The vast majority of National Labor Relations Board representation elections are for pretty small units: between 2020 and 2023, almost 90 percent of them were for units of one hundred workers or less. All workers should be in unions; unionized work is, on average, much better than nonunionized work, period. But from a macro perspective, such small elections aren’t going to do much to move the needle in terms of reversing the downward union density trend.

Large-unit labor elections, which I’ll take here to be any representation elections involving 250 or more workers, comprise a very small percentage of NLRB elections: in FY 2024, such elections comprised 4.4 percent of all NLRB representation elections, but they involved 48 percent of all eligible voters that year. By contrast, 88 percent involved one hundred workers or less, but these made up only 34 percent of all eligible voters.

There’s a good argument to be made, then, that overall trends in new union membership can be derived from an analysis of the small number of large-unit elections, given how consequential these elections are in terms of the numbers. This is what I’m going to aim to do here and in future monthly roundups: look at the results of all NLRB representation elections involving 250 or more eligible voters.

For those elections tallied in January, twelve involved 250 or more workers, and ten were successful, involving the unionization of 5,628 workers. One was the much-discussed unionization of 297 Whole Foods workers in Philadelphia. The rest were all in health care, and a whopping six were run and won by Service Employees International Union’s (SEIU) Committee of Interns and Residents (CIR). In one month, CIR gained 3,862 new members.

CIR has doubled in size since the beginning of the COVID-19 pandemic, now 37,000 strong. CIR president Taylor Walker believes that the pandemic was “the spark behind this huge wave of physician unionization,” but also that the pandemic simply exacerbated existing instability:

When the general public thinks about residency, they think about Grey’s Anatomy. And I think the assumption is, “Oh, you doctors, you’re totally fine financially.” The truth is that residents and fellows work on average eighty hours per week. That’s averaged over four weeks, so in a single week you can legally work 120 hours. . . . Then you look at the salaries that are anywhere from $50,000 to $90,000 a year. It doesn’t make sense. . . . We dedicate our twenties and thirties, our prime reproductive years, to medical education and training. When you think about starting a family and being able to provide for your family . . . residency really doesn’t facilitate that.

Average medical student debt, meanwhile, is $234,597.

While Dr Walker says that there were plenty of cases where hospitals have been collegial and supportive of resident organizing, there have also been those where “the corporatization of the medical system” has resulted in tougher fights, as is the case at Mass General Brigham in Boston.

They are the largest residency and fellowship training program in the country with almost 2,800 residents and fellows. They never had a unionized employee in their hospital ever until the residents chose to unionize with us.

Mass General is bringing a tough anti-union campaign. They keep saying that the residents are the highest paid in Boston. The reason that that is true is because before the residents voted to form a union, Mass General gave them a 10 percent raise and a $10,000 stipend as a classic union busting tool. Fortunately the residents took that as proof of concept, and said “thank you,” and then voted overwhelmingly to form a union. Now Mass General is using that 10 percent salary increase and that stipend as an excuse to take away previously offered benefits.

CIR’s rise has been supported by other health care unions, and in turn their example has helped spur new organizing efforts. After Mass General residents voted to unionize, attending physicians did the same through the Doctors Council SEIU. Walker asserts that they were seeing a lot of “cross-union solidarity,” which has in turn translated to better working conditions in the hospitals: “When you’re on a picket line together, you naturally show up for each other more on the hospital floors too.”

The committee’s big victories have been pretty lopsided — residents and interns clearly want to organize. But CIR has also taken on a very ambitious organizing purview, aiming to meet the scale at which there is organizing demand. In a citywide campaign across four locations in Philadelphia, they unionized 83 percent of all resident physicians in the city. On the West Coast, they’re aiming to negotiate a single contract for all of the residents and fellows at the University of California medical system. Walker credits the bargaining teams at each hospital for their dedication in creating both intra- and inter-hospital networks to accomplish such ambitious projects.

As I cover in more detail here, CIR’s wins continue a recent trend in large-unit labor organizing wins. Since 2022, unions have proven very good at winning large-unit elections, but those elections have become overwhelmingly concentrated in academia and health care, while such elections in all other sectors have declined in number. Health care and education services only make up a total of 14.8 percent of employment in the United States, so for 85.2 percent of workers, large-unit organizing efforts are waning.

This trend points in the direction of a compositional evolution of the labor movement away from more blue-collar occupations and toward more professional workers. When it comes to reversing the union density trend, much depends on whether such large-unit organizing as CIR has successfully pursued can catch fire outside of academia and health care.