Responses to Recent Emails & Announcements
Dear friends and colleagues,
We’ve seen a lot of information-sharing and discourse on unionization, both via email and in person, over the past several days. This is great! We welcome any and all discourse. As with any decision that affects a large number of people, there will be risks and benefits. We firmly believe that the benefits outweigh the risks. Let’s keep the discussions going so that every resident and fellow can make an informed decision based on accurate information, not one based on misinformation or fear. We are happy to discuss with you! You can always connect with us via text, email, this listserv, or in person. For those shy, you can have someone you trust ask those questions for you. You can also submit questions on our website (UBHousestaff.org), our Instagram (@UBHousestaff), or in our Town Halls.
Based on some of questions we have been getting, we want to clarify a few points:
- Taking away or downgrading benefits is retaliation and is illegal. Once a union is formed and we move on to negotiating our contract, it would be illegal for previously scheduled raises or benefits to be frozen, downgraded, or revoked. Since filing notice for elections with NLRB, we all came under legal protections against workplace retaliation and intimidation. We were made aware of tactics of intimidation made by individuals in meetings causing fear in residents. We do not stand for this, and have addressed this accordingly. As we move forward, we acknowledge that UMRS or individuals can act illegally and freeze pre-planned raises in the short term. UAPD has a fully versed legal team that would bring action against UMRS and would work to get us any missed back-pay for frozen raises or decrease in benefits, such as how they did for a physician group working for LA County in 2005: Los Angeles County illegally removed an existing healthcare plan for its members in favor of a lesser plan. UAPD took them to Court. The results ended with a new enacted state law preventing LA County from manipulating the benefits of union members. UAPD pursued restitution of a $10 million dollar clawback of lost benefits for those members. The risk of UMRS doing this does exist. We do not expect it to happen, and we are prepared with UAPD to act legally in the event that it does.
- A union provides the most direct and efficient way to address workplace inequality and does not diminish the necessity or work of GME. A unionized residency program brings legal resources and labor negotiation expertise to address workplace grievances such as lack of hazard pay, salaries, and retirement benefits, etc. GME works for and was created by UB to help bridge discussion between trainees and administration, but they are limited in scope as employees. UB residents did try to unionize about 10 years ago due to the same grievances that are being raised today. The problems we raise are not new, and administration has had over 10 years to make changes, and yet the salary and working conditions have not improved. GME has done what they can, and yet Buffalo’s working conditions have remained stagnant. We encourage everyone to look at their own contracts they were asked to sign and note its stipulations. Being unionized shifts the dynamic. We can and do support GME with adequate resources to improve our training experience, AND we will have a chance to vote on what we want and do not want in our contract!
- The vote to unionize is through a mail-in ballot sent by mail to you on April 12, 2023. Qualified voters are those with active UMRS employee status on March 1, 2023. Those employees who believe that they are eligible to vote and did not receive a ballot in the mail by April 19, 2023 at 5:00 p.m., should communicate immediately with the National Labor Relations Board by either calling the Region 03 Office at (716) 551-4931 or the national toll-free line at 1-844-762-NLRB. All ballots will be co-mingled and counted at the Region 03 Office on Thursday, May 11, 2023 at 1 p.m. You must sign the outside envelope for your vote to count. In order to be valid and counted, the returned ballots must be received in the Region 03 Office prior to the counting of the ballots on May 11th. Incoming PGY1s are ineligible for this vote. It will be impossible for anyone in GME or UMRS to know how you voted unless you chose to tell someone how you voted. There is nothing to stop you from declining to tell someone how you voted or lie about your vote if you fear retaliation. You can also let us know of any instances of intimidation and we will take action. The election will be won and a union recognized with 50% plus one or greater of eligible votes received by NLRB.
- No one wants a strike, but if it does come up, patient care comes first. Some people are afraid that the union will resort to a strike, which could have a negative impact on patient care. We, as union supporters, are averse to striking, too! There are three important points to consider:
- First, a strike is very rare. The last resident union strike occurred in the 1980s and is a rare occurrence. There are many other negotiation tactics to employ first. Should communications during negotiations break down to the extent that we feel a strike is warranted, union members must vote in majority favor to authorize a strike. Strikes will be defined by date and duration. Enough of us will need to express desire to pursue a strike in order for us to bring this to a vote, and it will then need to win by majority. In June 2022, LA County Resident Physicians CIR union voted to authorize a 3-day strike. Administrators came to the table to avoid the strike and within 4 days, residents and fellows negotiated a contract that included a $10K housing stipend to all residents and fellows along with large bulk payment to all incoming PGY1s to help offset cost of moving as well as a 14.5% PGY1 salary increase. The employer can come to the table at ANY TIME in good faith to reverse any actions.
