Two groups will vie to organize medical residents after the National Labor Relations Board's historic decision last month to allow house staff to bargain collectively (Dec. 6, p. 3).
Both have strong convictions, high profiles and wealthy benefactors. But otherwise, they couldn't be more different.
One group, the New York-based Committee of Interns and Residents, has decades of experience and strong ties to traditional organized labor. The other, the Chicago-based Physicians for Responsible Negotiations, was created by organized medicine this year (See chart).
The ruling is expected to significantly increase union organization by house staff. At least half of physicians in training, or 50,000 house staff members, will be organized by 2010, predicts Barry Leibowitz, M.D., president of the National Doctors Alliance, the Service Employees International Union's umbrella group for physician unions including the CIR. All 10,000 unionized house staff members are represented by the CIR, which negotiated its first contract 31 years ago.
Leibowitz calls the CIR "a brand name like Yahoo, IBM and Intel" and dismisses the American Medical Association-created PRN as a "company union."
Hyperbole, perhaps. But according to a report by the AMA's board of trustees, AMA policy does hamstring the PRN. The report was released before the AMA's semiannual House of Delegates meeting last week in San Diego, where the PRN held a forum on its activities.
The PRN is constrained, for example, because its constitution prohibits strikes, in keeping with the AMA's code of ethics.
Also, physicians interested in PRN representation must first undergo an "education/fact finding" exercise conducted by the AMA and local medical societies. They will be asked to consider if organized medicine can assist with their problems and educated about the "benefits and risks associated with organizing as a labor organization."
The CIR is headed by career labor organizers, while the PRN's acting executive director is Vice President for Legislative Affairs Ross Rubin.
Long term, last month's NLRB decision could encourage more attending physicians to join unions. About 40,000 attending doctors belong to collective bargaining units.
"We have found once doctors have been unionized as house staff, they become acclimated to unionization," Liebowitz says. He says he believes attending physicians will continue to seek employment to cover increasing practice expenses and achieve negotiating clout with health plans, ultimately increasing the pool of potential union members.
"The thrust of medicine now is to become employed, to seek regular hours, benefits and salaries," Leibowitz says.