Five Decades of Advocacy: A History of the UWHA
The University of Washington Housestaff Association (UWHA) has a long and storied history of advocating for residents and fellows. Through decades of hard work, the UWHA has provided for collective bargaining between University of Washington residents and the University in order to achieve a goal of improving the work environment of housestaff and better caring for patients. Since its founding in 1964, the UWHA, backed by enthusiastic residents and fellows, has fought a series of important battles to bring housestaff the benefits that they now enjoy.
1964 – the year the UWHA was founded – was a tumultuous time for housestaff at UW. Rising frustration over low salaries, lack of benefits and job security, and having to pay for use of call rooms had come to a head and residents were preparing a strike. The newly established Housestaff Association took the lead in advocating with the administration for workplace improvements. Fortunately, the UWHA was able to bargain collectively for a raise and increased benefits and was able to avoid the looming strike. The indignity of forcing residents to pay to use call rooms was also ended. Unfortunately, while this temporarily addressed some issues this was an ad hoc solution, and the UW refused to bargain with the housestaff moving forward. Furthermore, residents still lacked a contract, meaning that the conditions of their employment could change at any time.
From 1974 to 1975, the practice of summarily firing residents without any recourse came into question. The UWHA pushed for a bona fide contract to address this and other ongoing employment issues. A Memorandum of Understanding was created, but it did not become official University policy. In the 1970s, the administration assigned a lawyer to try and understand the issues facing residents and determine if collective bargaining would be beneficial. The study was performed by Mr. Olswang, an attorney backed by the Provost’s office, who took call with residents and did a survey trying to understand their concerns. The results of his survey were treated as “confidential information” and were kept secret from housestaff, however 6 years later, the UWHA was able to obtain the report. Olswang summarized the situation of housestaff as:
“I make no claim to be able to recommend that the hours worked by residents are too many or too few to achieve the end result of preparing excellent doctors…I can only point out that the hours worked are long and often consist of numerable hours in succession without sleep. Combine this with the inability to secure meals, lower pay than their peers, seemingly inadequate communication mechanisms, and little self representation by residents, and the outcome is some dissatisfaction by Resident.…In conclusion, the allegations of severe work load by house officers resulting in improper patient care crystallize the overdue recognition that house officers are not being listened to collectively at this time. While there is no indication of improper patient care, it is clear that cooperation and mutual decision making between the house officers and the School of Medicine will produce greater satisfaction on the part of house officers so as to make patient care more reliable than it is presently.“
By the mid-1970’s, as a result of Olswang’s study, the Dean’s office publicized a policy statement alluding to the importance of housestaff needs and advocating for improved benefits. Since the founding of the UWHA a decade earlier, residents had pushed for an official contract to codify their rights and ensure protection as employees. During the course of many meetings between the UWHA, medical school deans, representatives of the AMA, and large legal teams, a document called the “Blue Book” was created. This became the first draft “contract” for residents and provided for “mutual consent” (i.e., between residents and the UW School of Medicine). According to UWHA archives, the UW attorneys negated this document, eliminating the “mutual consent” and contractual language on the grounds that it represented acknowledgment of collective bargaining rights for residents. Despite years of efforts, the UW refused to grant residents and fellows the status of employees. Ultimately, in 1979 the Blue Book, in its significantly attenuated form, was adopted by the UWHA representatives who formed the first Housestaff Advisory Committee. In 1980, the advisory committee stopped meeting and the proposed grievance procedures faded away. The School of Medicine never publicized the Blue Book and residents again found themselves demoralized without a contract and without any legal basis for future negotiation.
In 1980, the UW administration refused to recognize the UWHA as a representative of the residents and again refused to bargain. Once again residents prepared to strike, and with the support of local medial outlets such as The Seattle Times and the Seattle Post-Intelligencer, the UWHA successfully negotiated a contract guaranteeing improvements in work conditions such as meals provided while on call, a grievance procedure, better pay, and fringe benefits. During the 1980-81 wave of resident activism, there was much discussion on the legal status of residents and their right to negotiate collectively. At that time, under the law, residents were clearly defined as students without the power or legal backing to collectively bargain. It was only by threatening to strike, which would have effectively shut down the city’s hospitals, that University officials were forced to recognize the residents as a nonexclusive collective bargaining group and accede to some of their demands.
Following its successes in 1981, the UWHA entered a state of dormancy over the next two decades, ceasing to hold regular meetings in the 1990s and with no elected officers for several years. During that time, the residency contract was revised to provide for an annual election of representative housestaff to serve on a Housestaff Advisory Committee. In 1999-2000, the eight residents elected to the advisory Committee were eager to improve the dialogue and discussion about resident working conditions in the UW system. These residents realized that restoring the UWHA was the best way to achieve these goals. They drafted new bylaws, elected officers, and resumed control of the Housestaff Association dues accounts. Over the next decade, the resuscitated UWHA achieved some improvements such as making residents eligible for civil and educational leave, enrolling residents in matched retirement accounts, and creation of the Safe-Ride-Home program.
