A spat over health insurance costs, fitness club fees and preferential parking spaces--fueled by allegations of disrespect--has mushroomed into a precedent-setting union vote by medical residents at a Chicago-area hospital.
The vote later this week by about 170 residents at 555-bed Lutheran General Hospital, Park Ridge, Ill., could trigger a wave of similar union initiatives at private facilities across the nation, organizers believe. They are upset by what they describe as management's dictatorial style.
Meetul Shah, a third-year resident in family medicine and the president of Lutheran's house staff, said he is confident the union movement will eventually spread to most of America's private hospitals.
"I think it's essentially a done deal for us--we're going to vote to unionize," said Shah, 28, a Chicago-area native and University of Illinois Medical School graduate. "And I know there's a bunch of Chicago programs waiting for us to do it. I expect a lot of them will follow our lead."
Shah is leading a labor crusade that will culminate on Dec. 6 and 7 with a dramatic vote to determine whether residents will be represented in collective bargaining by Physicians for Responsible Negotiation, an American Medical Association offshoot formed last year to help promote physician unionization. A final tally could be announced as early as Dec. 7.
If they vote for representation by the PRN, Lutheran will be the first group of private residents to form a union since a landmark decision last year paved the way for collective-bargaining by the 430-member house staff at Boston Medical Center. That vote came just a month after the National Labor Relations Board ruled last November that residents are not students but employees.
Most of the grievances cited publicly by Lutheran's house staff are relatively minor, Shah acknowledged. The real issue, he said, is the dispiriting cumulative impact of a series of unilateral decisions earlier this year by Lutheran management for the residents' 2000-2001 contracts.
For the first time, residents are required to pay for their health insurance--a cost that ranges from $300 to about $1,000 per year. Even though Lutheran provides residents with an insurance stipend of $300 per year, Shah, who conceded that most residents across America must pay health insurance premiums, faulted management for "not having respect enough for us to talk about it" before instituting the new charge.
Two other comparatively minor grievances also took on a life of their own, Shah said. Third-year residents who once parked next door to the hospital now must use a lot about a block away across a busy street, Shah said. Other residents must also walk a distance to their parked cars, prompting some concern among those who must come and go at night.
What's more, the hospital's fitness club, once free to interns, now costs $250 per year.
"It's no big deal in the grand scheme," said Shah. "But they didn't tell us any of this. We aren't told anything until it happens."
Robert Bernat, M.D., executive director of the PRN, said the real grievance at Lutheran involves far more than comparatively small concerns like parking spaces or health club dues. Of course, he said, the new charge for health insurance caused considerable hardship to some residents, and the location of parking spaces "doesn't sound so important unless you're a female and it's the middle of the night and your car is God-knows-where.
"The bottom line across the board," said Bernat, "is that they're looking for a voice on issues that affect their lives and the lives of their patients."
Dan Parker, spokesman for Advocate Health Care, the parent of Lutheran General, wouldn't discuss specific complaints or grievances from the residents, saying, "We prefer to deal directly with the residents--just as we prefer to deal directly with all employees."
He did, however, pointedly address allegations that hospital management has failed to address those grievances.
"One of the complaints was poor communication," Parker said. "Unfortunately, the first clear indication of any communication problem was (in August) when the residents filed the petition to have an election. What's unfortunate is that, from that moment, we were prohibited from taking any action to try and address their concerns."
Parker also said Lutheran "offers a very competitive package for residents."
For top officials at the PRN, the vote at Lutheran could serve as a referendum on the AMA's growing push for physician unionization. Lutheran's residents would be the first collective-bargaining group represented by the PRN, marking the initial step in a nationwide effort expected to greatly heighten the AMA's bargaining power and political clout.
The organizing effort at Lutheran is the "beginning of a trend," declared Susan Adelman, M.D., a pediatric surgeon from Southfield, Mich., and the president of the PRN.
Adelman said nearly 20 resident groups have contacted the PRN so far, including McGaw House Officers Alliance, which includes about 860 men and women at five Chicago-area hospitals, including 683-bed Northwestern Memorial Hospital.
Bernat said he expects thousands of doctors-in-training to join a union in the next several years.
He said he doesn't know yet whether issues such as parking spaces and fitness club fees will be on the table if the PRN becomes the collective-bargaining agent for Lutheran's house staff.
"We have no agenda," he said. "(The) PRN does not come to the table with an agenda. The agenda is set by the residents."
But the key issues cited by Shah are typical of the grievances voiced by residents around the country, according to Eric Scherzer, associate director of the New York-based Committee of Interns and Residents, which represents the house staff at Boston Medical Center and about 3,500 other residents at private hospitals in New Jersey, New York and Northern California.
Scherzer said most members of the house staff represented by the CIR do not pay for health insurance.
"It's increasingly become an issue," he said. "But healthcare coverage is not a uniform thing. I can't say that most residents have it or don't have it."
The unionization movement is strongly opposed by the Association of American Medical Colleges, which represents 125 accredited U.S. medical schools and about 400 major teaching and health systems.
Jordan Cohen, M.D., AAMC president, said unions will interfere with both the education of residents and the care they deliver to patients.
"First of all," Cohen said, "we believe there are existing mechanisms that should be used to resolve any concerns residents have. More than that, we just don't believe that the adversarial format of collective bargaining is an appropriate way for learners and teachers to interact over issues."
More than 97,000 residents work at hospitals around the country--including almost 80,000 at private facilities. About half of the 20,000 residents at public institutions are unionized.
That provides a huge opportunity for the AMA's union affiliate and other groups, including collective-bargaining competitors like the better-established CIR, which is affiliated with the Service Employees International Union.
Mark Levy, executive director of the CIR, applauded the PRN's work with Lutheran but said his organization has far more experience than the upstart PRN, formed in November 1999 with financial help from the AMA.
"We have 40 years of experience, a staff of 40 people full time," Levy said. "We have experience winning elections, negotiating contracts, handling grievances."
He also pointed to one potential drawback for the PRN during collective-bargaining negotiations. PRN officials have strictly ruled out any strikes by residents, saying a work stoppage would violate the physician's code of ethics and responsibility to patients.
"We don't think that a strike is something you start with, or a good solution," said Levy. "But we won't start out by giving up the right to strike."
PRN officials said they can have a greater impact through news reports highlighting the residents' poor working conditions and the potential threat to patient care. They say a strike would backfire because public sentiment would almost inevitably turn against the residents.
Shah said salary isn't an issue among residents at Lutheran, where the annual stipend begins at $33,000 for the first year and increases to $37,000 in the third. The average salary for a first-year resident in the U.S. is $35,720, according to the AAMC.
"Of course, we'd like to be paid more," Shah said. "Who wouldn't? But most of us are happy. We're probably average (in annual salary) across the Chicago area. All we really want is honest, truthful communication."