-hour shifts, verbal abuse, or a maternity leave limited to a single week), doctors haven’t historically been big lifters in the labor movement. For Montefiore residents, this is the furthest any unionization effort has gone in decades. But if doctors at Montefiore and more broadly embrace the opportunity to tell a different story about who we are, we could contribute to one of the most important labor struggles of the coming year.
Starting in my intern year in 2019, like-minded friends and I would talk to anyone who would listen about organizing a union. I’m certain that repeated invitations to talk annoyed a few of our colleagues who had other more pressing concerns—their applications to competitive subspecialties, spending time with their children, finishing their month of work on wards, or just catching up on sleep. But six months into my training, the Covid-19 pandemic made self-organization by residents a necessity, often done in concert with NYSNA nurses.
These reactive efforts did not immediately yield coherent or sustainable organization. I was demoralized for several months that summer—if the utter disregard for New York residents didn’t give rise to new organization, what more could I do? But with support from the Committee of Interns and Residents, and new interns who seemed to enter residency with an increasing desire to unionize every year, we eventually gained traction. I myself scheduled long conversations with 30 other doctors about starting a union, and altogether organizers reached over 1,000 doctors to bring the campaign to its current stage. There was a broad range of opinions about what to do about our situation, but the widely shared sentiment was that Montefiore was profiting off us and our patients, and we needed our own voice.
Montefiore has a reputation for being one of the most exploitative employers in the city. Whether on the floor with other health workers or waiting in line at the cafeteria, I was never far from someone who could relate to the sense that working at Montefiore felt like working in a factory, and that we were all being pressured to go faster by cutting corners. Guided by recommendations from McKinsey consultants, Montefiore recently consolidated its primary care practices, disrupting the care of thousands of patients at the Family Health Center clinic in order to reduce overhead. A broad coalition of community organizations and health workers united across professions fought this change, but they were left out of decision-making and could not put a stop to it. Montefiore already had a history of disinvestment from marginalized communities before McKinsey came along—it closed the ICU at Mt. Vernon Hospital during the height of the Covid-19 pandemic. In that instance, pressure from a coalition of patients and workers resulted in the preservation of some services in a hospital that had been slated for closure.
Montefiore didn’t become what it is overnight, and a thousand doctors alone cannot change it fundamentally. But the connections between the struggles over health care and broader movements that do wield such power are deep—the origin story of the burgeoning Amazon Labor Union included Amazon’s failure to keep workers safe from Covid-19. The history of deindustrialization in America—particularly the contraction of the steel industry—shaped the state of the health care industry and its power struggles.
Globally, health care remains a relatively safe place for investors to put their capital, as war and the climate crisis devastate the poor and make other markets less attractive. This is the larger context in which doctors are finally joining the labor movement.
Many doctors correctly intuit big problems with our health system, but the solutions most are willing to entertain politically or organizationally don’t always match the scale of the problem. For some, just deciding to actively support the union is a risk-benefit calculation—a short-term pay raise versus the now-diminished risk of joining the chorus in support of unionization—but the opportunity is much greater than that.
That’s because a challenge to Montefiore by a broad coalition of its own workers would be a frontline struggle against the most exploitative tendencies of the whole industry. During the pandemic, more doctors have woken up to the fact that we may just not be that special. Many health workers, not just doctors, face mistrust, and that mistrust has sadly been earned by the exploitative structures we work in as well as the unflattering history of American medicine. For the majority of doctors, prestige will not protect us from increasingly grueling working conditions and occupational hazards, a loss of autonomy, or a demoralizing sense of alienation. These are conditions we share with everyone working in this system.
If Montefiore chooses to dig in its heels instead of recognizing the resident union, the only way to a victory will be solidarity—that’s why the union is using the hashtag #OneHospitalOneFight. If self-empowered workers can make new strides against health care greed in the Bronx, we’ll have some hope of rejuvenating the relationship between American health workers and patients.