The nation's largest physicians' specialty society has formally opposed collective bargaining for medical residents, repudiating a policy the American Medical Association adopted when it created its own union affiliate nearly two years ago.
In a position paper published earlier this month in the Annals of Internal Medicine, the 115,000-member American College of Physicians-American Society of Internal Medicine stated unequivocally that collective bargaining for residents is "not appropriate in the educational environment."
The policy placed the group in direct conflict with the AMA, which created a union offshoot called Physicians for Responsible Negotiation in November 1999 with the expressed goal of providing collective bargaining for residents as well as other physicians.
In its policy statement, the Philadelphia-based specialty society said, "Collective negotiations between physicians-in-training and their teachers, programs or training institutions (are) not appropriate in the educational environment."
"Our major concern is the educational relationship of residents-that the educational environment not be disrupted by collective bargaining," said Jack Ginsburg, a policy analyst for the ACP-ASIM in Washington, who wrote the position paper. "Residents are both students and employees at the same time. Our bias was toward protecting the educational environment."
He declined to address the political ramifications of a direct policy clash with the giant AMA. The specialty society's chief executive officer, Walter McDonald, M.D., didn't respond to repeated requests for comment.
The college's position also is at odds with the National Labor Relations Board, which reversed a long-standing regulation in 1999 when it categorized residents as employees, not students, opening the way for unionization.
Susan Adelman, M.D., a Detroit-based pediatric surgeon who is president of the AMA's PRN, downplayed the differences in philosophy between the two organizations.
"They (the ACP-ASIM) are laboring under a lot of misconceptions (about collective bargaining for house staff)," said Adelman, who is on the AMA's board of trustees. "At the outset, you're going to have a lot of people who will give you knee-jerk reactions, opining about all the dreadful things that might happen" if collective bargaining is allowed.
She called the PRN a "work in progress," adding that her job is to help "educate our professional organizations across the country about what labor negotiation actually is, how it functions, and what it can do for patients."
The ACP-ASIM policy could have an adverse impact on the AMA's costly effort to organize house staff.
"I would assume that (the society's public position) would encourage those who might otherwise be inclined toward unionization to take a second look," said Jordan Cohen, M.D., president of the Association of American Medical Colleges, which has vigorously opposed residents' unionization.
The association believes that collective bargaining disrupts residents and essentially pits house staff against teachers and mentors. Officials say residents have effective methods for addressing concerns without joining a union.
Cohen said he was "gratified" that only a handful of residents has sought collective-bargaining rights since the NLRB's 1999 decision.
Although the AMA has lost about $29 million during the past four years, the organization already has committed about $3 million in loans to its fledgling union group, which is housed in the AMA's headquarters in Chicago. PRN officials have estimated that startup and ongoing costs, excluding interest expenses, will total at least $3.9 million through 2004, twice the original projection.
About 19 months after its formation, the PRN represents only a single group of 38 employed physicians at the Wellness Plan, a Medicaid HMO in Detroit. A labor organization representing about 20 emergency-room physicians at two hospitals in Austin, Texas, joined the PRN as an affiliate in April. Several other prospective deals are in the works, officials noted, including one involving 170 residents at Lutheran General Hospital in the Chicago suburb of Park Ridge, Ill. The residents there voted, but results have yet to be released by the NLRB.
Adelman defended the PRN's slow progress, calling union negotiation a long-term effort that required considerable time and patience.
"I wish we were moving five times faster," she said. "But it appears to me that we're tracking as fast as we can track."
By embracing unionization after years of opposition, the AMA hopes to build loyalty-and membership-among young doctors. It deflected internal criticism by adopting a policy that its union offshoot would never condone a strike or work stoppage.
When the PRN negotiates a union contract for residents, it will attempt to include annual dues to the AMA as part of the compensation package. This would help the organization, which has experienced declining membership, capture new blood.