Q: What’s the latest update on the union process that’s underway?
A: The NLRB (National Labor Relations Board) mailed ballots on Thursday, March 31st. You should have received a package by now from the NLRB that includes a ballot and return envelope addressed to the NLRB Region 32 office. (See FAQ: voting instructions and timeline for more details)
If you have not received your ballot package by April 7th, the NLRB asks that you immediately contact the Region 32 office at 510.637.3300 or call the NLRB Agent Nicholas Tsiliacos at 510.671.3046. Your ballot must be received by 5:00 p.m. on April 28th to be counted. The NLRB will count votes on May 2, 2022.
The secret ballot election process was triggered when CIR/SEIU (Committee of Interns and Residents/Service Employees International Union) filed a formal petition with the NLRB regional office.
Q: Why is it critical for all residents and fellows to vote?
A: The outcome of the election is determined by a simple majority (50% +1) of only those who actually vote. For example:
· 1,456 Eligible Voters
· 200 Vote (101 vote Yes for the union; 99 vote No)
· Result: All 1,456 eligible voters are now represented by the union, even those who voted no or didn’t vote at all.
It’s important to know that should this pass, you cannot opt out of union membership or dues. That is why it is so critical that eligible residents and fellows vote, so that your voice is included in this important decision. If you’re undecided, we urge you to vote “no.” If you have any uncertainty or hesitancy, voting “no” provides you with the greatest flexibility, so that you can take additional time to evaluate the facts and determine if a union is right. Residents and fellows can still revisit unionization after one year.
Q: What can we expect during the voting period?
A: The next several weeks may be intense and emotional. We ask that everyone affected by this vote remain respectful of everyone’s views, and remember that we are all connected in our shared commitment to providing the very best care for our patients and a preeminent educational environment.
We hope that you will take time to know the facts about how a union would impact residents and fellows now and in the future. We also hope that you will go to your faculty advisors, and program and residency leaders if you have any questions about the voting process or implications of a union. We are here to support you.
Do you have to pay dues regardless of whether you voted for the union or not?
You will be asked one question on the secret ballot: Do you wish to be represented for the purposes of collective bargaining by CIR/Service Employees International Union?
If a majority of Residents and Fellows, who vote, choose union representation, all Residents and Fellows will be represented by the union and will be subject to the provisions of any negotiated agreement. For example:
• 1,456 Eligible Voters
• 200 Vote (101 vote Yes for the union; 99 vote No)
• Result: All 1,456 eligible voters are now represented by the union, even those who voted no or didn’t vote at all.
In California, CIR/SEIU has historically and consistently negotiated contract clauses that requires all Residents and Fellows to become members of the union and to pay union dues as a condition of employment – which means if dues are not paid, then the Resident or Fellow would be dismissed from their training program.
Here is an example of a CIR negotiate contract clause at another private academic medical center.
Article 9 CIR/SEIU Dues and Security 1. It shall be a condition of employment that all House Staff Officers covered by this Agreement who are members of the Union in good standing on the effective date of this Agreement shall remain members in good standing and those who are not members on the effective date of this Agreement shall on or by the 31st day following the effective date of this Agreement, whichever may be later, become and remain members in good standing of the Union. It shall also be a condition of employment that all House Staff Officers covered by this Agreement and hired on or after its effective date or the execution thereof, whichever may be later, shall on or after the 31st day following the beginning of such employment become and remain members in good standing of the Union. For the purpose of this Agreement, “good standing” shall consist of the payment of periodic dues as uniformly required by the Union as a condition of membership or pay an agency fee to the Union.
I’m a fellow or a senior resident about to complete my training program at Stanford Health Care. Why should I still cast a vote?
It is important that all eligible residents and fellows vote so your voice is included in a decision that will fundamentally change the training programs and the experience for those who follow you at Stanford for years to come. For senior residents and fellows who go on to become Stanford faculty, it is critical to understand how a unionized environment will likely change your department’s training experience.
I understand that unions get involved in wages and benefits negotiations, but are they also involved in education and training programs?
Under a union contract, the union will become the exclusive bargaining representative for all 1,456 residents and fellows across 170 residency programs, making it difficult to consider the unique needs and preferences of all residents and fellows and their respective departments. This means that what may be important to specific training programs may not be among the top priorities of the negotiation committee.
We’ve heard from colleagues at other academic medical centers that these negotiations affected the ability for departments to make specific decisions about electives, team structure and dynamics, and program-specific resources and stipends.
