Buffalo Medical Residents Are Striking for Fair Pay and Better Conditions

Around 100 picketers stood in front of Buffalo General Hospital on September 4, chanting and talking to reporters under the midday sun. They gripped signs with slogans like “Fair Contract Now” and “United For Our Patients.” Cars honked in support as they passed by, with some drivers thrusting fists into the warm air through their open windows.

It was the second day of a four-day strike by University at Buffalo (UB) medical residents over pay, benefits and working conditions. The strike was authorized by a resounding 93 percent vote after more than a year of bargaining attempts.

The striking medical residents in Buffalo are part of a rising wave of unionization among medical workers stretching from California to Vermont and spurred by demands for better compensation and working conditions.

Medical residents — also known as resident physicians or house staff — play a critical role within hospital operations.

Going into September 6, the last day of their strike, they are determined to push their demands with the hope of returning to the work they love — but on terms that feel more just and respectful.

“Nobody wants to be out here, but there’s no other option for us,” Armin Tadayyon, a fourth-year anesthesiology medical resident, told Truthout. “This is the only way that we can ensure that we are treated fairly.

“The Linchpins of This Health Care System”

Medical residents play a critical role within hospital operations. They work long and intense hours, including in intensive care units, to support treatment across hospitals, from internal medicine to general surgery and from psychiatry to neurosurgery.

These resident physicians have finished medical school, and their residencies function as apprenticeships towards becoming fully credentialed doctors. But they are also jobs, and hospitals heavily rely on them to function.

“The house staff are the linchpins of this health care system,” said Stuart Bussey, president of the Union of American Physicians and Dentists (UAPD), at the September 4 press conference. “They serve the community with blood, sweat and tears, and yet they receive monetary scraps.”

“We are stuck at their mercy, and their mercy is to be minimum wage, to have horrible health care benefits, have no retirement, have no hazard pay.”

In February 2023, UB medical residents announced their intent to unionize, and in May 2023 they won their union by a 270 to 114 (70 percent) vote. They are affiliated with the UAPD and, today, represent around 830 resident physicians who work in several Buffalo area hospitals.

Tadayyon, who helped organize the union, said a key driver behind unionization was poor compensation.

“We are the lowest paid residency program in the region,” he said, noting that with the long hours, some effectively make minimum wage.

The union also says that UB medical residents lack retirement benefits and meal and training stipends, and they have the worst health care policy in the region.

There’s also what Tadayyon calls the “bully culture” at work. Medical residents are not yet licensed to practice independently, but they can’t easily quit and go to another hospital. He says this leads to a power relationship where hospitals have the upper hand to exploit house staff.

“We are stuck at their mercy, and their mercy is to be minimum wage, to have horrible health care benefits, have no retirement, have no hazard pay,” he said.

Hijab Khan was a medical student at UB last year when the resident physicians unionized, and she was very supportive of their union drive then. Now, she’s a first-year medical resident in psychiatry and taking part in the strike.

Medical residents work up to 80 hours a week. One time, she calculated her hourly wage after a long week, and was shocked to discover she made less than $12 per hour.

Khan echoed other demands that the union is making, including protected lunchtime, meal stipends, clean call rooms to rest in and help covering the costs of exams. She loves her field, and like other medical residents that Truthout spoke to, she’s okay with the long hours. Learning to deal with the strenuous work environments at hospitals is an important part of her professional training. But that doesn’t mean there shouldn’t be fair compensation and decent working conditions.

“It’s a special job,” she said, “but you want to make sure it’s a fair one.”

“The Downstream Effect Is on Patient Care”

Echoing other medical residents, Khan also says patient care is a top reason she’s striking.

“If I had a family member in the hospital, I would want the people taking care of them to be well rested and not burned out, and compensated fairly for what they were doing,” she said.

“Being a physician is a labor of love. But we weren’t compensated for it and we weren’t acknowledged for it.”

While long hours are part of the job, says Khan, a lack of fair compensation, good health care, guaranteed lunch breaks and clean places to rest creates unnecessary stressors.

“The downstream effect is going to be on patient care,” she noted.

Tadayyon analogized the situation to an overworked pilot. “Would you ever want to step onto an airplane with a pilot who works 80 hours a week, is underpaid, doesn’t get a meal break, has absolutely zero benefits, and is fatigued and burnt out?” he asked.

Other medical workers have also cited patient care as a major concern tied to working conditions. For example, nurses across the U.S. have been striking the past few years, especially for lower nurse-to-patient ratios.

Over and over again, medical residents Truthout spoke to stressed their commitment to their professional calling and to their patients — and their patients also attested to the dedication of the UB house staff.