- Second, patient care is a team effort and responsibility does not fall on residents alone. NLRB has specific guidelines for hospitals. A minimum of 10-day notice of strike must be sent to the employer in advance so that they can prepare. In practicality, the communication will be open and they will have months to prepare for a possible strike. They can elect to pay for attending physicians, NPs or PAs to do work on the resident-lead services so that patient care would not be affected, or have a contingency plan to move or divert patients to other hospitals in or near the region.
- Third, no one in the union can force you to strike even if a strike is authorized. Crossing a picket line is within your rights that are protected by the first amendment of the US constitution. You are protected by the NLRB from intimidation from the union itself. We are physicians, we take our Hippocratic oath seriously. Your union members will be your colleagues. We stand in solidarity with you despite differences in opinions. The truth is that the hospital system also has the responsibility to care for our patients AND that we also need to be treated fairly and supported in order to be at a place where we can give the most care to our patients. In the long run, we believe unionization would lead to better patient care.
- We are the union, and we are advocating for ourselves. The UAPD is an organization with integrity and consistency. These emails are being sent by us; we are meeting with attorneys; we will sit with UB and hospital administration, not UAPD administrators. There is a possibility that a representative from each affected body will send representatives, much like ourselves. NLRB dictates that that individual MUST have the authority to bargain on the employers’ behalf. We are not looking for a scribe to hear our grievances. A strong union requires dedication, investment, and time from its members. The negotiator has already been hired and contracted and we will proceed with solidifying workplace demands once our union is recognized. We are doing this for the first time and learning along the way. We are fast learners, and have an innate ability to make difficult decisions quickly. We want everyone represented from the largest programs like IM and Pediatrics, to the smallest like Vascular Surgery and Medical Informatics, and everyone in between. Continue to reach out to us. We want to know your needs. UAPD provides expertise, a vast library of experience, and importantly, legal backing. As we get closer to the vote, we will solidify our plan for fair representation. We are NOT ‘self-appointed’ but we are stepping up to the challenge after hearing from hundreds of residents and fellows. We welcome anyone who would like to help with this process and be the voice of your peers. We welcome all and any ideas. We understand our legal rights outlined by the NLRB and our employer MUST come to the table to negotiate in good faith. We will negotiate a fair contract and we pledge to take your faith in us seriously. Once a tentative deal is reached, all union members would vote on whether to approve or reject the contract. It is in the interest of both parties to come to a fair deal. Your voice always matters.
- New York State is NOT a Right-To-Work state, meaning that if a union forms, all residents and fellows will be automatically joined into the union. We recognize that some people are politically opposed to unions in general. This is a democratic process. While no form is a perfect panacea for the problem at hand, we believe democracy is better than an authoritative body. Every resident and fellow has a vote and should vote their conscience. We will continue to strive to represent all residents with integrity, regardless of how you voted, and will welcome dissenting views.
- UB students are overwhelmingly in favor of a union. Over 95% of students of Jacobs Medical school signed a letter through their student organizations in support. UB students make up a substantial part of the residency and fellowship program each year. Even if you don’t feel strongly about a union or will directly benefit from a union, you have a no-lose way to offer a voice for those who don’t have a vote.
We acknowledge that each person will weigh the risks and benefits differently. What we all can agree on is that the status quo could be improved and that, as it stands, we have little say in making any changes or improvement. We call Buffalo our home, and are firmly invested in making positive changes. We believe that a union is the best way to give us the power and structure to make real, beneficial, and lasting change. We are undeterred by the risks that exist and steadfast in our conviction that unionization is the way forward. Lastly, we encourage every resident and fellow to consider their legacy, what will be most beneficial for future generations of residents, and to vote their conscience. Your vote today will change the culture of Medicine for generations to come, for the better!
