Med Students To Unionize
The doctors-in-training who provide basic care at many of the nation's private hospitals have the same rights as other workers to form unions and negotiate working conditions, the National Labor Relations Board has ruled.
Medical students, unions and teaching hospitals agreed the landmark decision could change medical education, but they disagreed over whether it will be for better or worse.
"It opens the door for thousands of interns and residents to stand up for their patients and their profession," said Andrew L. Stern, president of the Service Employees International Union, which represents many health care workers.
Dr. Andrew Yacht, chief resident for internal medicine at Boston Medical Center, said many medical students hope the ruling could eventually bring some relief from the notoriously long hours they typically work.
"I'd like to think now that we would have more of a say in determining our own working conditions, and hopefully sidestep all of those problems that we have had with working an 80-hour week," said Yacht.
However, Dr. Jordan Cohen, president of the Association of American Medical Colleges, said there would be dangers if unions could challenge faculty decisions such as denying advancement to poorly-performing students, for example.
"The notion of an arbitrator (from a union or government) having the ability to second-guess an academic program ... it's just a prospect that sends chills up my spine," said Cohen.
The NLRB's board members themselves were divided, 3-2, on changing the 23-year precedent that has held that medical residents, interns and fellows are primarily students, denying them collective bargaining rights.
The ruling in favor of the change, publicly released Monday, cited other professions in which individuals serving in traineeships, such as associate lawyers and apprentice architects, are considered employees protected by federal laws.
"Plainly, many employees engage in long-term programs designed to impart and improve skills and knowledge. Such individuals are still employees, regardless of other intended benefits and consequences of these programs," said the written majority opinion.
Dissenting NLRB members Peter J. Hurtgen and J. Robert Brame III, however, warned that the decision could undermine time-tested doctor training programs as well as hospitals' ability to provide care during labor disputes.
"The majority thus forces medical education into the uncharted waters of organizing campaigns, collective bargaining and strikes," wrote Brame.
There are about 100,000 medical interns, residents and fellows working in the nation's hospitals. They generally have completed four years of medical school but several more years of hands-on training is typically required for certification in their chosen medical specialties.
These advanced medical students do not pay tuition and normally receive a modest salary and some benfits such as health insurance for their work. They are supervised by staff physicians but do much independent work and are often the first doctors hospital patients see.
The board's ruling on their status came in a case involving 430 advanced medical students in Boston who belong to the Committee of Interns and Residents.
The CIR is affiliated with the Service Employees International Union and represents nearly 10,000 doctors-in-training at hospitals in California, Florida, Massachusetts, New Jersey, New York, Ohio and Washington, D.C.
Those jurisdictions and others include hospital interns and residents under laws that protect public employees' collective bargaining rights.
However, Boston Medical Center, a private institution, voluntarily recognized the CIR as part of the 1996 merger deal that combined the public Boston City Hospital and Boston University Medical Center Hospital as the Boston Medical Center.
Seeing a chance to overturn a 1976 ruling in which the NLRB had declared medical students unprotected by collective bargaining rights, the union asked the NLRB to consider making this private-sector recognition of CIR mandatory.