Despite incremental improvements, due to the Seattle tech boom and resulting dramatic increase in the cost of living in Seattle, by the 2010s, the UWHA became aware of increasing financial hardship among housestaff. A survey was conducted to better outline the pertinent issues. The results of the clearly demonstrated that residents were suffering from low wages relative to the cost of living in Seattle and high educational debt burdens. Furthermore, despite the high cost of living in Seattle, UW was paying residents at or below the national average. This was further compounded by the high cost of parking, where residents were forced to pay thousands of dollars just to commute to care for their patients. This was in striking contrast to the majority of residency programs nationwide that provided free or substantially subsidized parking. Finally, the UWHA found that in particular, residents with children were suffering financial hardship due to the lack of daycare options and the high cost of childcare in Seattle. These financial concerns prompted a second wave of resident activism, and motivated the association to take action.
The UWHA brought these issues to the University’s attention, but were unfortunately met with heavy resistance and the administration once again refused to bargain with residents. The UWHA leadership recognized that the only way to move forward was to restructure into a state-recognized collective bargaining unit. Fortunately since the 1980s the position of the National Labor Relations Board had shifted, providing residents an opening. In 2014, after collecting hundreds of signatures from housestaff, the UWHA filed paperwork with the state Public Employees Relations Committee (PERC) to reorganize into a union. The University fought this assiduously, filing a petition to the State Supreme Court attempting to block this reorganization on the grounds that “Residents and fellows are not ‘clinical employees’ in the plain sense. They are not there to provide clinical care to patients, but much more to learn how to provide care.” The University also hired outside lawyers specializing in “union abatement” and other consultants to block restructuring. Fortunately, the State Supreme Court recognized the value of services provided by residents to the region’s patients and determined that they were in fact employees with the right to unionize. Thus, despite hundreds of thousands of dollars spent on an extensive propaganda campaign and legal challenges by the University, in the fall of 2014 UW residents were given the opportunity to unionize. The housestaff had voted overwhelmingly (>75%) in favor of forming a union.
Immediately following the vote, UWHA became recognized under state law as the representative of the residents and fellows and, for the first time, the University was obligated to come to the bargaining table. Negotiations between the UWHA and UW began in January of 2015 and continued for almost two years. Initially, UW refused to offer any form of housing or parking funds and refused to increase salaries commensurate with the costs of living. When asked about paid parental leave, one program director on the UW bargaining team exclaimed repeatedly “This isn’t Sweden!” The UWHA team pushed back with facts, presenting the results of surveys demonstrating the extent of resident hardship and extensive data about the costs of living in Seattle, the increase in resident debt burden, and the lack of access to important services such as childcare. UWHA also read aloud stories of dozens of housestaff who endured hardship, such as relying on Charity Care at UWMC to care for their families. These arguments, coupled with extensive media coverage and public support from the Seattle City Council, other unions, and the public was effective in prompting the UW to negotiate fairly. After over 20 months of, at times quite contentious negotiations, the UWHA and UW reached a new contract. This contract included:
- significant annual salary increases and a signing bonus
- new housing and parking stipends
- full reimbursment for medical licenses and other required expenses
- an annual education fund for all residents
- a childcare fund, administered by UWHA
- a bike transportation fund, jointly administered both UWHA and GME
- extended paid leave for residents with serious medical issues
- increased bereavement leave
- legal protections to prevent residents from unfairly being disciplined or terminated
- a fair process that guarantees the right to moonlight for all residents
The new contract was brought to the housestaff, who voted overwhelmingly (>99%) to ratify it. Following ratification on November 1, 2016, the new contract went into effect. That year the UWHA administered childcare fund was established, providing needed relief to families. Implementation was initially smooth, but facing an administrative backlash the Graduate Medical Education (GME) office at UW became increasingly antagonistic towards residents and the UWHA. Since 2016, the GME has attempted repeatedly to renege on some of the contract obligations, such as refusing to pay for licenses for new residents, refusing to fully reimburse residents for licenses, cutting funding for the childcare program and the bike transportation program. Using the newly established grievance procedure, however, the UWHA fought against these changes and won on every issue.
In 2017, the residents voted to change the UWHA constitution, more than doubling the number of board members and officers. The increase in staff and the continued enthusiasm has enabled the association to expand its role, providing more services to housestaff. Unfortunately, as the University faces a widening fiscal shortfall, the GME has continued to cut resident benefits. Current issues facing housestaff include GME’s decision to stop supporting the Safe-Ride-Home program, their failure to support the bike transportation program, and their ongoing attempts to undermine the right to moonlight. Furthermore, the costs of living in Seattle continues to rise. These issues and others will be paramount in the next round of contract negotiations beginning in 2019. The experience of the UWHA has clearly shown that residents are at our best, and we accomplish the most, when we establish clear goals and work together to achieve them. With the continued enthusiasm and support of over 1300 members, the housestaff represented by UWHA will meet these challenges and continue the five-decade struggle for better wages and benefits.
Written by Nick Mark, MD, Past President of UWHA