UB Residents & Fellows UAPD
Dear UB Housestaff,
We are aware that there have been communications expressing concerns about the potential downsides of forming a union. While no solution is perfect, we strongly believe that unionizing has numerous benefits that outweigh the possible drawbacks. We appreciate the concerns raised in recent emails and wish to continue the discussion on why we think unionization is the best choice for our community.
- Union Dues – We acknowledge that forming a union requires payment of union dues. These dues provide tangible benefits to us as trainees by supporting a collective voice in advocating for our rights, including better working conditions, salary increases, and improved benefits. This collective bargaining power will help us negotiate fair and equitable terms with our employer. Yes, the UAPD is not doing this for free, but their incentives are aligned with ours: to secure better working conditions and compensation for us as healthcare professionals. The potential for dues renegotiation in future contracts is standard practice and does not detract from the benefits of unionizing. UAPD, due to the unique population it serves, physicians and dentists, has one of the lowest percentage union dues while maintaining its resources. UAPD’s dues since its inception in 1972 has never gone above 1%, and was reduced to 0.9% 10 years ago. This roughly equals $500-600 of your current pre-negotiated salary, or roughly $5-6 per paycheck, a number we hope to well surpass with salary improvements.
- Salary – GME funding is a complicated topic with many misconceptions surrounding it. Part of the reason our employer is UMRS rather than individual hospitals is that there are multiple sources of funding for GME. Medicare, the VA, and the individual health systems all contribute funding for GME positions. Not all interns/residents/fellows are in “Medicare-funded” positions. UMRS pools all this funding and pays us and provides our benefits. Any increase in our salary or benefits would need to come from the health systems that benefit from our labor. We are looking to negotiate for pay parity with other comparable regional programs. We are proud of our program, and we are assets to our community. It is reasonable to ask for fair and comparable wages. There is no guarantee that we would get exactly what we ask for, but we believe the benefits we stand to gain far outweigh the cost. Unionized residents in other cities have been able to achieve substantial increases in their salaries. For example, in San Francisco, unionized residents received a 16% increase in their salaries. Without collective bargaining and legal support, would our local health systems be as responsive to our requests?
- Benefits – We agree that we already have a good healthcare plan that is comparable to others in the region, and we do not have to contribute to premiums. Our current benefits are the floor of bargaining and cannot be retroactively removed. While negotiating we can agree to change our benefits but this cannot be done unilaterally by our employer. An example of improved benefits would be a housing stipend or retirement benefits. While it is true that this may come from the same pool of money as our salary, depending on the benefit structure, it can be provided to us at a reduced cost to our employer when compared to providing it as salary. For example, retirement contributions can provide tax benefits (thus cost less to the employer than comparable increase in salary). We are looking for equitable collaboration, not contention.
- Training Duration – We recognize that many of us will not see the full benefits of collective bargaining during our training period. We are not just advocating for ourselves, but for future trainees as well. We can ensure that future residents and fellows will have the same protections, benefits, and rights that we are fighting for now. This is a long-term investment in our profession and our community. No one wants to extend our training duration any longer than it already is and everyone recognizes the time-in training requirements that may be impacted in the event of a strike. A strike is a tool of LAST resort and only can occur after a majority of votes approve such an action. There are many less drastic options that can be employed without resorting to striking and prolonging our training.
- Working Conditions – While it is true that the ACGME prescribes the vast majority of our working conditions, there is always room for improvement. Collective action will give us the power to advocate for additional improvements not mentioned by ACGME, such as clean call rooms and easy access to clean sheets, hazard pay, or bonuses. It will also allow for ACGME guidelines to be put in place into the contracts and clarified so that they become legally enforceable. The recent blizzard showed us that emergencies can and will happen. We need to ensure that we are legally protected, and our needs are appropriately considered for emergencies. As we are not employed by the health systems we work at, we are easily forgotten when emergencies do occur.
- COVID19 Healthcare Worker Bonus – We are grateful to UB GME for collaborating with resident leaders and NYS throughout this year to ensure that we receive the COVID-19 healthcare worker bonus. We agree that our initial exclusion was not entirely the fault of GME as our employment model was excluded by a legal technicality. However, GME did elect and design our employment model and this could be considered an unintended consequence of that. Our employment model also potentially could exclude us from other benefits/resources we have not foreseen. While a union would not fix this, collective action may allow us to mitigate some of these risks and provide continued resources to respond more effectively.
