The Jefferson gig workers who act as medical patients want to unionize

In practice-exam rooms at medical schools across the city, there are workers who act as patients.

They memorize entire character profiles — symptoms, family histories, emotional temperaments. Dressed in thin hospital gowns and underwear, they allow their bodies to be examined by students, who palpate their stomachs and scope their ears.

In some instances, these “patients” may be instructed to scream or cry. And then they give the students feedback on their examination.

Known as standardized patients, these gig workers say their roles are crucial to public health but invisible to the public and often undervalued. Now, the ones at Thomas Jefferson University want to unionize.

Workers cite low pay, erratic scheduling, security breaches, and theft at their Center City workplace. They’re concerned that artificial intelligence threatens their job security.

“I‘ve seen personally the lightbulb go off when a good medical student gets it,” said 44-year-old standardized patient Charlotte Northeast, “when they realize that a tiny little interpersonal connection can make all the difference between diagnosing something important or not. And so if we’re replaced by AI, or we’re downsized into nothing, ultimately, patients suffer.”

Earlier this month, more than two-thirds of the 140 standardized patients at Jefferson signed a letter to the university’s top executives, asking them to voluntarily recognize their union with the Office and Professional Employees International Union’s Local 32. Jefferson declined.

“We believe that our employees should have an opportunity to formally vote in a secret ballot election based upon accurate information without outside pressure,” Jefferson provost Matt Dane Baker wrote in a response to the workers, adding: “We strongly believe that a direct relationship between all employees and our leadership results in the most productive teams and best empowers employees to advocate for themselves.”

Jefferson sent the The Inquirer a similar statement.

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OPEIU has filed with the National Labor Relations Board for a union election and is waiting for a date.

If the union campaign is successful, it would likely be the first union of this kind of workers in the country.

Chief among the workers’ concerns is pay. Standardized patients at Jefferson have been making the same amount since 2008: $20 an hour. It’s the lowest of all pay rates for this kind of work at Philadelphia schools, which typically pay $22 an hour or more, according to three standardized patients who work at multiple institutions.

Workers said their compensation was especially low when looking at the compensation of former Jefferson CEO Stephen Klasko, whose $5.4 million salary made him the second-highest paid hospital executive in the region in 2021. He was paid even more in 2019: $7.4 million.

“The entire reputation of this program is built on the back of this labor and they can’t find it in their budget to pay their workers fairly?” asked Andy Moholt, 37, a standardized patient who’s also a touring musician.

Standardized patients often choose their field for the flexibility. Their hours vary from month to month — they might work 15 hours a month or 80, depending on their own schedules and the school’s needs. Despite this, the majority of standardized patients at Jefferson are employees, not independent contractors. Independent contractors are not legally allowed to unionize.

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Many standardized patients are actors or other kinds of artists. Landis Smith, 71, and his wife, Jennifer Smith, used to work as patients part time while they ran their theater company but now work full time as they’ve retired from theater work. They cobble together hours from six different schools in the area.

Kimya Imani Jackson is a standardized patient who has a doctorate in biobehavioral health and was formerly a researcher in health disparities. Jackson, 46, says she was called to the work because of her mother’s history with the medical system. When her mother was young, her scarlet fever was misdiagnosed and she ended up spending months in the hospital and missing a half-year of grade school.

The doctors initially dismissed her mother’s concerns, she said, which is why it’s so important that standardized patients teach medical professionals how to make patients feel heard and respected.