Q & A: Union Organizing Process & AFSCME


OHSU House Officers Union's mission is to advocate for residents and fellow physicians as we provide safe, high-quality care to patients throughout Oregon. Our union will insist that OHSU invests in its house staff in ways that materially improve our livelihood, our health, and our ability to provide excellent patient care.


Being a union employee means having a real voice at the decision-making table at OHSU. We would be part of the conversation about our wages, benefits, hours, workplace safety, time off, and work-life balance.

  • A true voice: We need an equal seat at the decision-making table to elevate our perspectives and leverage our expertise and passion as frontline healthcare professionals.
  • Improve patient care: We will advocate for changes that will improve the care delivered at OHSU. Many departments depend on residents’ services. We need increased patient safety through adequate coverage for resident personal, sick, or wellness leave.
  • Benefits: Our benefits are not on par with our West Coast peers:
    • Lack of housing stipend in one of the country’s most competitive markets
    • High insurance deductibles
    • No matching on retirement savings
    • No compensation for licensing, boards testing, travel to conferences
    • No educational material stipend
    • No stipend for childbirth costs
    • No compensation for home call
  • Earned time off: Our current culture dissuades residents from taking our allotted sick leave. We should be able to cash this sick leave in at the end of our residency or have adequate coverage to allow utilization of this sick time. Additionally, we should have four weeks of vacation like most programs.
  • Recruitment: We are one of the last public institutions on the West Coast without unionized house staff. Competitive applicants are looking for the benefits in morale, compensation and leadership that come from a clear, independent advocate and a strong bargaining position.

How is Oregon AFSCME structured and where would we fit in?

  • Oregon AFSCME represents over 27,000 members and is part of AFSCME International, with 1.7 million members wide. 

  • Within Oregon AFSCME, there are 180 local unions with separate governance (for example, AFSCME local 328 represents 7000 members at OHSU, while Graduate Researchers United is the AFSCME local for graduate students).

  • Oregon AFSCME is run by an executive committee and board elected from locals across the state. 

  • Our resident union would operate within AFSCME but be independent from other chapters, with separate contract negotiations highly specific to our needs. 

  • AFSCME Oregon provides resources to its locals - lawyers, organizers, and negotiation experts. 

Why should we unionize with AFSCME?

  • We can leverage and learn from AFSCME’s copious experience at OHSU.

  • We are part of a huge network of OHSU employees. There is strength and protection in numbers.

  • AFSCME can provide us specific resources, such as lawyers, organizers on the ground, and negotiators with experience working with physicians and with OHSU. We are strapped for time and have limited experience in these areas; we’re calling in our AFSCME consult!

  • AFSCME has experience working with physicians, representing doctors at the Oregon State Hospital, Lane County, Multnomah County, Virginia Garcia, and Outside In. 

  • Working with AFSCME does not preclude collaboration with other resident unions nationwide; in fact, AFSCME encourages collaboration and solidarity with our peers. 

Why does AFSCME want to work with us?

  • AFSCME Oregon believes in workers rights and understands that house officers are particularly vulnerable workers in our healthcare system.

  • AFSCME currently represents over 7,300 employees at OHSU (as above) and the larger the organization, the stronger our collective bargaining power. 

How would our union be organized?

  • We would have our own local with elected house staff leaders including representatives from all specialties. 

  • We would write our own by-laws and constitution (drawing from previous examples),

  • We would have our own contract and would be bound only by our contract.

  • If collective action is required by other members of AFSCME Oregon (i.e. pharmacists, graduate students), we would not be required to participate.


OHSU is a public employer which means it is under the Public Employees Collective Bargaining Act (PECBA) which is enforced by the Employee Relations Board (ERB).  In the public sector, if 50%+1 members of a bargaining unit sign authorization cards, their union can be recognized by the ERB. 

Once recognized, we would have our own local with elected house officer leaders including representatives from all specialties. We would write our own by-laws and constitution (drawing from previous examples) and we would negotiate our own contract with AFSCME Oregon’s support.  AFSCME currently represents over 7,300 employees at OHSU and the larger the organization, the stronger our collective bargaining power.

  • OHSU is a public employer which means it is under the Public Employees Collective Bargaining Act (PECBA) which is enforced by the Employee Relations Board (ERB).  

  • In the public sector, if 50%+1 members of a bargaining unit sign authorization cards, their union can be recognized by the ERB. 

We need to:

  • Identify resident leaders in each specialty to talk with our colleagues and confirm we have overwhelming support for a union.

  • Collect union authorization cards. Signing a card is a vote for creating a union. OHSU never sees the cards or gets a list of who signs them. AFSCME would provide staff to help us with our card campaign.

  • Signing cards is a LOW RISK STEP. After we become a union, we go into contract negotiations and residents have to ratify any new contract. If we don’t get a contract we like, we default to our current contract and nothing changes. We don’t pay dues until we get a new contract.

  • Submit the authorization cards to the Oregon Employee Relations Board and demand recognition from the OHSU administration. AFSCME has experience working with OHSU on this; for example when they attempted to not recognize the graduate student union. 

Once we have a union, we:

  • Set our priorities through surveys to determine what to negotiate in a collective bargaining agreement (CBA) with OHSU. The length of a CBA varies but is typically between 2-3 years.  

