LABOR Health Care Worker Unions Are on the Side of Patients


Hospitals portray unions as opposed to the interests of patients. The opposite is true: health care unions have been the strongest advocates for safer conditions and patients who can’t pay debts.

At the nation’s largest academic medical centers, resident physicians have rekindled a long-standing debate over health care worker unionization. According to the Committee of Interns and Residents, the number of unionization wins increased from one in 2020 to two in 2021 to five in 2022. This year alone, residents have voted in favor of unionization in landslide elections at Penn Medicine in Philadelphia (88 percent), Mass General Brigham in Boston (75 percent), Montefiore Medical Center in New York (82 percent), and George Washington University Hospital in Washington, DC (94 percent).

As unionization efforts have spread, they have renewed debate over the role of resident labor in hospitals, the rights of trainee-workers, the ethics of health care worker strike actions, and the financial priorities of C-suite executives in the modern hospital.

One of the major points of contention is what effect unionization will have on the most important people in any hospital: the patients. In this debate, supporters and detractors alike have tried to draw lessons from other health care worker unions. Opponents of unionization, on the other hand, accuse nursing unions of seeking to impose inflexible mandates that frustrates efforts to provide care in unavoidably fluid circumstances.

Advocates of unionization point to unsafe conditions when hospital executives pursue their priorities without effective worker input, as well as the very real threats of termination that hospital employees face when they speak out about these conditions without the protection of a union. Pro-union voices also cite econometric analyses that demonstrate a causal link between nursing unionization and improved patient outcomes.

There is, however, a longer history that we can draw from to understand how unions can advocate for patients. Hospitals have often painted themselves in this debate as the protectors of patient care against self-seeking workers, but when the decisions of hospital executives cause patients harm, unions have been a crucial countervailing force. The example of the Service Employees International Union (SEIU) at Yale New Haven Hospital (YNHH) provides such a case study.

In May 2001, the New Haven Advocate, an independent weekly magazine, published a story titled “Predator on the Hill” written by Paul Bass. The story detailed the hospital’s practice of foreclosing on the homes of patients, some of whom worked low-paying jobs at the hospital, over unpaid debts. When asked for comment, hospital executive Marna Borgstrom claimed the hospital only sued patients with the ability to pay and blamed debtors for their lax spending habits: “I’m always amazed at what people pay for discretionary items.”

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