As Chairs and Program Directors have discussed the issue of unionization with Interns, Residents, and Fellows, we have heard your perspective and received a number of questions. We appreciate the dialogue and want to make sure that everyone has answers to the questions that were asked by your peers. We have posted those questions, and the answers, below.

In the box below you can anonymously ask more questions, and we’ll update the post with the answers.


As Chairs and Program Directors have discussed the issue of unionization with Interns, Residents, and Fellows, we have heard your perspective and received a number of questions. We appreciate the dialogue and want to make sure that everyone has answers to the questions that were asked by your peers. We have posted those questions, and the answers, below.

In the box below you can anonymously ask more questions, and we’ll update the post with the answers.


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Question: We have heard a lot of information from attendings in supervisor roles who have spoken out against unionization. However, I have yet to hear from any physician, who had been directly involved in a union and disliked the experience, despite the fact that we have many attending, who went to programs that were unionized. Are you able to provide us any examples of physicians who joined unions who did not like the outcome?

We have spoken to Fellows and Attendings and others who came from unionized programs.  They have described the following experiences: a complete lack of flexibility with Program Directors who would tell residents that if it wasn’t in the contract, they could not do it; Program Directors telling residents that they had to speak to the union rep about workplace issues; a less pleasant and collegial environment than exists at Montefiore; challenges with addressing trainees who did not meet competencies, which affected resident morale poorly and the reputation of their programs; it was nice to get paid extra for Sick Call, but they never realized how underpaid they were; and the statement that the union did nothing for them. These descriptions come from several different individuals, and we think it would help for others to hear these stories but, as you can imagine, it has been very difficult for these people to raise their voices in our current environment.

Why are hallway beds back?

It has never been the goal or objective of Montefiore to treat patients in the hallways.  Hallway beds are a result of incredible demand for healthcare in our community, which exceeds our regular capacity.  As an institution, we are committed to providing necessary care and we will not turn these patients away.

We don't have the same benefits as residents at Wakefield at all. Why is there so much misinformation in the FAQ section?

If you read the Wakefield contract you will see that the salaries and benefits of Wakefield residents are exactly the same as here at MMC, although Wakefield residents are required to pay 1.6% of their pay in union dues.  

If the union were to announce a strike, would residents be required to comply with it? Could there be fines or penalties if we wanted to work?

In the event CIR called a strike against Montefiore, the union would expect residents to strike and there would be tremendous pressure to strike even if you wanted to exercise your right to work, as was true during the nurses’ strike.  Unions have the right to impose penalties–typically monetary fines–on union members who cross picket lines to work during the strike.

How is it intellectually sound to suggest we shouldn't vote for the union because Jacobi makes less-are you implying that our wages will drop of if we unionize

Montefiore has zero interest in reducing pay.  The point of the comparison is to demonstrate that being part of CIR does not guarantee any improvements.  We encourage all physicians and dentists to review what CIR has, and has not, accomplished in other contracts that it negotiated.  We have provided information from other CIR contracts and we encourage all voters to analyze the facts and decide whether you want to pay ~$1,200-$1,560 per year and risk ending up with no more than you would get without a union.

How does our relationship with our Program Directors/Chairs change if the union is voted in?

Voting for the union means designating the union to speak for you on matters relating to pay, benefits, and working conditions.  Under the National Labor Relations Act, it is unlawful for the employer (in this case, your Program Directors) to engage in what is called “direct dealing” with employees on matters relating to pay, benefits, and working conditions.

Will my residency employment be impacted by supporting the union?

If the union wins the election, everyone’s residency employment will be dramatically impacted by collective bargaining and the collective group approach taken by the union.  However, Montefiore has always recognized that this is your decision, and no one will be subjected to retaliation or differential treatment based on their support for, or opposition to, CIR.

Why is Montefiore participating in union busting?

We are not engaged in “union busting”.  We are sharing facts about CIR and collective bargaining because we know how important information is to our physicians and dentists.  We are confident that you can analyze and assess the information from both sides and make a decision on that basis.

What do you believe the hospital stands to lose as a result of interns and residents forming a union?

Your Program Directors and Chairs value the one-on-one relationships they have with you which gives them the ability to work with you directly to address your individual needs and desires.  Each of you is unique and your leaders want to be able to continue to help you in the ways that you need, rather than what a union may choose to negotiate for the collective, without regard for you as an individual.  If we lose those relationships, or they are negatively impacted by the adversarial nature of the collective bargaining process, we may all regret it.  

If unions are so bad why did you spend all this money and effort to convince residents that it's bad?

When CIR filed its petition, it was pretty obvious our residents and fellows had only heard from CIR and its supporters.  The debate is not about “unions” in general, but what CIR specifically means to the Montefiore community.  We believe it is important for out physicians and dentists to have all of the facts regarding the impact that collective bargaining and CIR can have on their employment and training–including what the union does not tell you.  We are doctors–not labor relations experts, and so we used the services of outside experts to ensure we comply with the law and provide you with accurate information.  

