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Resident Forum
February 18, 1998

Collective Negotiations for Residents

Author Affiliations
 

Prepared by Ashish Bajaj, Department of Resident Physicians Services, American Medical Association.

JAMA. 1998;279(7):498J. doi:10.1001/jama.279.7.498

At its 1997 Interim Meeting in December, the American Medical Association House of Delegates voted to support the right of resident physicians to negotiate collectively with their residency programs. Collective negotiations could have a tremendous effect on residents' work environment. Resident organizations have used collective negotiations to address concerns such as work hours, workload, and employment benefits. They have also used collective negotiations to improve patient care. For example, in 1975, because resident physicians at Cook County Hospital in Chicago considered the hospital's equipment standards to be unacceptably low, they negotiated for basic items such as a working electrocardiogram machine on each floor of the hospital.

This issue recently gained prominence when Boston City Hospital, a public institution, merged with the private Boston University Hospital to form Boston Medical Center in Boston, Mass. Under the National Labor Relations Board's interpretation of the National Labor Relations Act, residents have had the status of students rather than employees, and therefore not had the right to negotiate collectively. However, Massachusetts' law recognizes resident physicians at Boston City Hospital as public employees. Last year the Committee of Interns and Residents, the union that had represented residents at Boston City Hospital, petitioned the National Labor Relations Board to overturn its 1976 interpretation and allow the Committee to represent all residents at Boston Medical Center.

Collective negotiation has also gained prominence because of the growth of managed care, which has caused some physicians to feel a diminution of their ability to make decisions regarding treatments. Some physician groups have turned to labor unions to address their concerns. Residents have also been affected by the growth of managed care, as hospitals cut costs by downsizing or merging with other hospitals or managed care organizations. In some cases, hospital reorganization has led to less supervision by senior residents and to an increased workload and work hours.

The AMA based its recent policy decision on 2 long-standing AMA policies: one that supports the right of a resident to negotiate freely with an institution, either individually or collectively, and one that opposes the withholding of medical service as a mechanism for negotiations. The AMA and AMA Resident Physicians Section (AMA-RPS) believe that the Accreditation Council for Graduate Medical Education (ACGME) must play a role in protecting the rights of residents to negotiate collectively. The major points adopted by the AMA are the following.

  • That the AMA seek to amend the ACGME Institutional Requirements to require teaching institutions to develop resident physician organizations empowered to work with the institutions to resolve issues of patient care and resident well-being. Teaching institutions would be forbidden from retribution against individual residents for activity related to a resident organization.

  • That the AMA seek means to ensure more timely and vigorous enforcement by the ACGME of its Institutional Requirements. By adopting this language, the AMA recognized that many benefits and protections for residents are outlined in the ACGME Institutional Requirements. However, at the meeting, several residents expressed the opinion that the ACGME's process for addressing complaints against programs is unsatisfactory.

  • That the AMA provide sufficient resources through its Division of Representation to prepare resident organizational model(s) and provide adequate staff support to resident groups, as well as other physician groups, seeking to form organizational entities. The AMA created its Division of Representation in 1997 to increase its advocacy activities. The new division has already studied models at 2 public hospitals and hopes to become more proactive by directly assisting groups of residents who wish to form collective negotiation organizations.

By taking these actions, the AMA has shown its commitment to help resident physicians have greater control over their work environment and their ability to treat patients. The RPS Governing Council will continue to advocate for the ability of residents to form collective bargaining organizations.

If you have questions about this issue, we encourage you to contact the RPS through Ashish Bajaj at (312) 464-4743, or by e-mail at ashish_bajaj@ama-assn.org.

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