At the September 4 press conference, Liina Sarapik, a patient who has suffered from Long COVID for the past year and half, praised the care and attention she’s received from medical residents.

“It’s been an incredible experience to receive the treatment that I’ve received,” said Sarapik, “but especially from the residents.”

Who’s the Boss?

A major frustration for medical residents has also been the question of who, actually, is their boss.

Technically, they’re paid by — and have been bargaining with — an entity called University Medical Resident Services (UMRS). But the union says this is a shell company created by hospitals and the University at Buffalo, who hold the real power over house staff working conditions but evade accountability through leaning on a separate legal unit

Bargaining has been frustrating, says Tadayyon, because hospitals and UB have not directly joined talks despite union demands. Instead, the union has had to bargain with a lawyer from UMRS who says they don’t have control over working conditions.

“The setup in Western New York is extremely convoluted, and I think that’s done intentionally,” said Tadayyon.

All this is a big reason bargaining has gone poorly, the union says. It has filed unfair labor practice charges with the NLRB against UMRS and UB as the joint employer around bad faith bargaining and bullying and surveillance around union participation. They also filed charges around “unilaterally degrading healthcare benefits of residents and fellows during the bargaining process” and “violating the New York State Family Medical Leave Act,” according to the union.

The union says that hospitals receive more than $150,000 per resident in Continuing Medical Education (CME) federal funding. UB medical residents are asking why regional peers, who receive the same government funding, can offer benefits that UMRS claimed are too onerous, and they are demanding that UB and UMRS open its books.

According to the union, UMRS has moved on its salary demands, but not on anything else.

“They’ve offered nothing to improve our benefits or improve our working conditions,” said second-year internal medicine resident Steven Moran. “Don’t let them play you all as fools. UMRS knows we’re asking for more than a higher salary, and they just don’t care.”

“We Are the Grunts”

UB medical residents are not alone in struggling for better pay and working conditions.

The past few years have seen a booming national wave of unionization among medical residents, with resounding unionization votes at the University of Pennsylvania Health System, Mass General Brigham, George Washington University and University of Vermont Medical Center, to name a few.

One immediate driver of this trend is the impact of COVID-19. Tadayyon said the pandemic amplified how essential medical residents are to hospital operations, but also how poorly compensated and unappreciated they were.

“Residents are the ones that are stepping up to take shifts that nobody else wants,” he said. “We are the grunts, and honestly, we love doing this. Being a physician is a labor of love. But we weren’t compensated for it and we weren’t acknowledged for it.”

Medical residents are embedded within an ever expanding corporatized health care system generating huge industry profits and CEO salaries.

Tadayyon also noted that, when their hours are stretched, medical residents are “equal to two full-time equivalents.”

The growing cost of living — everything from rising rents and child care costs to price inflation — also impacts medical residents, who are often in their 30s and 40s and may be caring for families.

There are also long-term structural factors. Medical residents are embedded within an ever expanding corporatized health care system generating huge industry profits and CEO salaries. Bussey, who has been a family doctor for 40 years, says workers within this complex “need a voice.”

“Doctors are part of an industry now,” he told Truthout. “There’s $4 trillion in this industry, and a lot of people want to get their hands into that money.”

“The Workers Need to Be Cared for as Well”

At the picket on September 4, support for the strikers was loud and clear. Cars honked constantly while unions across Buffalo turned out in support.

“I’m here to show solidarity for the residents and fellows that made a very difficult decision to go out on strike,” Mary Nowocien, director of Organizing and Mobilizing for CWA Local 1168, whose members include many nurses, told Truthout. “Anyone working in health care needs to be taken care of, just like we take care of our patients.”

Jomo Akono, a council representative with the North Atlantic States Regional Council of Carpenters Local 276, told Truthout that the carpenters in his union helped build the hospitals surrounding the picket, and they were there to support the medical residents’ demand for a fair contract.

“Our families and our communities are impacted by what happens here and with those who are caring for us,” said Akono. “The workers need to be cared for as well, and we’re here in solidarity with them.”

But the press conference suggested that medical residents are not receiving this care.

Amanda Duggan, a second-year resident in internal medicine and pediatrics, spoke with clear emotion when she described how she was diagnosed with colon cancer after she started her residency. She needed chemotherapy and lifesaving surgery, and she took vacation time to get treatment.

When she needed just one afternoon a month to see her oncologist for infusions, she was “essentially told” that if her residency said she had to work those afternoons, “then that was what was going to happen.”

Throughout this fight, she said, her union coworkers stuck up for her.

“Standing behind me are residents that supported me through that terrible, terrible experience,” said Duggan, “and I’m standing here today in front of you all for them, because they deserve better than that.”