“They wanted a system for the larger programs, and we were forced to adapt to that, which is suboptimal for our program,” he said. “Otolaryngology is a small piece of the pie. Over the last two decades, I’ve found that our program has always had collateral damage from overall decisions made by the GME office, the institution, and multiple other large national organizations when they make decisions or enact protocols that affect medical residents in the broader school of medicine.”
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November 2023Dr. Wax said that another pitfall of unionization has been the fact that otolaryngology cannot offer some of the perks and benefits that they did in the past, such as various outings and purchasing books and loupes for residents, although he doesn’t think this has adversely affected residents from an educational perspective.
Dr. Ruckenstein anticipates some of the same once residents at Penn Med are unionized, even though he trained in Canada where residents were unionized 25 years ago, and he said that he never encountered a union issue or even a union rep.
“What it’s going to change is the discretion of program directors and other leaders in the department to address things at a departmental level,” he noted. “We’ll be governed by a contract—the same contract that governs all the residents in the health system, and we’ll be obliged to follow the rules and regulations stipulated in that contract, which diminishes our personal ability to address issues and provide benefits,” he said. “It just makes it much more official.”
A lot will depend on how the contract at Penn Med is written and whether it provides individual departments with latitude that allows them to bestow certain benefits on their residents. For example, in the past, otolaryngology residents could come to the otolaryngology department to request an increase in their cell phone benefit because they couldn’t get a cell phone at the benefit level provided. The request, and the phone, could then have been decided at the departmental level.
“Now, if the contract stipulates a certain cell phone benefit to the entire residency body, then that’s what we have to adhere to,” Dr. Ruckenstein said. “We can’t give a better benefit because we can’t have an internal medicine resident go to their PD and say, ‘Otolaryngology is giving $100 a month, and we’re only getting $50.’ It has to be equitable. Again, it could be that the contract will be written to allow certain levels of leeway to individual departments. But, in general, now we’re going to have to go back and check the union contract to see how something like this is supposed to be handled.” He added that this isn’t necessarily a bad thing—it’s just different.