The American Medical Association has riled some physician union activists by dodging an opportunity to support residents and interns who want the right to bargain collectively under federal law.
In a key case pending before the National Labor Relations Board, the AMA refused to pick sides despite its longstanding advocacy of collective bargaining for house staff.
Instead, the AMA is trying to persuade teaching hospitals to head off union organizing by voluntarily giving house staff a bigger voice.
The move comes as one of the nation's largest, most aggressive state medical societies considers forming a bargaining unit that would include residents and interns (See story, p. 32).
At the AMA's request, the American Council on Graduate Medical Education developed accreditation standards designed to promote better treatment of interns and residents at teaching institutions. A draft of the standards was released last week.
"Who better but the ACGME to be the ones controlling this, because we're the ones accrediting the programs. The institutions need to be beholden to a set of standards," said Richard Allen, M.D., a member of the AMA's Council on Medical Education and the immediate past chairman of the ACGME, which accredits teaching institutions.
The ACGME's five sponsors include the AMA, the Association of American Medical Colleges and the American Hospital Association, whose members employ residents and interns.
Union advocates say accreditation standards are not adequate to protect residents from exploitation. "That's like a company union," said Sandy Shea, Boston-area director for the Committee of Interns and Residents, a New York-based union. "It's not real collective bargaining as far as we're concerned."
The CIR has petitioned the NLRB for the right to represent the 430-resident house staff at Boston Medical Center.
Nationwide, only a few residents and interns bargain collectively at public institutions or through voluntary arrangements with teaching institutions. A ruling in CIR's favor could extend the right to collective bargaining to all the nation's 110,000 physicians in training (Oct. 6, 1997, p. 99).
The AMA filed an amicus brief in the case saying the medical community, not the federal government, should determine how house staff and teaching institutions relate.
The proposed accreditation standards, which the ACGME will vote on in June, would require teaching institutions to have "an organizational system for communications and exchange of information on all issues pertaining to residents and their educational programs." Also required would be policies for adjudicating resident grievances and resident representation on a graduate medical education advisory board.
"The language is designed to support a variety of residential organization models," said ACGME Executive Director David Leach, M.D. "We don't dictate that there has to be collective bargaining or negotiation."
In its brief, the AMA declined to address the essential legal question of the case before the NLRB: whether interns and residents are employees.
That put it at odds with two of the nation's largest state medical societies, California and New York, which supported the union cause, as well as with its fellow sponsors of the ACGME, which sided with the employer.
But the AMA endorsed the right of house staff to negotiate collectively with hospitals over matters of "patient care and resident well-being."
All this coincides with rising physician interest in unions. The AMA recently established the Division of Representation to help physicians form collective bargaining units, but it says medical societies can better represent doctors than unions can.
Harry Franklin, the CIR's general counsel, accused the AMA of "knuckling under" to the AAMC, which has firmly opposed trainee organizing.
"I think (the AMA) missed an opportunity to speak forcefully for the residents," Franklin said.
But Andrew Thomas, M.D., a resident who sits on the AMA's board of trustees, said the association "is a proactive voice on behalf of the residents. Our policy is actually pretty clear; we think they are both employees and students."
Thomas said the AMA plans to petition Congress for a "student physician" category under the National Labor Relations Act, which would allow residents to bargain collectively but not to strike.
The NLRB is not expected to decide the case before late spring at the earliest.