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AAMC President Cohen Criticizes NLRB Ruling in New England Journal of Medicine Editorial

Washington, D.C., February 9, 2000 — Association of American Medical Colleges (AAMC) President Jordan J. Cohen, M.D., reaffirms his concerns about the effect unions will have on medical education and the practice of medicine in a February 10 New England Journal of Medicine (NEJM) editorial. Dr. Cohen's "Sounding Board" article addresses the National Labor Relations Board (NLRB) November 1999 ruling in the Boston Medical Center case, which concluded that medical residents are employees and as a result are entitled to form collective bargaining units.

"If residents had no alternatives to unions for addressing their concerns, I might well be persuaded to accept the NLRB's new ruling despite the devastating impact that I foresee it having for our profession," writes Dr. Cohen. "But residents do have alternatives for addressing their legitimate concerns. And the potential impact on our profession of residents' unionizing is devastating indeed. So, in thinking about what's better and what's worse, I do not hesitate to conclude that resident unions are a very bad idea."

The AAMC has long held that residents are students and provide patient care only within the framework of their educational experience. Residents are engaged in a formal educational program, subject to accreditation by an independent national body, the Accreditation Council for Graduate Medical Education (ACGME). This formal part of resident education is essential for gaining licensure to practice independently and for achieving eventual certification as a specialist or subspecialist in a chosen field. The concurred with the AAMC's position in the 1976 Cedars-Sinai case determining that residents possess many more characteristics of students than employees. In Boston Medical Center, the NLRB reversed itself and overruled this longstanding precedent.

Dr. Cohen notes that medical education cannot achieve its objectives without a firm foundation of trust between teacher and student. The tools available to unions to achieve their goals, such as "job actions" or strikes, create an adversarial environment that undermines the educational growth process.

Dr. Cohen writes, "Residents are not powerless. They may be unaware of their power, or of how to exercise it, but residents do have the power to improve the conditions under which they learn. They need to know that the ACGME requires all institutional sponsors of GME programs to establish formal procedures whereby housestaff can register their complaints, grievances, and/or recommendations." The ACGME strengthened its call for effective representation of residents' viewpoints as recently as September 1998, when it adopted a new set of institutional requirements.

Dr. Cohen recognizes that teaching institutions should seek a balance between the medical profession's responsibility to inculcate the knowledge, skills, attitudes and behaviors necessary to provide quality care, and the need to treat residents as adult colleagues.

In the final analysis, Dr. Cohen writes, "Doctors seeking marketplace leverage though unions are trading their precious ethic of professionalism for commercialism's promise of a quick fix. Residents need to be fully acquainted with the perils inherent in that Faustian tradeoff."

For a copy of the AAMC's position paper on negotiating units for physicians, please contact Stephanie Pearson, AAMC Office of Communications, at (202) 862-6209 or spearson@aamc.org.

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The Association of American Medical Colleges represents the 125 accredited U.S. medical schools; the 16 accredited Canadian medical schools; some 400 major teaching hospitals, including 74 Veterans Administration medical centers; 91 academic and professional societies representing nearly 88,000 faculty members; and the nation's 67,000 medical students and 102,000 residents.

Additional information about the AAMC and U.S. medical schools and teaching hospitals is available at www.aamc.org/newsroom.

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