AAMC Reporter: January 2000: A Word from the President

Volume 9,
Number 4

Jordan J. Cohen, M.D., President

January 2000

A WORD FROM THE PRESIDENT
"The NLRB Rules Against Education"

Photo of Jordan J. Cohen, M.D. As I'm sure everyone knows by now, in its ruling in the Boston Medical Center case, the National Labor Relations Board has overturned (by a vote of 3 to 2) its own 23-year-old precedent and decided that house officers are, after all, employees (not students) under the meaning of the National Labor Relations Act.

Residents in private institutions are now eligible to form collective bargaining units as defined by the Act. This far-reaching judgment marks a sad turning point for our profession. Until recently, programs of graduate medical education were shielded from the adversarial dynamics that frequently characterize labor-management relationships in the American workplace. No longer. Labor unions are now free to solicit the allegiance of interns and residents in the hundreds of private hospitals in our country that host residency programs. And I have no doubt that vigorous organizing efforts began in all regions of the country as soon as the ink was dry on the NLRB's ruling.

By promising to put union muscle behind demands for shorter work shifts, more days off, fewer nights on call, and a variety of other "benefits," labor organizers will, I'm afraid, find receptive prospects among our residents. Despite major improvements in the working conditions of residents in most GME programs over the past several years, we all know that some programs still require excessively long duty hours and do not fully comply with the spirit and intent of the ACGME's standards governing the treatment of trainees. Unionization efforts would die aborning if residents were uniformly content with the demands placed on them by their training programs, and were confident that whatever concerns they had would be taken into consideration without fear of retribution.

So, why not welcome unions to help residents address their legitimate concerns? The answer is that the tools employed by unions to extract benefits for their members are fundamentally antithetical to the educational setting. Education cannot achieve its objectives without a firm foundation of trust between teacher and learner. The foundation for collective bargaining is, by contrast, naturally adversarial.

The ultimate tool of unions is the withholding of services through "job actions" or strikes. What could be more out of keeping with the educational setting, to say nothing of the clinical setting, than a strike, or even the threat of a strike? And if a union should, by contract, waive its right to strike, the National Labor Relations Act requires that unresolved grievances be subjected to binding arbitration. What might these grievances be? Examples that leap to mind are a program director's decision not to promote a resident, or to dispense some disciplinary action because of unprofessional behavior, or to dismiss a resident from the program because of repeated unsatisfactory evaluations. I shudder to think that such academic decisions might be subjected to second-guessing by an outside arbitrator.

But the clincher, I believe, is that housestaff unions are simply not necessary. Residents are not powerless. They do not need labor unions to voice their concerns. Most programs with which I am familiar encourage and welcome input by housestaff. More structured avenues for communication include resident-run housestaff associations and regularly scheduled meetings between resident representatives and the institution's Graduate Education Committee.

In addition, the ACGME mandates that all institutional sponsors of GME programs establish formal procedures whereby housestaff, individually or collectively, can register their complaints, grievances, or recommendations. Failure to comply with this mandate threatens an institution's accreditation status. Residents are also free to communicate to the ACGME directly (and anonymously, if they wish) if they perceive that their concerns are being ignored or are fearful of retaliation.

I fervently hope that residents will be made aware of the institutional mechanisms already available to them and will use those mechanisms to express their views. I also hope that residents will make absolutely certain, before entertaining membership in a union, that they have exhausted all other avenues for registering their complaints and their recommendations for improvements.

Even more important, all program directors and institutional authorities responsible for GME programs should make doubly sure not only that their residents have appropriate channels for communicating their concerns, but that their residents are being treated with all the care and respect that students deserve.

No matter what the NLRB ruled, to my mind residents are still, first and foremost, students. But if they feel more like employees, that's an open invitation to the nearest union.

Jordan J. Cohen, M.D.
AAMC President