- Representation – We acknowledge that each specialty and program has different needs and requirements. By joining a union, we can ensure that all residents have a voice in advocating for their rights and interests. The UAPD is the largest union representing licensed doctors in the United States. We have confidence that they will assist us in representing our interests fairly and effectively. We strongly believe in our collaborative vision to expand the ability to make resident-driven improvements within our programs through collective bargaining. We have plans to formalize a group of 10-15 residents representing a variety of specialties that would constitute our bargaining unit and be backed up by UAPD legal presence and support. All house staff would know who these residents are and can advocate to them for needs from the union or for contract items. We are looking for people to step up to volunteer for this role, and are open to an election process. This is an improvement from the current system where GME negotiates on our behalf based on their assessment of what is in our best interests.
- Politics – Yes, unions are involved in politics and political action. So are many other organizations representing groups of people. The American Medical Association, American Hospital Association, American Heart Association, and all of our professional societies in some form engage in political lobbying – this can benefit us. For example, due to the balance budget acts previously passed by Congress, CMS proposes cuts annually to the physician fee schedule. Our professional societies lobby against this and attempt to preserve our hard-earned future income. Other lobbying efforts include efforts to stop, limit, or roll back scope creep and preserve physicians, with our years of training and experience, as the head of the healthcare team. While lobbying is often associated with negative feelings, it remains one of the most effective tools groups can use to collectively advocate for their interests.
We encourage all residents and fellows to consider both the advantages and disadvantages of collective action and unionization. In our view, collective action, in the form of unionization, provides the strongest avenue to advocate for our interests and those that follow us. To continue this discussion many of us will be at the Town Hall hosted by UAPD this Sunday 3/26 at 7:30pm. The president of UAPD, the organizing director, and UAPD’s lead attorney for Buffalo will be present to answer questions and discuss concerns. We are all happy to engage in further constructive debate and discussion as well. For anyone who wishes to show support, UAPD has also provided pins, buttons, and other items that are being passed around. Let any of us know if you would like something and we will ensure you get one.
Your pro-union colleagues
We strongly encourage you to vote for the collective bargaining of UB residents and fellows in our upcoming general election. You work hard every day to serve Buffalo’s most vulnerable populations. You put your blood, sweat, and tears into ensuring every patient receives the best care possible. We believe that you should be compensated justly and fairly for the life-changing work that you do.
Many people have asked, “What will a union provide?”
While the Union of American Physicians and Dentists (UAPD) provides us with the legal resources and expertise, the Union of UB residents & fellows is us. We are the Union. UB residents and fellows will be sitting across the table with hospital administrators negotiating our contracts – fighting for higher wages, housing stipends, meal stipends, and child care. With a union, we have a seat at the table. We can make meaningful changes that will enhance our educational experience and provide the utmost quality of care to our patients.
Currently, you receive a contract via email for which you or other residents had zero input. You are expected to sign this contract without regard for your priorities. Individually, our voices are left unheard. We are one of the lowest-paid residency programs in New York State. When compared nationally, we rank in the lowest percentiles in regard to salary and benefits. This paradigm shifts with a strong collective bargaining unit. With a union, we will have a say in what goes into our contracts and how it is written. With a union, our bargaining power is significantly increased. Livable wages, monthly meal stipends, and annual housing stipends are within reach. Your colleagues will fight for what is important to all of us.
Starting April 12, 2023, ballots will be mailed to you from the National Labor Relations Board (NLRB), a branch of the federal government, via USPS. This ballot will be de-identified (no names) and anonymous. Please vote with this ballot and sign the outside of the yellow envelope. This ballot will be returned to the NLRB via USPS (no postage required). Ballots must be received by Wednesday, May 10th, and will be counted on the following day, Thursday, May 11th. The results of the general election will be announced on Friday, May 12th.
If you have any questions, please visit the website that your fellow UB colleagues created: www.ubhousestaff.org. Most questions can be answered on the Q&A page or you can anonymously ask a question on the website or click here. Feel free to reply back to this email if you’d like to talk one-on-one. UB residents & UAPD will be hosting an All-Resident Town Hall on Sunday, March 26th at 7:30pm on Zoom. More information to come soon.
Thank you for the work you do. Continue to work hard to serve this community’s most vulnerable. Please vote in the upcoming general election.