  • Elect colleagues from across departments and specialties to be trained and then serve on the bargaining team to negotiate our contract with the support of Council staff (Council representative with support of researchers, legal, field campaign, etc.)

  • Vote on (or ratify) our contract.  We do not pay dues until after the contract is ratified.  

  • Select and train stewards to help with contract enforcement and representation.

  • Start Labor Management Committee (if part of the CBA).

What is collective bargaining?

  • Collective bargaining is the process of negotiation between employees and their employer over wages, work conditions, benefits and other issues involving compensation and rights.

  • A committee of House Officers — chosen by us — sits down and hammers out an agreement known as a "union contract" on every issue of concern to our bargaining unit. The committee sits at the bargaining table as equals with management.

  • The majority of members House Officers must approve the agreement before it can become accepted as a contract (this is the vote/ratification).

  • Collective bargaining is not the only power we will have as a union. As a union, we could establish a Labor-Management Committee that would meet regularly with the administration and relevant department heads. In these meetings, we can work on issues and initiatives as they come up. AFSCME-represented employees at OHSU were able to create the Career and Workplace Enhancement Center through their Labor/Management Committee which provides courses, career & conflict counseling, etc. Funding for this Center is protected in their union contract.

How long will this take?

  • As soon as we have a committee up and running, an accurate list, and confirmed majority support from the interns/residents/fellows then we start our card campaign.  Oregon AFSCME staff will work with leaders to make plans for each of their departments and also ask Local 328/Graduate Researchers United members to help if needed. There are lots of fun ways to sign cards: department parties, happy hours, informational meetings, quick coffees/meet-ups (these events should all include food provided by AFSCME and be at times that work for the group).  We know folks are busy and siloed so any way to make it easier helps. 

  • The GRU started organizing seriously in the Spring of 2018 and filed for their election in the Fall of 2018.  GRU was officially recognized as a union in December 2018 and they started bargaining in March 2019.

  • First negotiations tend to take longer because you are bargaining a contract from scratch.  

  • Local 328 started bargaining their contract in February (with a 6/30) expiration and reached a tentative agreement in August 2019. 

How do we handle conflicts with members and OHSU?

  • In the contract, we outline a grievance procedure to follow if we believe the contract has been violated.  We can also take a case to arbitration if necessary.  

  • During negotiations, we have the option of using a mediator if we need to. Mediation is the involvement by a neutral agent (often provided by the Federal Mediation and Conciliation Service or State agency) to assist in negotiations by discussing the disputed issues with the parties together or separately, and assisting the parties in reaching a settlement. This is a voluntary procedure that is non-binding on the parties.

What if someone from the administration/department head/attending tells us not to form the union or intimidates us in any way?


  • Under Public Employees Collective Bargaining Act, OHSU management/administration must stay neutral and if they do coerce, threaten, surveillance, etc. we can file an Unfair Labor Practice charge with the Employee Relations Board.  

  • Oregon AFSCME will provide a full training/fact sheet as well to clearly outline our rights and the law.  

What could our capacity be for state or national change? How are political endorsements made?  Are we bound by these?

  • The House Officers union can have a political committee and endorsement process for local, State, and National politics when it comes to legislation, ballot measures, and political candidates.  The committee can then recommend voting for the legislation, ballot measures, and political candidates the organization endorses but any member can vote any way they want in a political election. 

  • In addition, Oregon AFSCME also has a political caucus that goes through the same process where members of the House Staff union can participate as well.  

  • Oregon AFSCME sponsors lobby days at the Capital, drafts and lobbies for legislation and ballot measures that impact members. We can also work with our National Union on federal policies.  

  • All of these opportunities are volunteer-based.  

How do the standards set by ACGME work with negotiating a contract? 

  • The goal is to have a union that sets FAIR standards at OHSU that allow ALL of our specialties to meet ACGME requirements. AFSCME has hired staff to help us negotiate this and as we enter bargaining EVERY residency group would have representation regardless of the size of the program.


The best way to protect your program is to be an active participant in the union! Administration does make changes that affect house officers without our input (we have examples from surgery, psychiatry, internal medicine, and others). Being in a union gives house officers more of a voice and helps keep and protect the things that we already have and like through a collective bargaining agreement.

Your relationship with your program director is not likely to suffer. Other institutions that have unions have good relationships between house officers and administration. Unions decrease the power differential and allow for more honest communication between different levels of seniority.


Negotiations are a delicate balancing act and a contract is a whole package that includes wages and benefits that we know are secure and help us to plan our lives financially.  It is possible that we don’t get everything we want when it comes to salary increases for example, but other benefits might get a lot better. (For example, there might be a tax advantage to reimbursing $1,000 for medical licenses rather than a $1,000 salary bump).  In addition, with a union during contract negotiations, we legally get to ask OHSU for financial information that we don’t have access to now through information requests. 

The way to make sure we get the benefits we want is to be part of the union, because right now house officers have ZERO say in their salary! We are confident house officers would NEVER vote to accept a contract that wasn't fair to their interests.


This is really a worst-case scenario, but the process is essentially the same in reverse, if things are really bad you vote to dissolve the union and that vote has to get certified by the labor board. We will be negotiating our own contract for house staff (with help and input from AFSCME staff), and before it becomes a legally binding contract, we’ll all get an opportunity to vote yes or no on the proposed contract, so it’s unlikely we’d vote for a contract that is worse than what we already have.