Should Interns/Residents Unionize?

Three public hospitals in Southern California have for years allowed their interns and residents to join a labor union. The National Labor Relations Board recently extended that right to doctors-in-training at private hospitals nationally. KAREN KARLITZ discussed whether residents and interns are students or employees with a union representative and a labor lawyer.

ANGELA NOSSETT

Third-year resident in family medicine, Harbor UCLA Medical Center; executive president of the Joint Council of Interns and Residents

The recent NLRB decision will help strengthen unions in California.

Benefits to unionizing are many. Working conditions at hospitals are a major issue. Residents work as many as 120 hours a week. The Accrediting Council of General Medical Education recommends an 80-hour work week. It is the ACGME’s job to help protect us from being used as cheap labor and to help us get an education in addition to our work experience. An 80-hour work week was recently made part of our contract negotiations, and we plan to enforce it.

The union has been able to change the humanitarian aspect of the job. If we’re on call, the hospital now has to provide us with a room to sleep in. And we’re fighting to keep our cafeteria open at night because when we work 36-hour shifts, for 12 hours we have no access to food and yet legally cannot leave the hospital. We’ve also been making strides to reduce 36-hour shifts to 24 hours.

Change won’t come overnight, but I think it will happen. We have to stop that cowboy attitude: “It’s always been this way, we’re tough, we don’t complain.” Many residents want to complain, but they’re in an environment where if they do, they’re punished. Residents have to fight for all these things and, without a union, they don’t have any legs to stand on.

We have also made strides in being involved in decisions regarding staff cutbacks and reorganizations. We believe good patient care happens when you have good staffing-to-patient ratios. A lot of cost-cutting affects staffing ratios in a very detrimental way.

Surprisingly, salary is not No. 1 on most residents’ lists when they decide to unionize. Most people join a union because they feel disrespected and their working conditions are deplorable. Under our contract, residents got a 3% yearly pay increase.

Some hospital administrators don’t want to see residents and interns unionize because they carry the hospital budget on the backs of these doctors-in-training. Residents are not paid by the hour, whereas most staff in the hospital is, so it makes more fiscal sense to increase the residents’ workload. What we’re trying to do is protect our patients. How do you get doctors who care about their patients? Certainly not by working them 36 hours straight. That’s what we try to fight. We care a lot about our patients and we care about the conditions we work in.

GARY OVERSTREET

Employment lawyer

As an employment lawyer who represents health care organizations, many of which are hospitals with teaching programs, I’ve spent a lot of time negotiating with labor unions, including doctors’ unions. I also have a daughter who is a first-year intern in Los Angeles.

If I could decide for interns and residents whether to belong to a collective bargaining unit, I would say don’t do it. My principal argument is that there is an extraordinarily important educational aspect of the intern/residency period. The hard reality is that once you get residents and interns into the bargaining process, it’s not possible to separate the employment aspect from the education aspect.

The NLRB act was designed originally for steelworkers and such, and virtually every aspect of employment is subject to negotiation. But the supervisor in the intern/resident situation may also be the teacher.

The bargaining process commonly takes a year, and in residency programs, people constantly enter and leave. There’s no continuity. From time to time, the NLRB has exercised its discretion, saying it wants to stay out of industries where employees come and go quickly. In these situations, there isn’t enough time to conduct traditional elections and deal with unfair practices.

Also, once interns and residents are covered under the NLRB act, you give them the power to strike. Striking will disrupt the educational progression of classes, clinical practice and testing. A student wants to come in and have some certainty that his or her three-year residency will take three years. How would they feel if suddenly they were told they wouldn’t finish on time and, whether a strike is a good idea or a bad one, that they’re not going to be able to take a board exam?

Ultimately, the fact that interns and residents are within the NLRB act and can bargain doesn’t mean working conditions will change. It just means the conditions are a subject for the bargaining table. It may be one of those cases where you should be careful about what you wish for, it might come true. They’ll get the opportunity to strike and then realize they’ve messed up the progression of their education.

I’d tell my daughter if she were voting on the union stuff, if you vote on this, you’ve got to be prepared for the consequences. One consequence could be that you have to walk away from a patient or that your three-year residency program is turned into four or five years.