Source: Colorado Sun

February 3, 2025

At the University of Colorado School of Medicine, first-year residents — doctors just starting their careers — make about $75,000 per year.

That is solidly within the middle class in Colorado, albeit on the lower end.

But residency is also a notorious meat-grinder phase of medical or surgical training. Residents work long hours, sometimes with overnight shifts or 24-hour shifts. All told, it can come out to as much as 80 hours per week. And residents say they may feel pressure to work longer, unreported hours.

So slice that $75,000 another way, and you get about $18 an hour — lower than Denver’s minimum wage.

All of this comes with the stress of learning a complicated profession while also constantly worrying about failure. Doctors must complete residency if they hope to ascend to high-ranking (and better-paying) jobs in medicine.

“It’s a really tenuous phase,” said Dr. Nik Kaufman, who completed his residency training at the University of Colorado and has just begun a fellowship in hospice and palliative medicine.

Request to form a union

Kaufman is one of the co-presidents of the Housestaff Association of the University of Colorado Hospitals — “housestaff” being a term to describe both residents and fellows, who are more experienced doctors receiving advanced training in specialty areas of medicine. (The name comes from the fact that such trainee doctors used to literally live at the hospital.)

To address the tenuousness of the positions and to improve pay, the Housestaff Association, which Kaufman says counts more than 90% of CU residents and fellows as members, wants to become a full-fledged union, with collective bargaining rights.

But, as public-sector employees, the residents don’t have an automatic right to collective bargaining under state law. A law passed in 2023 gives more protection to public workers to organize and speak out on issues important to them. But the university has to give its OK to collective bargaining. And it doesn’t.

Kaufman and his fellow co-president, Dr. Allison Martin, said the university has repeatedly rebuffed their requests for collective bargaining rights. Efforts to set up a meeting with the CU Board of Regents were also denied.

“The softest union ask”

Martin said this is particularly puzzling since the university already works with the Housestaff Association on setting pay for residents and other issues. What the association is asking, she said, is just for those agreements to be made enforceable.

“This has been the softest union ask I have ever heard of,” said Martin, who is a fourth-year resident in pathology. “Essentially we’re asking them to write it down and agree to do the same thing that we’ve been doing.”

In an emailed statement, Mark Couch, the medical school’s associate dean of communications, did not elaborate on the university’s opposition to recognizing the Housestaff Association as a union.

“The School of Medicine values the tremendous work that our residents and fellows provide in patient care, research, and education of their peers and our medical students,” Couch wrote. “We work closely with resident leaders, hospital partners, and program directors to ensure they have an excellent learning and working environment.”

Emails between the Housestaff Association and a CU regent, which the association shared with The Sun, provide more insight.

Regent Callie Rennison expressed concerns about maintaining “the uninterrupted care of our patients.” She also wrote that none of the hospitals where CU-affiliated residents work — UCHealth University of Colorado Hospital, Denver Health, Children’s Hospital Colorado, and the Rocky Mountain Regional VA Medical Center — have given the OK for collective bargaining among their other employees, such as their nurses or technicians.

“The unionization of the housestaff would not only be an outlier in comparison to all other provider groups at the affiliate hospitals, but it could put the uninterrupted delivery of care at our affiliate hospitals at risk,” she wrote. “That is something I cannot support.”

To Kaufman and Martin, her response was frustrating because it implies that residents want the right to strike.

“We do not want to go on strike,” Kaufman said.

Dispute over pay agreement

Instead, Kaufman said they want collective bargaining to focus on creating a grievance and dispute-resolution process and on holding the university to its promises.

For instance, he mentioned the process that went into setting this year’s salaries for residents. Kaufman said the Housestaff Association and the university had agreed to use a formula. But when that formula produced higher-than-expected raises, Kaufman said the university went back on the plan.

The resulting pay raises were still notable — first-year resident pay went up about $9,000 per year, up from around $66,000. But they were less than residents had hoped for.

“There was no recourse for us,” he said.

“Far exceeds that minimal mandate”

Couch, the school spokesman, said the national body that accredits medical schools, the Accreditation Council for Graduate Medical Education, already requires that schools work with their residents on setting salaries — which the university calls stipends — and on other major decisions.

“The University of Colorado far exceeds that minimal mandate through regular and frequent meetings with the housestaff and inclusion of housestaff on all major decision-making committees and subcommittees,” Couch wrote in an email.

He said the university has committed to adjusting pay based on the increased cost of living — after the 13% raise this year, residents are set to receive another 6% raise for next year, bringing the pay for a first-year resident to around $80,000, Couch said. The university has also added a retirement match and a moving stipend for first-year residents.

“Our university leadership holds monthly meetings with housestaff to discuss and move forward topics related to stipends, benefits and other elements of support that allow our hardworking housestaff to be well-supported as they train to be independent physicians,” Couch wrote in an email.

Unionization efforts among residents and fellows have gained steam in the past few years across the country, in response to the difficult working conditions and the rising cost of living. Research shows that residents are particularly prone to burnout, poor mental health and suicide.

Martin said the Housestaff Association’s goal is to bring a little more stability into the lives of young doctors. She said the association isn’t going to end 24-hour shifts for residents.

“But when they come home,” she said, “I want them to be able to order DoorDash and not worry about overdrawing their account.”