How can you say that unions will only affect pay when NYSNA successfully negotiated changes to staffing ratios, hallway beds, and the reopening of Klau 6?

Unions can negotiate over mandatory subjects, which include pay, benefits and working conditions.  The relevant question for this election is what CIR has negotiated and, in particular, what they have negotiated with Montefiore.  We can test this, as Montefiore has a contract with CIR at Wakefield.  Residents working under the CIR contract at Wakefield have the same pay and benefits as Montefiore residents, and CIR has not negotiated staffing ratios, hallway beds, or the opening or units at Wakefield.

Will voting for the union result in automatic changes to our pay and benefits?

No. When you vote, the ballot will ask: “Do you wish to be represented for purposes of collective bargaining by the Committee of Interns and Residents?” Your vote (Yes or No) will answer that question. A vote for the union means that you are designating the union to speak for you in collective bargaining. It does not result in any automatic change in pay or benefits.

When can we expect to receive the Health Care Worker Bonus for the second Vesting Period?

We are pleased to announce that the second installment of the NYS Health Care Worker Bonus will be paid to eligible House Staff on January 27, 2023, consistent with the requirements for the timing of the payment by the State of New York.  This second installment of the Health Care Worker Bonus will be paid to those House Staff who worked during Vesting Period 2: 4/1/22-9/30/22.  If you have any questions about this payment, please contact the House Staff Office.

Will collective bargaining result in changes to our pay and benefits?

Not necessarily. Federal labor law provides a process – collective bargaining – but not an outcome. In collective bargaining, both parties must agree before there is a contract. The law does not guarantee changes to pay or benefits as a result of collective bargaining.

What happens to our pay, benefits and working conditions while we are in collective bargaining?

Under the law, your current wages, benefits and working conditions remain in place unless and until something different is negotiated as part of collective bargaining.

Some of us work with residents who are covered by the Jacobi contract with the CIR. Wouldn’t we get that contract if we voted for the union?

No. Montefiore is not a party to the Jacobi contract. Montefiore Interns, Residents, and Fellows would not be covered by the Jacobi contract if you voted for the union. A vote for the union simply means that you are designating the union to speak for you in collective bargaining. The union would then have to bargain with Montefiore over the terms and conditions of a contract.

What about the 3% increase that was announced for Spring 2023?

While all wages, benefits and working conditions would be subject to bargaining if you were represented by the union, and would remain in place unless something different were negotiated, changes that were planned and approved for the future would still be implemented. So the 3% that was approved and announced for implementation in the Spring will be implemented, no matter what happens with the NLRB vote.

Will voting for the union result in changes to staffing of nurses or other positions such as phlebotomists or transporters?

No. A vote for the union means only that you are designating the union to speak for you in collective bargaining. It does not result in any automatic change in staffing or any other working conditions. Moreover, collective bargaining for Interns, Residents, and Fellows should not be expected to determine the staffing levels or working conditions for employees in other positions.

Wouldn’t the union ultimately improve pay, benefits and working conditions?

Not necessarily. The union can engage in collective bargaining, but that is a process with no guaranteed outcome. In addition, if the key issues are not ones that can be resolved through the bargaining process, one should not expect them to change. This may be one reason why a study of unionized and non-union residency programs (a total of 5,701 residents in 285 programs) found that there were few differences on the most important issues.

The researchers found “no difference in burnout, suicidality, job satisfaction, duty hour violations, mistreatment, salary, or the educational environment were found between residents at unionized and nonunionized programs.” They concluded that: “These findings suggest that resident labor unions do not appear to improve resident well-being.”

See, National Evaluation of the Association Between Resident Labor Union Participation and Surgical Resident Well-being, published in the JAMA Network, September 1, 2021.

Aren’t most residency programs unionized?

Definitely not. Interns, Residents, and Fellows at the vast majority of residency programs in the U.S. are not unionized.

Why wouldn’t we vote for the union? Isn’t this our only option to make meaningful change?

We don’t think so. We all share the same goals. We all have the same commitment to our patients and our education. We know that there are options for stronger collaboration, but the collective bargaining process is not well-suited to those options.

Why should we listen to you? Some have said that we shouldn’t listen, because you are just trying to talk us out of what we want.

We respect the fact that this is a decision you will make. But we also know that the decision will affect all of us. We want to learn as much about this process and what it could mean, and we recommend that you do the same thing. We encourage you to keep an open mind, get as much information as you can, and make the decision that you believe is best.

It is regrettable that some of your colleagues urge you not to engage with Chairs and Program Directors, or consider what we have to share. Are we not to be trusted as sources of information, and as colleagues who care for you, for the program and for our patients? We disagree strongly with anyone who advocates this position. We note that those who suggest there is no room for dialogue, or consideration of additional information we are trying to share, may be demonstrating the way that the collective bargaining process can turn colleagues into opponents or adversaries. We sincerely hope that is not in our future.