Six months after their last contract expired, resident physicians in Oakland, California, are speaking out about the challenges they’re encountering at the bargaining table. Oakland residents with the Committee of Interns and Residents – Service Employees International Union (CIR-SEIU) have been without a contract since November 2022, and are now holding “unity breaks” to discuss Alameda Health System’s (AHS) conduct during their bargaining process, understaffing, and the need for better working conditions which will improve the care they provide for their predominantly working-class patients.

The resident physicians at Highland Hospital say they regularly work 80-hour weeks for low hourly wages, and cover many gaps in the hospital due to understaffing. The residents say they are seeking a contract that will protect patient care in one of Oakland’s most underserved areas. 

“Many of my colleagues and I came to AHS and Highland Hospital because we wanted to provide care to a community that has been structurally underserved for far too long,” said DaShawn Hickman, a third-year emergency medicine resident at Highland Hospital and a CIR regional vice president. “All we want is a contract that ensures humane working conditions, but instead, management is acting in bad faith by failing to respond to our demands diligently and in a timely manner.”

On March 21, the residents held a unity break, an event that represents a collective time out from the status quo of resident physicians’ exploitative working conditions to come together, speak out, and demand good faith bargaining and a fair contract from AHS. The physicians who attend a unity break are those who are able to do so without disrupting patient care. The goal is to bring attention to AHS’s misconduct during contract negotiations and the way physicians are overworked while they serve on the frontlines of the county’s primary trauma care center. At the bargaining session on the night following the unity break, management came back with a small increase in their salary proposal (an additional 2% spread over three years). However, resident physicians say there is still a long way to go, and they’ve yet to see movement on a number of crucial priorities, like paid parental leave. AHS continues to refuse to offer more than six weeks of paid parental leave and continues to reject the resident physicians’ child care and proposals for fertility coverage.

According to organizers with CIR, AHS has been painfully slow at the table and has repeatedly engaged in bad-faith bargaining. Late last year, management delayed bargaining for weeks because they suddenly said they had no authority to bargain, and CIR had to fight to bring negotiators back to the table. In Aug. 2022, workers filed an unfair labor practice charge against AHS through the California Public Employment Relations Board. An administrative law judge found that AHS was in violation of a bargaining act for changing its enforcement of dependent eligibility requirements for medical coverage, without allowing SEIU an opportunity to meet and discuss.  At their session on March 8, AHS showed up with no proposals for the physicians. 

Ajeet Singh, a fourth-year internal medicine resident physician and bargaining committee member, became involved in the union early on during his studies. 

“I saw our union during residency as an opportunity to have some sort of collective agency and ability to negotiate within the hospital,” Singh said. “This is my last year, but I really leapt at the opportunity to join the bargaining team to help benefit the working conditions and the contract for my peers moving forward to Highland.”

According to Singh, the medical training pipeline has exacerbated poor working conditions for residents. On an average day, residents have morning reports, lectures, and noon conferences, while also having to present to their attending and supervising physicians. The extensive work has resulted in extreme stress for the physicians and has prevented many from furthering their families and personal lives.

“Yes, there is learning, but the people who are actually doing all the frontline delivery of care are the residents,” Singh said. “This is not a classroom. When the day shift starts, whether it’s at 6 AM or earlier, it is not the supervising or attending physicians who are there, it is the residents. It is the residents who first look at all of the lab results, who first see the patients and speak with nursing. It is the residents who respond to emergencies and need to make in-the-moment decisions that are critically important for very high-stakes situations.”

According to Singh, most residents are working at least 12-hour days in the pursuit of advancing their medical career. Before they get there, they’ve spent years studying to “match” with a residency program. 

“They get locked into a program where before they see any contract that includes their working conditions, just by entering in the match, they are contractually obligated to accept that program,” Singh said. “Once you enter, you’re sort of stuck with whatever working conditions you are given.”

At Highland, Singh said they get four days off a month, which creates obstacles for physicians with families or planning for children. On weekends, residents are expected to have their pagers with them 24/7, making it nearly impossible to plan life events. From 2022 to 2023, the median rent in Oakland increased by more than 16%. However, across their last two contracts, their housing stipend only increased by less than 1% of the median and annual rental costs in Oakland. 

“We’ve seen really minimal gains and they have really left us on the backfoot in terms of being able to pay for housing near where we work,” Singh said. 

Singh and the residents are also asking for fertility benefits, protected time off, and adequate  compensation to attract diverse physicians that reflect the community they care for.

“Unfortunately, I think we still have a long way to go in adequately representing the kinds of patients that we are treating and being able to have the best and most well-supported workforce that can then better support high-quality patient care at Highland,” Singh said. “In Oakland, we are caring for some of the most marginalized populations across multiple intersections of race and ethnicity, primary language, immigration status, health, [and] literacy. I mean, these are populations who have endured decades and centuries of structural violence, and we’re all sort of at the front and final line of trying to meet them and guide them towards a path of better health and recovery really, in spite of all these factors. So I see our residents being a part of the critical force and protecting the health of this community.”

He hopes residents have a better contract before the end of June when the new class of residents is set to enter.