Resident physicians and fellows at Howard University Hospital in Washington D.C. recently joined the Service Employees International Union. According to union leadership, residents had a range of concerns including parking, meals, salary, and the financial sustainability of the hospital. The financial stability of the hospital element is most noteworthy.

In late 2014, the Washington D.C. hospital hired southern Californian Paladin Healthcare Capital to “reengineer” its operations at the financially strapped institution. On its website, Paladin Healthcare described itself as “a special opportunity investor that makes private equity, structured debt, and real estate investments in the healthcare sector.” It continued, “We provide capital to over-levered and/or underperforming hospitals that can be transitioned to stable and profitable enterprises, with a particular focus on urban community hospitals.”

One of the hallmarks of employees seeking union representation is for job security. Howard resident physicians felt insecure with Paladin Healthcare reengineering the hospital. In a letter from D.C. Councilwoman Anita Bonds (D) to Howard University, she said, “I believe that a unified voice for resident physicians could well benefit the hospital . . . and meet the financial challenges it faces.” Um, saving an employer money is not high on a union’s objective list, especially when the union says that meals and salary are some of the members’ concerns.