Mary Vest Mason. Are Residents Considered Students or Employees?. JAMA. 1998;279(20):1668F. doi:10.1001/jama.279.20.1668
Prepared by Ashish Bajaj, Department of Resident Physician Services,
American Medical Association.
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.