Collective Negotiations for Residents. JAMA. 1998;279(7):498J. doi:10.1001/jama.279.7.498
Prepared by Ashish Bajaj, Department of Resident Physicians Services,
American Medical Association.
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
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 firstname.lastname@example.org.