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Residents turn to unions in battle for salaries, rights

From the March 1996 ACP Observer, copyright 1996 by the American College of Physicians.

By Christine Wiebe

If crises spawn opportunities, then housestaff labor unions may face a promising future. Threats of Medicare cuts and privatization of public hospitals are driving more and more residents to join forces in defending their rights and those of patients, union leaders say. But the market changes and cost-cutting efforts pushing the movement may imperil its ability to win more rights--and money--for residents.

"We've got more organizing going on now than we've had for years, and that's because housestaff are getting squeezed from more directions than ever before," said Mark Levy, associate director of the Committee of Interns and Residents (CIR), a New York City-based affiliation of housestaff unions.

As budgetary constraints force many hospitals to cut residency and fellowship slots, the remaining residents are left with more work, Mr. Levy said. In addition, many ancillary staff positions are being cut, and residents are being asked to pick up those duties too.

It could get worse. If Medicare cuts actually take place, hospitals could respond by slashing salaries or even eliminating some residency programs. "This doesn't encourage people to feel very secure," Mr. Levy said.

Strength in numbers

The potential cuts--and their fallout--may be behind residents' recent interest in pulling together. At many hospitals, residents have formed associations that informally advocate for the rights of housestaff. Residents at other hospitals, however, have found that they need the formal relationship with a union to resolve contract disputes over salaries or to get benefits such as parking. Some resident groups have joined local unions that include other health care workers or hospital service employees. Others have linked with CIR, a 7,000-member organization that serves as an umbrella organization for housestaff unions. CIR has affiliates primarily on the East Coast, but is expanding nationwide.

For example, CIR recently helped residents at the University of Cincinnati Medical Center in contract negotiations by providing details on what comparable institutions paid their housestaff. Maureen Miller, FACP, a second-year fellow in allergy and immunology at the medical center, believes residents will get a raise as a result. The center's residents had voted overwhelmingly to join CIR a year ago after futile efforts to negotiate a contract with the hospital when the residents were represented by an independent house staff association.

CIR also provides long-term continuity, Dr. Miller said. "[CIR] has brought us more resources and more of an internal memory. So even though the residents come and go, there's someone who knows what's happened."

Residents had feared that a liaison with CIR could hurt their relationship with attendings or somehow reduce their autonomy, but neither has occurred.

Although some housestaff still are turned off by the idea of joining a union, most are receptive to the group's activities, Dr. Miller said. She hopes a strong resident association ultimately will bring housestaff together.

Residents should be aware that forming a union can lead to hostile interactions with employers. Although federal law gives all employees the right to form or join a union, disputes over such activities are common. According to the National Labor Relations Board (NLRB), which oversees labor disputes, about 13,000 complaints were filed in 1994 against employers for changing workers' terms of employment because of their union activity. Only about one-third of those cases led to the workers being reinstated or having their original duties restored, said Richard Hardick of the NLRB's division of operations management.

Residents also should recognize that by joining a union they will be approaching the administration as a collective unit, rather than individually, said attorney Carl E. Ver Beek, who represents various health care employers. He warned that some residents might prefer to pursue issues other than those the union identifies as most important. Sometimes it can be "counterproductive," he said, for residents "to subjugate their interest to that of a collective process."

Salaries, benefits

Much of housestaff unions' efforts focus on employee contracts where the key issues include salaries, benefits and leave time, disciplinary and grievance procedures, on-call duties and excessive non-physician work.

Although residency programs are governed by accreditation guidelines and state requirements, residents who are not represented by a union often have little recourse if their program violates those standards, said CIR's Mr. Levy. For instance, New York laws restrict residents' hours, yet many residents' schedules exceed those limits. "The only way you can enforce [the laws], really, is through a union contract," he said.

Salaries are a perennially hot issue for residents as well, particularly in light of federal proposals to cut hospital funding that goes to pay for those salaries. "Housestaff are the cheapest hospital staff there are on an hourly basis," Mr. Levy said.

CIR has successfully negotiated higher salaries in the past, said Mr. Levy. For instance, resident salaries at D.C. General were $24,173-- below the national average--before housestaff joined CIR and won a contract with the hospital administration in late 1992, he said. The contract called for a retroactive increase to $29,028 beginning in the fall of 1992, and for a jump to $32,022 in July 1994.

However, in the current economic climate, hospitals may not have much room to negotiate, said Alan Liebowitz, director of human resources at North General Hospital in New York City. But, he said, the union's presence benefits residents overall.

"Even if the market is very soft for medical graduates, having the union helps cement the wage rates," he said. "There are definitely hospitals who would take advantage of [residents] if they weren't unionized."

Whether or not the unions can prove useful despite continuing budget threats remains to be seen. "I don't believe that resident unions are going to get stronger; in fact, they may get weaker," predicted Robert Gumbs, executive director of Health Systems Agency of New York City, a not-for-profit group that tracks health planning.

"If you look at hospitals these days, occupancy is dropping rapidly," Mr. Gumbs said. "Just as we will have surplus beds and surplus hospitals we will have surplus physicians. "When that happens, everyone starts scurrying for survival, and that's not the environment that helps unions."

Mr. Levy is more optimistic that unions will always have something to offer physicians in training. "Doctors are very idealistic and committed," he said, "so they get infuriated with bad patient care, and they get mad when they are personally demeaned. Unions offer residents a productive way to respond."

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