UB House Staff, a collective group of UB residents and fellows
P.S. – UMRS has cited a challenge to our Union election, declaring that “Chief Residents” and “Chief Fellows” should be excluded from union election and representation as they are supervisors. This would mean that Chiefs would also be alienated from the financial benefits and protection that the Union provides.
Let us be clear, we will not stand for this. We are challenging this claim. We believe that every resident and fellow at UB, regardless of their chief status or not, deserves to be compensated fairly. This is just another example of how hospital administrators try to undercut your value.
From Student Organizations at the Jacobs School of Medicine and Biomedical Sciences
We, the undersigned student organizations at the Jacobs School of Medicine and Biomedical Sciences, are proud to announce our support for the organizing efforts of University at Buffalo residents, interns, and fellows, in collaboration with the Union of American Physicians & Dentists (UAPD).
Our residents are overworked and underpaid even as they do the essential work of running our healthcare centers, caring for our families and neighbors, and teaching us – the next generation of doctors. For example, during the recent holiday blizzard many residents worked tirelessly to save the lives of our community members without receiving a single penny of extra compensation, while attending physicians and other healthcare workers received generous combinations of overtime, hazard, and holiday pay. A housestaff union would set the stage for residents to democratically vote on their priorities, and collectively bargain for better working conditions and improved patient care.
Nationally, over 25,000 residents, interns, and fellows are part of a union. Whether a housestaff is unionized is now a strong consideration for selecting an attractive residency program. In New York State alone, 25 hospitals staffed by residents are unionized. Just last week a supermajority (82%) of residents at Montefiore Medical Center in the Bronx voted to unionize, bringing that number up to 26! We know that our school actively seeks students with a commitment to WNY in the admissions process, and encourages us to stay locally for residency. Buffalo is a union town– 1 in 5 workers count themselves as part of a union vs. the national average of 1 in 10. We are much more likely to choose to stay in WNY knowing that we’ll be joining a unionized program where our interests are represented at the decision-making table.
Every worker deserves a good quality of life. As medical students, we feel fortunate to learn from doctors who understand that high-quality, comprehensive clinical care is only truly possible when healthcare workers feel safe and represented in the workplace. Our UB interns, residents and fellows deserve our support. They staff our hospitals, teach us students, and voluntarily support the operation of numerous student-led clubs and service organizations. Ensuring resident safety and fair compensation is not only in their best interest, but also in the interest of the Jacobs School and greater Buffalo community.
(in alphabetical order)
American Medical Association at Jacobs School of Medicine and Biomedical Sciences
Anesthesiology Interest Group
Animal Advocacy and Assisted Therapies Club (AAATC)
Asian Pacific American Medical Student Association (APAMSA)
Association of Women Surgeons (AWS)
Best Buddies UB Med Chapter
Bioethics Journal Club
Buffalo Health Law Society
Cardiology Interest Group (CARDIG)
Child Advocacy Club
Christian Medical & Dental Associations (CMDA)
Coding with Real Applications for Students in Healthcare (CRASH)
Dermatology Interest Group (DIG)
Diabetes Mentoring and Education Club
Emergency Medicine Student Association
Family Medicine Interest Group
Friends of the Night People Clinic
Gastroenterology Interest Group
Geriatric Medicine Student Association
Global Health Interest Group (GHIG)
Heart Sounds Magazine
Human Rights Initiative at the University at Buffalo (HRI)
Jacobs Climbing Coalition
Jacobs Community Group Fitness
JSMBS Food is Medicine Coalition
Latino Medical Student Association (LMSA)
Lighthouse Free Medical Clinic (LFMC)
Med-Peds Interest Group
Medical Students for Choice (MSFC)
OB/GYN Interest Group
Oncology Interest Group
Ophthalmology Interest Group
Orthopaedic Interest Group
Palliative Care Interest Group
Parent and Spouse Student Club (PASS)
Pathology Interest Group
Pediatric Interest Group
Plastic and Reconstructive Surgery Interest Group
PM&R Special Interest Group
Preventative and Lifestyle Medicine Interest Group
Psychiatry Special Interest Group Network (PsychSIGN)
Public Health Interest Group
Radiology Interest Group (RIG)
Society for Internal Medicine
South Asian Medical Student Association (SAMSA)
Student National Medical Association (SNMA)
Students for a National Health Program (SNaHP)
Students for Growing Interest for Transplantation (S4GIFT)
Student Interest Group in Neurology (SIGN)
The Jonathan Daniels Chapter of Black Men in White Coats (BMWC)
The Jonathan Daniels Chapter of White Coats 4 Black Lives (WC4BL)
UB Difficult Decisions
White Coat, Black Diamond
*The views in this letter are expressed by the student-leaders of these clubs and are not necessarily meant to be a reflection of any faculty advisors.
