Medical training is a difficult task. As residents and fellows, we move wherever the Match sends us, endure grueling hours, and sacrifice time with loved ones—all in pursuit of becoming the best doctors we can be and delivering excellent patient care. But we should not have to sacrifice our own well-being in the process.

In Washington, D.C., more than 450 residents and fellows employed by George Washington University (GW) spent the past 15 months fighting for our first contract. In spring 2023, nearly 95 percent of house staff voted to unionize with the Committee of Interns and Residents (CIR), a branch of the Service Employees International Union (SEIU) and the largest and oldest house staff union in the country. Contract negotiations began in fall 2023, but progress was slow.

Simple, Reasonable Demands

Our demands were simple and reasonable. First, we sought a livable wage in one of the most expensive cities in the U.S. Under our original contract, with the long hours we work, many of us earned, on average, less than the D.C. minimum wage of $17.50 per hour. Compared with other residency programs in the same city, our salaries were among the lowest.

Second, we pushed for better access to therapy and mental health benefits. We deal with difficult and traumatizing situations daily, and nowhere is this more apparent than in the emergency department, where sickness, violence, and death are routine. Last year, our friend and colleague, ophthalmology resident Dr. William West, Jr., died by suicide. In a public letter, he highlighted the pressures of residency and stigma surrounding mental health, warning that “there are other residents fighting a true life-and-death battle—one that is waged both inside and out at the clinic/hospital.”¹ His tragic loss underscores the urgent need for mental health support for residents and fellows. 

Other demands included increased time for parental leave and childcare, clean resident call rooms, reimbursement for board exam fees, and improved medical benefits coverage. These issues were not merely matters of personal convenience—they are fundamental for enabling us to provide the best possible patient care in one of the region’s biggest hospitals. Addressing these concerns helps combat physician burnout, which has been widely identified as a threat to patient care and the broader health care system.² ACEP Now has previously written about the reasons for physician unions, particularly among emergency physicians.^3,4 Our motivation was similar: The only way we can take good care of our patients is if we take good care of ourselves.