I am not aware of how residents and fellows actually inform and shape decision making – I just know what benefits are available to me. Are there current forums and committees that enable residents and fellows to have input?
Stanford Health Care has a process for dialogue and direct engagement with resident committees across a range of meaningful issues. This direct engagement has enabled us to accomplish significant improvements to our benefits.
For example, the Resident Safety Council meetings with the CEO of SHC have led to improved patient care and clinic management. The SCH Advocacy Council helped address community needs. A number of resident- and fellow-driven initiatives resulted in a 403B retirement plan, solutions to pandemic-related needs, and addressing concerns around staffing and space at the new 500P building.
I’m still undecided and don’t really have the time to sort through all this information? What should I do?
We fully appreciate that this is a complex decision. We want people to vote - we are encouraging a high voter turnout. If you’re undecided, we urge you to vote “no.” Remember, a simple majority decides the outcomes of this election. If you have any uncertainty or hesitancy at all, voting “no” provides you with the greatest flexibility going forward.
If the majority of those who vote, vote “no,” you can take additional time to evaluate the facts and determine if a union is right. Residents and fellows can still revisit unionization after one year. A “no” vote gives us all a chance to work together, and still provides residents and fellows the opportunity to initiate another election after 12 months if they so choose.
At the end of the day – no matter what the result – we always want to continue to work with you as best we can to ensure the strongest learning environment possible.
If residents and fellows vote in a union at SHC, who will sit at the collective bargaining table? Who is responsible for negotiating the agreement? Will I have a say?
In preparation for bargaining, both CIR/SEIU and hospital leadership would identify and form bargaining teams. How represented residents and fellows can express their views on contract matters depends on the internal procedures and decision-making process of CIR/SEIU and its officers, as well as who sits on the bargaining team.
Generally, a very small subset of individuals will actually be at the table (often less than 1% of represented individuals) and the bargaining efforts would be led by an individual employed by CIR/SEIU.
Under federal law, an employer is prohibited from bypassing a union and dealing directly with represented employees in connection with terms and conditions of their employment, including program-specific compensation (i.e., stipends, bonuses, etc.). Accordingly, programs may not engage in separate bargaining with house staff or unilaterally provide program-specific benefits outside of the bargaining process.
•Stanford Health Care’s leave policies for residents and fellows comply with ACGME requirements and include leave policies for:
•The birth, adoption or foster care placement of your child.
•The care of your spouse, domestic partner, child or parent who has a serious health condition.
•A serious health condition that makes you unable to perform your job.
•A qualifying exigent circumstance related to the active duty or deployment of a qualifying service member.
•The care of a family member who is an ill or injured military service member (up to 26 weeks).
How much parental leave do I get? How much with pay?
•Residents and Fellows can take a minimum of 6 weeks paid new parent leave, plus an additional 5 days to cover the state disability waiting period. The actual length of leave will depend on a physician’s certification. This includes parental leave for the pregnant or non-pregnant parent, and all new hires are eligible.
•Pregnant residents and fellows are entitled to Pregnancy Disability Leave (PDL) of up to 17.5 weeks because of medical disability related to pregnancy and the birth of a child, as verified by a physician, in accordance with California law. If eligible for leave under the Family and Medical Leave Act and California Family Rights Act (FMLA/CFRA), residents can take up to 12 additional weeks of leave to bond with their newborn following disability leave.
•If eligible, there is a maximum of 12 weeks of leave protected by the Family and Medical Leave Act and California Family Rights Act (FMLA/CFRA).
What is the criteria to be considered for FMLA/CFRA leave?
•The criteria for eligibility are one year of service and 1,250 hours of work during the 12 months preceding the leave. The leave entitlement can not have been exhausted within the previous year.
•When “foreseeable”, a resident must provide 30 days advance notice of leave.
How much vacation/sick days can I take off?
•Residents and Fellows can take a total of 4 weeks of vacation/personal days per year. This includes 3 weeks of vacation and 1 week of an education leave or vacation.
•Residents and Fellows are allowed 20 sick days per year.
If I have to make up time at the end of my residency, will I be paid?
Q: What is collective bargaining? Unions often talk about what they will get for employees, can a union guarantee this outcome?
A: During a campaign, unions have significant leeway to “promise” higher wages, more benefits, and other changes. However, CIR/SEIU cannot guarantee any of that will actually happen. Collective bargaining is a give-and-take process between management and the union to discuss wages, benefits and terms and conditions of employment. There are no guarantees. This means that the highly competitive total compensation and benefits package residents and fellows already have today goes on the negotiation table and must be bargained anew. At the end of bargaining, they may get the same, more or less.
