AAEM Resident and Student Association Podcast · American Academy of Emergency Medicine / RSA

Resident Labor Rights: History of Unionization

·32 min·2 clips

The 1976 NLRB ruling said house staff were “not students,” then the 1999 Boston Medical Center case reversed that logic.

Lauren Lamparter introduces the RSA podcast and frames this as the second installment in its unionization series, following the AAEM Scientific Assembly Resident Labor Rights panel discussion. Dr. Michael Losak joins the conversation as a practicing emergency physician and assistant professor at the Stanford School of Medicine, and he says he led the organizing committee that won a new house staff union at UCSF in 2017. He explains that his interest in unionization grew after he started residency in 2015 and looked back on a different job and career he had before medicine. He says he had reviewed contracts in that earlier work, was surprised by the lack of a contract in residency, and was struck by making less money at 32 than he had at 22. From there, the conversation turns into a step-by-step explanation of how union recognition works. Dr. Losak walks through the card check process, the meaning of a simple majority, and the fact that an employer may voluntarily recognize a union but is not required to do so. If the employer declines, he says, the process goes to a vote overseen by the NLRB. He then distinguishes private-sector organizing from public-sector organizing, where federal law leaves much of the process to the states. The discussion makes clear that the legal route can vary a lot depending on whether a hospital or clinic is public, state-run, or otherwise government-affiliated. UCSF is used as the grounding example. In that case, the organizing group collected cards, proved majority support, submitted the result to PERB, and was certified without needing a vote. The episode treats that example as a useful reference point rather than a universal rule. It also keeps coming back to the fact that these processes are built around representation and bargaining, not just symbolism. Dr. Losak returns again and again to the point that unionization is not only about wages. It also affects the day-to-day reality of residents, the shape of training, and whether institutions have to answer to the people doing the work. The tone stays instructional and advocacy-minded throughout, with the hosts using plain language to keep the legal material approachable. By the end, the listener has a workable historical frame for how resident unions form and why they matter in residency training. The final note ties the effort back to patient care, making the case that resident labor and the health and wellbeing of patients are connected concerns.

As heard by us

A clear guide to how resident union organizing works in practice.

This episode gives a steady history of resident unionization, focusing on what drives physicians to organize, how recognition can happen, and why private and public institutions take different routes. Dr.

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Hear how resident unionization moves from frustration to a certified house staff union.

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