American College of Physicians: Internal Medicine — Doctors for Adults ®


Resident's union celebrates its Golden anniversary

Members tacklemodern-day issues and a payment system that entices physicians away from primary care

From the July-August ACP Observer, copyright 2007 by the American College of Physicians.

By Stacey Butterfield

PHILADELPHIA—With attendees in blue jeans and dreads, and not a pharma rep in sight, the national convention of the Committee of Interns and Residents (CIR) held here recently was not a typical physician meeting.

About 300 physicians gathered in May to mark the 50th anniversary of the largest medical resident union in the U.S. One of the issues discussed was the difficulty in getting hospitals and other employers to recognize residents as physicians, not just trainees.

"There is one thing that slows our organization down," said CIR Executive Director Eric Scherzer. "It's the myth that residents are students." Throughout its history, the CIR has faced opposition from hospitals as well as the National Labor Relations Board. Only in 1999 did the NLRB agree that residents in private hospitals were employees with the right to organize.

CIR president Simon A. Ahtaridis, ACP Associate Member

CIR president Simon A. Ahtaridis, ACP Associate Member: "CIR has been very successful at a local level at protecting our health care system. In the future, we're going to have to think a lot bigger."

The union now has chapters in New York, New Jersey, California, New Mexico, Florida, Puerto Rico, Massachusetts and the District of Columbia. The newest chapter, New Mexico, organized earlier this year, because residents were concerned about their hospital's plan to increase housestaff's insurance premiums.

The delegates of the CIR/SEIU (the resident union is affiliated with the Service Employees International Union) also reflected on how far the union has come since its formation in 1957.

"When Elvis was at the top of the charts and metformin was a brand-new drug," the CIR was formed by a group of residents upset about conditions in New York City's public hospitals, CIR president Simon A. Ahtaridis, ACP Associate Member, reminded convention attendees.

Since then, the union has negotiated better pay and benefits for residents, rallied to protect hospitals from closure, and provided funds for improved patient care. The group has grown, especially in recent years, expanding from 7,000 members in 1997 to 12,500 (12% of U.S. medical residents) today.

Protecting residents and patients

CIR chapters around the country have significant successes protecting residents' pay and benefits, reported CIR Regional Vice President Hillary S. Tompkins, ACP Associate Member and third year resident at Boston Medical Center.

Union members pledge to work for improved quality of care, better working conditions for housestaff and to uphold the good name of CIR.

Union members pledge to "work for improved quality of care, better working conditions for housestaff and to uphold the good name of CIR."

For example, when a hospital merger brought some un-unionized residents into the CIR, they saw a dramatic salary jump, she said. "We call them the luckiest residents in the world. Their salary increased $12,000 overnight and they no longer had to pay for health insurance." In the past year, other CIR chapters have preserved residents' parking privileges and obtained housestaff lounges, among other benefits.

CIR exists not only for the benefit of residents, however. Fitzhugh Mullan, MD, former assistant surgeon general and CIR president from 1970-72, described in his keynote address how social concerns motivated early union leaders.

"We didn't want to be fat, complacent white males," he said. CIR proposals of his era included a registry, open to the public and the press, in which housestaff would report adverse medical events caused by hospital staffing shortages.

However, hospitals (not surprisingly opposed to such proposals) often defeated them by offering enough pay and benefits in negotiations that the CIR membership couldn't refuse. "We were beaten with money," said Dr. Mullan. "The notion of social reform was not high on the agenda of most housestaff."

Today's CIR contracts include public benefits through the mechanism of patient care trust funds. Unions use funding allocated in their contracts to pay for anything from new equipment for a hospital to taxi rides for discharged patients.

The unions also lobby the government on public health issues, and join with other unions to rally in the streets on major issues. The New York Chapter has been particularly active in the past year, protesting the state governor's plans to close several public hospitals. "No CIR-represented hospitals were forced to close," reported CIR Regional Vice President Spencer G. Nabors, ACP Associate Member and third-year resident at Kings County Hospital in Brooklyn, N.Y.

In San Francisco, CIR members rallied in support of a proposal to require paid sick days for all workers. In Boston, the union supported a group of janitors in its efforts to unionize and gain health benefits. "Many of these janitors are our patients," said Dr. Tompkins, explaining the connection between the two groups, both of which are SEIU members.

Moving forward

The convention's lunchtime speaker, Mary Kay Henry, international executive vice president of the SEIU, encouraged the CIR to work even more closely with other unionized workers.

The SEIU, which represents more than half-a-million health care workers, is pushing for a system of universal health coverage to be developed with input from front-line health care providers and implemented by 2012. "We refuse to be defeated by the pessimists who say it's never going to happen in the U.S.," Ms. Henry said to hearty applause from the convention attendees.

Health care reform was a theme throughout the convention. Dr. Mullan bemoaned a payment system that entices physicians away from primary care, and urged CIR members to resist greed and focus on global public health.

"The skill set you have is pertinent to all 6 billion people on the planet. Don't let the pursuit of a flat-screen [television] be what drives you. Let it be the pursuit of love, happiness and medicine," he said.

Dr. Ahtaridis also expressed concern about the broken U.S. health care system. He lauded his members for their efforts to deal with resident issues like work hours and handoffs, but pointed to health care reform as the next target.

"CIR has been very successful at a local level at protecting our health care system," he said. "In the future, we're going to have to think a lot bigger."


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