Q: How long can it take to negotiate a contract?
A: On average, first contracts can take over 500 days to negotiate, sometimes even longer. There is no set timeline for reaching an agreement. This means that even if the decision is made to create a union, the outcome of the negotiation may not occur for another 18 months. For example, we know of an organization involved in a NLRB secret ballot election in November 2019 with the first bargaining session held in February 2020. They are still bargaining two years later with no immediate end in sight.
Q: What happens during bargaining periods?
A: During the lengthy bargaining period, there is a legal requirement called “status quo” that requires wages and other terms and conditions of employment to remain the same throughout unless both parties agree to make changes. In some instances, during this status quo period, the hospital may choose to provide new benefits or enhance current ones for its workforce. As part of this process, those enhancements may not be made available to the group represented by the union for quite some time due to the status quo obligation and the practicalities of union negotiations. For example, we have learned of an organization that enhanced parental leave benefits and added health care coverage for gender identity surgeries. These new benefits were immediately available to those not represented by the union but unfortunately, they were delayed for the union represented employees because of the pending negotiations over a first contract.
Q: Do you have to pay dues regardless of whether you voted for the union or not? How much are the dues?
A: Yes. Should this pass, all fellows and residents will have to pay dues regardless of how you voted. According to CIR/SEIU, dues are 1.6% of your gross salary. This means for residents and fellows who are PGY I, II and III, union dues will be approximately $1,200 per year.
Q: If the union represents all residents and fellows and they don’t like the contract, can they opt out?
A: No. Once a union represents a group of residents and fellows, the contract that is negotiated applies to all of the residents and fellows in that bargaining unit. Generally, the residents and fellows would not be allowed to “opt out” of a union contract he or she doesn’t like, nor would a resident or fellow be allowed to disregard portions of the contract that he or she doesn’t agree with. No changes that can be made to the contract until it expires or unless both Stanford Health Care and the union mutually agree.
Q: Does the union offer a “trial” period, and if residents and fellows do not like union representation can they withdraw from the union?
A: No. There is no “trial” period associated with unions. A union is presumed to represent employees for as long as the contract remains active unless employees become dissatisfied and take action to vote out the union. Under the law, employees have the right to vote to “decertify” the union. The process is a difficult one that is quite complex and there are time limits and rules about when/how this can happen. Employers cannot assist in any way to decertify the union.
Q: What is Stanford Health Care’s perspective on the efforts of residents and fellows to have CIR/SEIU be their union representative?
A: We respect the rights and opinions of all of our residents and fellows. Stanford Health Care declined to voluntarily recognize CIR/SEIU because we believe it is up to you to choose whether or not to join a union. It is every resident and fellow’s decision, and, under the National Labor Relations Act, each resident and fellow has the right to express their views on union representation through a secret ballot election conducted by the National Labor Relations Board (NLRB). This election will likely happen in the next 3-4 weeks.
Q: How will a possible residents and fellows’ unionization effort impact the graduate medical education experience at Stanford?
A: We are committed to providing the highest levels of education and training to prepare our residents and fellows to deliver exceptional patient care, become preeminent in their chosen specialty, and be remarkable health care leaders. The success of your education and training experiences depends in large part on the direct relationship you have with your program leadership and clinical program departments.
This direct relationship is invaluable as it allows us to optimize the experience for each of our 1,456 residents and fellows across our 170 residency and fellowship programs. We want to make sure you are aware that if a union represents you, that relationship will have to shift to be between Stanford Health Care and the union.
Q: Would residents and fellows have a stronger voice if a union represented them?
A: We don’t think so. Here’s why: We believe that when residents and fellows have their own voice and the ability to express their opinions and desires directly to us, it is more powerful and effective for them and our patients. In a union environment, those messages may be factored in with many other potentially competing voices, and then delivered to us by the union through filters. This “indirect” method may not accurately or completely express individual views.
Q: Does this mean a union contract is a “one-size-fits-all” agreement across all departments?
A: Yes. Under a union contract, residents and fellows across departments may find themselves subject to a “one-size-fits-all” situation. The union will become the exclusive bargaining representative for the entire group, making it difficult to consider the unique needs and preferences of all residents and fellows and their departments. This means what may be important to specific training programs may not be on the top priorities of the negotiation committee.