Dr. Leah Rethy was pregnant during the first year of her internal medicine residency at the Hospital of the University of Pennsylvania in Philadelphia. She gave birth during her second year. She worked through her 40th week of pregnancy so she could save her time off and spend more time with her newborn.

Now she's back at work and needs child care. A lot of child care. Medical residents often work long and irregular hours, sometimes as many as 80 hours a week. And child care is one of the main issues motivating Rethy to push for a union at her hospital.

In February, most residents at two major Penn Medicine hospitals decided to form a union, and the National Labor Relations Board will conduct their election in early May. They join a wave of other residents unionizing at programs around the country, most recently at Montefiore hospital in New York, George Washington University in Washington, DC, and Mass General Brigham in Boston.

If successful, these residents would join the Committee of Interns and Residents, the union for medical residents. According to the union's figures, the number of campaigns spiked from two in 2021, to eight in 2022, an unprecedented increase.

Child care challenges

Rethy says her problem with child care is not unusual — residency follows undergraduate education, and usually four years of medical school, so it overlaps with childbearing years for most people.

"I know a lot of people who've delayed having children," she says. "And I also have heard a number of stories of people delaying having children and then, ultimately, having real challenges getting pregnant because of being older and various factors."

Rethy laments the waiting lists for child care affiliated with Penn Medicine, and says finding her own child care is prohibitively expensive.

"The cost of day care ... in a month is about half of my salary in total, and the cost of a nanny is essentially the entirety of my salary," says Rethy.

She says this experience led her to believe unionizing is the best way for residents to demand better working conditions and higher pay, which would lead to better patient care.

A workforce that can't leave

Sunyata Altenor is the communications director of Committee of Interns and Residents, or CIR, as the union is known. She says residents who want to unionize understand the program is supposed to be hard work, with long hours. But they want to be treated fairly for their efforts, at a workplace they cannot just choose to leave, as it's a required part of their training.

"It's easy to exploit physicians during this time in their career," Altenor says. "They're only going to be there for a few years. It's sort of expected that you go through this hard, hazing culture, and then you come out at the other end an attending physician."

Prominently, Stanford Medicine did not include residents in their COVID-19 vaccination plans in 2020, leading to protests, and later, a successful unionization drive.

Dr. Chantal Tapé, a third-year resident in family medicine at Penn Medicine, said residents expect challenging work and long shifts, but they would also like to be able to be healthy and financially stable so they can focus on taking care of patients.

She said it is "frustrating as someone who is a prenatal care provider," to watch colleagues struggle during pregnancy make it to prenatal care appointments and during early parenthood to afford child care. Her colleagues can't follow advice she recommends for her patients.

Parking, mice and roaches, too

Penn Medicine residents cite many issues for their decision to form a union, such as: the upcoming loss of parking benefits that would lead to an extra $200 monthly cost for residents; and dirty call rooms, which are rooms where residents stay and rest if they have to work overnight.

Residents say some current call rooms have mice and cockroaches.

Dr. Madison Sharp, a third-year OB-GYN resident, recalls not even having a call room to sleep in during a 24-hour rotation.

"So I tried to sleep in a dialysis chair that didn't lie flat in a conference room off to the side," she said. "Two years later, residents on that same rotation still don't have a place to sleep for a few hours on a 24-hour call shift ... keep in mind that Penn just opened a billion-dollar hospital but neglected to create physical space for us."

In a prepared statement, Penn Medicine says it values residents and is "proud of the ways in which we have sought to continually improve resident life and wellness." The statement maintains it provides benefits and increased salaries to offer competitive working conditions. Starting July 1, resident salaries will start at a little more than $69,000 a year, according to Penn Medicine. They also say "trainees" should bring their concerns to administrators through an existing advisory council.

"I was the president of this council last year, and I can tell you firsthand that the House staff governing council is extremely limited in what we could accomplish," Sharp said. "It was incredibly frustrating to advocate for residents and fellows and not be heard or have our concerns brushed aside or dismissed."

Residents at the University of Vermont Medical Center voted to form a union last year. Following the successful union vote for residents, support staff including maintenance workers and technicians are unionizing as well.

The union for residents at Jersey City Medical Center has already argued for a better work environment in the years since they've organized, said Dr. Andrea Attenasio, a fourth-year resident in orthopedic surgery. For instance, she said they recently managed to ask the hospital to provide food for residents who work after hours; to provide bedsheets for the rooms where residents stay if they work overnight; and to stop tying salary increases for residents to overall hospital performance, a major concern with rising inflation and cost of living.

Attenasio said the bargaining power and strength in numbers that comes from being a union member makes a difference for residents:.

"It's an automatic support system and it allows you to go to your hospital administration as a united front."