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Resident Forum
May 27, 1998

Are Residents Considered Students or Employees?

Author Affiliations

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

JAMA. 1998;279(20):1668F. doi:10.1001/jama.279.20.1668

The employment designation of resident physicians is as controversial today as it was 22 years ago when the National Labor Relations Board (NLRB) first reviewed it. The subject is being revisited now because the Committee of Interns and Residents (CIR), a labor union, has petitioned the NLRB to allow CIR to represent residents at Boston Medical Center. The February 18 issue of Resident Forum reviewed these recent events. This week's column presents a historical overview of this issue.

When you ask resident physicians whether they consider themselves students or employees, many say that they are employees. After all, there is a distinct difference between the environments of medical school and residency. Unlike students, residents receive paychecks and have employment contracts and job descriptions with assigned responsibilities and duties. Their training institution receives financial compensation for the work they do. In exchange, they receive education and training vital to the development of their career. However, in 1976, the NLRB ruled that residents are students rather than employees. They felt that the services provided by residents was primarily an academic endeavor that only indirectly generated revenue for the hospital.

It is important to look at the historical context of the NLRB's decision; several events may have influenced their ruling. In 1975, resident groups in New York City, Los Angeles, and Chicago went on strike. Although the residents in these cities won concessions on wages, working conditions, and efforts to improve patient care, the work stoppages reflected poorly on them. In Chicago, some union leaders and physicians who had sided with the residents were severely reprimanded. It is possible that this negative publicity had some influence on the NLRB's decision.

After the NLRB's ruling, some regional and state labor relations boards disagreed with the NLRB's ruling. In 1976, the Massachusetts Labor Relations Commission ruled that because residents have a financial relationship with their hospitals, they are employees and should not be denied rights provided under labor relations laws. In 1978, the Public Employee Relations Board of Prince George County, Maryland, also recognized the uniqueness of residents' status. They ruled that residents have status as both students and employees and allowed them collectively bargaining rights. Many local and state boards have made similar rulings; hospitals in those states or cities can allow residents to unionize or to collective bargaining despite the 1976 NLRB decision.

Increasingly, the NLRB's ruling and the rulings of local and state labor relations boards are clashing partly as a result of the recent trend toward hospital mergers and takeovers. The situation at Boston Medical Center arose when 2 hospitals merged that had different policies on resident collective bargaining; as a result all the residents lost collective bargaining rights.

Currently, most residents do not have the protection of the National Labor Relations Act if they choose to collectively bargain with their training institutions. Residents can still participate in organizations or forums that represent their views on employment, education, and patient care issues, but only if their sponsoring institution allows them to set up such a forum. In general, they have little influence on wages, hours, and working conditions. While the primary purpose of residency is to train physicians, the primary responsibility for training rests on the institution.

If the NLRB reverses or otherwise changes its 1976 ruling, it will have a tremendous impact on the relationship between residents and their training institutions. The ruling may define whether a resident's role in a teaching institution is that of a student or an employee. It may carve out a special student-employee designation unique to residents. It is also possible that we may revisit this issue again in the future if circumstances warrant it. Regardless of the NLRB's upcoming decision, the issue will probably continue to spark debate.