Dear UB Residents and Fellows,
It is with great pride that we write to you that Union of American Physicians & Dentists (UAPD) have joined forces with UB residents and fellows to exercise our rights to organize for greater collective bargaining power. In unity, we aim to amplify our voices to improve salaries and advocate for safer working conditions.
We have continuously been overworked and underpaid by our UB affiliated hospitals. Compared to our colleagues in similar cost-of-living areas such as Rochester, Syracuse, and Albany, UB house staff are paid significantly less despite having equivalent health insurance and benefits. Despite rising costs of living and inflation, UB has spent the last decade raising salaries 1-2% a year. Our salaries no longer reflect the reality of the cost of living in Buffalo. The time has come to stand up for ourselves and gain the bargaining power needed to make meaningful change.
Resident and fellow salaries are funded by the federal government via Medicare. Medicare provides the funds to the hospitals and GME, who in turn reallocate those funds as they deem necessary and redistribute what is left over as our salaries. While funds per resident vary depending on location, some studies suggest that at minimum, Medicare is providing $150,000 per resident to GME . These funds represent the direct payment the government pays the hospital to train you as a physician. How much of that $150,000 are you receiving?
A myth in the business of medicine is that residency programs are a massive cost to hospitals. Take for example the neurosurgery residency program at the University of New Mexico. In 2019, the neurosurgery residency program at UNM lost its program accreditation due to ACGME violations . As a result, 10 neurosurgical residents were placed at other training programs away from UNM. To keep its continued neurosurgical services to the community, UNM had hired 23 advanced practice providers to replace its 10 lost residents. The annual cost to replace its 10 lost residents by hiring 23 APPs was an average of $1.5 million per year. Next time our hospitals tell us that the residency program is costing them money – think about the neurosurgery program at UNM and the large stipend they receive from Medicare.
During the Buffalo Blizzard of 2022, many residents and fellows were forced to stay at their respective hospitals and work overtime, breaking ACGME duty hours. None received extra compensation while other health professionals, such as attending physicians, nurses, techs, and APPs were given combinations of overtime pay, holiday pay, and hazard pay. All made possible by the power of collective bargaining contracts. We fully support the well-deserved bonus compensation of our health professional allies. Why do we accept payment for ourselves in the form of a pat on the back for a job-well-done? It’s time we advocate for ourselves.
Hospital administration has few incentives to fairly compensate medical trainees. Residents and fellows represent a vulnerable section of the working class, made up of a revolving group of young altruistic individuals willing to take an average of $202,450 in debt to pursue the dream to help others . Options to leave for another residency program or career are limited. We are often exploited for our devotion to our profession and willingness to sacrifice. Despite the monumental impact residents and fellows had on the Buffalo community taking care of patients on the front lines during the Covid-19 pandemic, little was done by leadership to reward these efforts. While the front-line workers we worked alongside received the New York State Healthcare Workers Bonus months ago, residents and fellows were left behind again. Until we started speaking up for ourselves.
We understand medical training is not supposed to be easy and that there is a culture of putting in your dues, but the blatant disparity experienced by UB residents and fellows puts patient care at risk. This can no longer be tolerated. We need a say in our working conditions and we need to demand a seat at the table so that we can provide a safe working environment for ourselves and for the safety of our patients.
Join us in collectively organizing UB residents and fellows with the collaboration of UAPD. Together, our voices are stronger and we can make a difference. We can better working conditions for ourselves, and protect future trainees from exploitation. There is a reason most of your healthcare team in Buffalo are unionized. Nurses, techs, ancillary staff work hard and deserve their fair compensation. We have done, and always will do our part to advocate for our patients. Now it is our turn to advocate for ourselves.
Sincerely and in solidarity,
UB House Staff
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