Residents and Interns Unionizing. Will raise costsÿ
for teaching hospitals. Make non-teaching hospitals like HRCÿ
more competitive to HMOs because of lower cost.
TA
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interactive.wsj.com
December 1, 1999
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ NLRB Ruling on Resident
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ Authorityÿ
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ To Organize Worries
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ Administrators
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ By LAURA JOHANNESÿ
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ Staff Reporter of THE WALL STREET JOURNAL
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ At Boston Medical Center, home to one of the nation's
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ oldest labor unions for doctors-in-training, residents get
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ one day off a week and are generally on call no more
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ than every third day.
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ They also make $35,000 to $50,000 a year, several
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ thousand dollars more than counterparts at other
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ hospitals, says union area director Sandra Shea.
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ Such modest improvements in working conditions and
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ pay may begin to spread to hospitals across the country
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ after a recent National Labor Relations Board decision
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ that found that residents are "employees" with the right
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ to unionize under federal law. That decision is expected
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ to give unionizing efforts new momentum.
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ And that has sent shivers throughout hospital
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ administrations. Hospitals fear not only the proliferation
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ of unions, but their empowerment. The current unions
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ mostly do not have the right to strike -- whereas the new
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ breed of union empowered by federal laws does. That
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ means, says Jordan Cohen, president of the American
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ Association of Medical Colleges, that unions will likely
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ grow bolder, and possibly push for gains even steeper
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ than the relatively modest protections won at Boston
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ Medical.
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ "We have every reason to believe the effort will be
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ made to extract further financial benefits for house staff
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ whether it's higher salary or employment of other
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ health-care workers," to ease their workload, says Mr.
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ Cohen, whose group represents 400 teaching hospital.
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ "All of those issues are going to add further to the cost
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ burden of institutions that are already reeling."
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ The unionizing pitch will likely have appeal to residents,
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ who have found their workloads increasing as hospitals
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ merge and cut support staff to save money.
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ Rigors of Residency
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ Traditionally, medical-school graduates are required to
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ serve a residency of three years or more before they can
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ be certified to practice on their own. They had been
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ considered students rather than employees, and at some
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ hospitals some residents work 100 to 120 hours a week.
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ So far, unions have had modest goals -- seeking to limit
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ residents' hours to about 80 hours a week, for example.
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ To date, about 10% of the nation's 100,000 notoriously
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ overworked residents belong to the Committee of Interns
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ & Residents, the only major residents' union, says
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ executive director Mark Levy. Residents are willing to
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ join a union, even if they will only be there for several
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ years, because the need for residents to have some
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ control over their working conditions is so severe, says
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ Mr. Levy.
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ Many of the existing unions are at government-owned
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ hospitals, where the right to unionize is guaranteed by
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ some state laws. But, until the recent NLRB decision,
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ unions at private hospitals had no status unless, as at
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ Boston Medical, the hospital voluntarily chose to
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ recognize them.
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ In anticipation of the NLRB decision, a team of 10 union
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ organizers have already begun meeting with residents in
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ hospital waiting rooms and over pizza lunches. The
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ organizing blitz is focusing primarily on six northeast
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ hospitals the union declines to name. Once the unions are
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ in place, says Mr. Levy, they will work for the same sort
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ of protections seen at Boston Medical Center.
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ Strikes as a Last Resort
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ Mr. Levy says the unions will use strikes only as a last
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ resort, and will make sure they give enough notice so
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ hospitals can safely transfer patients or arrange for
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ alternate care.
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ One major area unions plan to target is hospitals' level
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ of support staff. For example, the Boston Medical
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ contract requires the hospital to employ interpreters for
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ patients who don't speak English and phlebotomists to
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ draw blood -- two tasks that otherwise would get piled
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ onto residents' already full plates.
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ "We still work an awful lot of hours, but the contract has
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ resulted in some improvement," says hospital chief
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ resident Andrew Yacht. He adds that, while limiting
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ hours and raising pay certainly costs the hospital some
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ money, it is good for patients.
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ Hospitals will try to forestall unionization by persuading
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ residents that there are other mechanisms for seeking fair
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ work conditions, says Mr. Cohen, the hospital
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ association president. For example, he says, many
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ residents aren't aware that accrediting guidelines for
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ their graduate education programs provide some
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ protections against overwork. Enforcing those guidelines
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ might be enough to satisfy many students, he said, making
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ unions unnecessary.
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ In the long run, even a modest increase in residents'
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ union activity could kick-start the nascent doctor's union
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ movement.
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ "If interns and residents find that being represented in a
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ collective bargaining unit is a positive experience for
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ them, they will want to continue that experience," says
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ Ross Rubin, a spokesperson for the Physicians for
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ Responsible Negotiations, a union launched by the
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ American Medical Association about a week ago, which
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ plans to represent both residents and board-certified
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ doctors.
ÿÿÿÿÿÿÿÿÿÿÿÿÿÿ Write to Laura Johannes at laura.johannes@wsj.com |
