As residents who feel overworked and underpaid begin to make noise about flexing their year-old right to unionize, some hospitals are placating disgruntled house staff with offers of improved employee benefits of parking spaces and better healthcare coverage.
But resident labor leaders claim this pacification is nothing new and is not enough. They warn residents to beware: Enticing overtures are not always binding and may not be in the residents' best interest.
While resident unions long have been legal in public hospitals, it was just last November when the National Labor Relations Board ruled that all interns, residents and fellows are employees, not just students (see January, page 2).
House staff now are eligible to form protected bargaining units in both public and private facilities.
Two recent actions--a sweetened deal held out to one group of Chicago residents and a petition filed by the AMA's union to represent another--illustrate how residents' new status is playing out.
As of Oct. 1, about 860 residents at Northwestern Memorial Hospital and four other hospitals affiliated with the McGaw Medical Center in Chicago will receive enhanced primary care, prescription drug and dental coverage, in addition to a tax-sheltered retirement plan and better access to parking. The offer comes on the heels of an annual review of house staff salaries by McGaw, which led to a 5% pay raise this spring. The improved benefits will put residents on par with employees at other McGaw hospitals, says Holli Salls, Northwestern Memorial's vice president of marketing and public relations.
McGaw began reviewing residents' benefits in the fall after studying recommendations from the American Council of Graduate Medical Education, Salls says. ACGME advised the creation of a forum for residents to communicate with management, which the hospitals still are working on, she says. On their own, the residents formed McGaw House Officer Alliance, which uses unionlike language in its communications.
"At no time did McGaw negotiate benefits, wages or anything" with that group, Salls says. "We don't believe a third party between the hospitals and the residents is necessary. It is actually disruptive to a collegial environment and is not conducive to learning."
The House Officer Alliance was modeled in part after one that has existed at nearby Rush-Presbyterian-St. Luke's Medical Center since the mid-1970s, says Pankaj Jain, M.D., a third-year urology resident at Northwestern Memorial and president of the alliance. Rush's House Staff Council was designed to help residents determine their needs and to have a unified voice when addressing the administration, Jain says. There was no such mechanism at Northwestern Memorial, and residents jumped at the opportunity to be heard.
"Since the NLRB decision, most residents here realize we're employees. We work like employees, we're taxed like employees, why aren't we treated like employees?" Jain says.
Residents have been very open and nonconfrontational in raising awareness about their complaints, Jain says. "No resident here wanted to be in a union, and we don't want to strike."
Jain is confident that McGaw's administration will honor its promises to the residents, if only to maintain a positive public profile.
Resident union organizers, however, worry that offers made to house staff organizations may lull residents into a false sense of security, distracting them from the power a union wields.
"Many hospital administrators have taken advantage of the fact that many doctors don't know much about unions," says Susan Stroud, M.D., a fourth-year resident
in emergency medicine at Highland General Hospital in Oakland, Calif. Stroud serves on the executive board for the Northern California division of the Committee of Interns and Residents, the nation's largest house staff union, which represents more than 11,000 interns and residents.
"In reality, orders come up from the members about what's important and what actions, if any, should be taken," Stroud says. "Doctors aren't used to taking information from the bottom up, so it's easy to tell a resident that this union will be controlling you. That's the experience many residents have, of control coming from the top down."
Residents at the private Lutheran General Hospital in Park Ridge, Ill., decided not to repeat the cycle of promises and retractions. In August, Physicians for Responsible Negotiation, the union formed by the AMA in 1999, filed a petition with the NLRB to collectively represent 167 residents and fellows at Lutheran General. A labor board hearing will determine if and when Lutheran's residents can elect PRN as their bargaining agent. If a majority vote yes, Lutheran must recognize the union.
According to PRN President Robert Bernat, M.D., Lutheran house staff grievances include parking conditions, on-call schedules, benefits, salary and patient care.
"We believe the residents should be allowed to make their decision through their own election, rather than us voluntarily recognizing PRN as their representative," says Lutheran spokesperson Marcia Opal.