The National Labor Relations Board opened the door to the unionization of an estimated 90,000 medical residents at the nation's teaching hospitals by giving house staff the right to bargain collectively.
The 3-2 decision, which cannot be appealed, reverses 23 years of precedent. House staff members, who contend they are working longer hours and performing more nonphysician duties as hospitals cut workers, are expected to unionize as a result.
"The whole healthcare system has taken advantage of residents, who have had no rights," said Mark Levy, executive director of the Committee of Interns and Residents, which brought the case. Levy noted that only one state, New York, has a law to limit the number of hours residents can work.
The 32-page ruling, released last week, determined that residents, interns and fellows are employees. It overturned a 1976 NLRB decision that deemed them "primarily students" who were not entitled to protection under the National Labor Relations Act (See chart).
The Association of American Medical Colleges, which represents teaching hospitals, opposed the finding, saying labor disputes would interfere with education and patient care. Its views were echoed by the American Hospital Association and backed by two dissenting NLRB members.
"If anything, it will add to the financial burdens of teaching hospitals, so many of which are already reeling under current pressures," said Jordan Cohen, M.D., president of the AAMC.
The ruling stems from a petition the CIR filed in 1997 seeking certification of a bargaining unit of the 430-member house staff at Boston Medical Center, the primary teaching hospital for the Boston University School of Medicine.
Late last week, the medical center scheduled an election on certification for Dec. 21.
The CIR handpicked the case to ask the NLRB to require private hospitals to recognize resident unions, in part because one of the medical center's predecessor organizations had a 30-year track record of successful collective negotiations by house staff.
Boston Medical Center was created when Boston University Medical Center and Boston City Hospital merged in 1996. Under state law, residents could bargain collectively at Boston City Hospital because it was a public hospital. The merger agreement required the new private medical center to recognize the residents' bargaining unit. But house staff was concerned that without certification by the NLRB, bargaining privileges might not transfer if the hospital underwent another merger.
Andrew Yacht, M.D., a chief resident in internal medicine and co-president of the house staff bargaining unit at Boston Medical Center, testified in the case. He said he's glad future residents won't have to endure 80- to 100-hour workweeks consumed by grunt work such as drawing blood and transporting patients.
"It's something we've been waiting for for a long time," Yacht said.
The issue divided organized medicine, with the American Medical Students Association, the American Medical Women's Association and the state medical societies of California and New York taking the side of the CIR. It was also supported by the American Nurses Association and the American Public Health Association.
The medical center was supported by the American Council on Education, the American Board of Medical Specialties and the Council of Medical Specialty Societies.
The American Medical Association and the Massachusetts Medical Society took the middle ground, arguing that residents should be allowed to negotiate collectively on patient care and working conditions but should not be allowed to strike.
The AMA called the ruling "an important change" that gives residents more leverage to address patient-care and workplace issues. The AMA said it decided to create a union for employed physicians earlier this year partly because of the likelihood of a favorable decision for residents.
The AMA's union for employed doctors, Physicians for Responsible Negotiations, announced its formal launch just days before the NLRB decision was released. The PRN has rejected strikes as a negotiating tool.
Both the AMA and the CIR will vie to represent residents and interns.
The CIR represents about 10,000 physicians in California, Florida, New Jersey, New York and Washington. Some states allow residents and interns at public hospitals to collectively negotiate, and about 15 private hospitals have voluntarily signed contracts with the CIR.
CIR officials said the Service Employees International Union provided it with $1 million in cash and in-kind support to organize interns and residents. The SEIU is engaged in organizing efforts in Boston, California and New York.
"We expect that as the sense of their own rights starts to enter their busy schedules and into their busy minds, there will be organizing. How fast, it's hard to tell," Levy said last week.