Medical training is a difficult task. As residents and fellows, we move wherever the Match sends us, endure grueling hours, and sacrifice time with loved ones—all in pursuit of becoming the best doctors we can be and delivering excellent patient care. But we should not have to sacrifice our own well-being in the process.

In Washington, D.C., more than 450 residents and fellows employed by George Washington University (GW) spent the past 15 months fighting for our first contract. In spring 2023, nearly 95 percent of house staff voted to unionize with the Committee of Interns and Residents (CIR), a branch of the Service Employees International Union (SEIU) and the largest and oldest house staff union in the country. Contract negotiations began in fall 2023, but progress was slow.

Simple, Reasonable Demands

Our demands were simple and reasonable. First, we sought a livable wage in one of the most expensive cities in the U.S. Under our original contract, with the long hours we work, many of us earned, on average, less than the D.C. minimum wage of $17.50 per hour. Compared with other residency programs in the same city, our salaries were among the lowest.

Second, we pushed for better access to therapy and mental health benefits. We deal with difficult and traumatizing situations daily, and nowhere is this more apparent than in the emergency department, where sickness, violence, and death are routine. Last year, our friend and colleague, ophthalmology resident Dr. William West, Jr., died by suicide. In a public letter, he highlighted the pressures of residency and stigma surrounding mental health, warning that “there are other residents fighting a true life-and-death battle—one that is waged both inside and out at the clinic/hospital.”¹ His tragic loss underscores the urgent need for mental health support for residents and fellows. 

Other demands included increased time for parental leave and childcare, clean resident call rooms, reimbursement for board exam fees, and improved medical benefits coverage. These issues were not merely matters of personal convenience—they are fundamental for enabling us to provide the best possible patient care in one of the region’s biggest hospitals. Addressing these concerns helps combat physician burnout, which has been widely identified as a threat to patient care and the broader health care system.² ACEP Now has previously written about the reasons for physician unions, particularly among emergency physicians.^3,4 Our motivation was similar: The only way we can take good care of our patients is if we take good care of ourselves.

A Fair Contract is Essential

Despite more than a year of negotiations, by December we had yet to reach an acceptable agreement. On December 3, the union announced plans to strike, with 98.7 percent of union members voting in support. This decision was not made lightly. Historically, labor unionization among health care workers is uncommon,⁵ including among resident physicians,⁶ and the prospect of striking even more so.

One of the first documented strikes among house staff officers took place in 1974 at Howard University here in Washington, D.C., and resulted in increased salaries, improved facilities, and better benefits.⁷ After decades without a resident physician strike, one took place last year at Elmhurst Hospital in Queens, N.Y., where residents went on a multi-day strike and secured higher salaries, meal stipends, and transportation benefits.⁸ Striking is a last resort, but we were ready to follow in these footsteps, knowing that securing a fair contract is essential for our health and well-being and the quality of care we provide to our patients.

Strike Avoided

Fortunately, less than 12 hours before the strike was scheduled to begin, our union came to an agreement with GW. Thanks to the tireless advocacy of our residents, fellows, and CIR/SEIU representatives, we reached consensus on many critical issues. Our new contract includes significant salary increases, annual stipends for mental health, a ratification bonus, and other measures that address core concerns.

This victory is about more than just numbers. A fair contract is not just about wages or benefits—it is about creating a foundation where physicians can thrive, patients can receive the best care, and the future of medical training is sustainable. By standing together, we demonstrated that meaningful change is possible, and we hope our efforts set a precedent for residents and fellows across the country who face similar challenges. Our advocacy seeks to build a system that ensures doctors are supported and equipped to deliver the care our patients deserve.

Dr. Chung is a PGY-4 resident in emergency medicine at George Washington University in Washington, DC. She is interested in a wide variety of topics related to health equity and population health.  

References

1. Portnoy J. A young GWU doctor’s last words serve as a warning for healthcare providers. The Washington Post. https://www.washingtonpost.com/dc-md-va/2024/10/03/will-west-doctor-gwu-suicide-note-mental-health/. Published October 5, 2024. Accessed December 7, 2024.
2. Oakman T, Smith-Ramakrishnan V. Physician burnout will burn all of us. The Century Foundation. https://tcf.org/content/report/physician-burnout-will-burn-all-of-us/. Published October 25, 2023. Accessed December 9, 2024.
3. Adelman LC. Is it time to unionize? ACEP Now. https://www.acepnow.com/article/is-it-time-to-unionize/. Published April 15, 2024. Accessed 9 December 2024.
4. Beresford L. The ER docs strike back. ACEP Now. https://www.acepnow.com/article/the-er-docs-strike-back/. Published August 28, 2024. Accessed December 7, 2024.
5. Ahmed AM, Kadakia K, Ahmed A, et al. Trends in labor unionization among US health care workers, 2009-2021. JAMA. 2022;328(24):2404-2411.
6. Ahmed A, Li X. Labor unionization among physicians in training. JAMA. 2023;330(19):1905-1906.
7. Thompson SL, Salmon JW. Strikes by physicians: a historical perspective toward an ethical evaluation. Int J Health Serv. 2006;36(2):331-354.
8. Brosnan E. Elmhurst doctors’ strike ends as hospital, union reach deal. Spectrum News NY1. https://ny1.com/nyc/queens/health/2023/05/24/elmhurst-doctors–strike-ends-as-hospital–union-reach-deal-. Published May 24, 2023. Accessed December 7, 2024.