AN ESSENTIAL Rx FOR TOMORROW'S DOCTORS
By Dick Meister
They are among the nation's most exploited workers. They are college
graduates. They are in fact professionals, performing some of society's most
vital tasks. Yet they are forced to work as many as l20 hours a week --
sometimes as many as 36 hours consecutively -- and for minimal compensation.
They are the nearly 1OO,OOO interns and residents at the country's
teaching hospitals -- recent medical school graduates who must complete
three or more years of on-the-job training in order to be certified as
Although the hospitals rely on them heavily, in part to ease the workload
of their staff doctors, nurses and other regular employees, the hospitals
always have insisted that the young doctors-in-training are just that --
trainees or students rather than employees.
The distinction is crucial. Employees have the legal right to form unions
and bargain collectively to try to improve their conditions of employment.
Trainees and students have no right but to accept the conditions imposed on
The hospitals had their way for many years, easily fending off sporadic
challenges by interns and residents who demanded employee status. Finally,
however, the outrageously overworked young men and women are winning the
basic and essential union rights long denied them.
Their latest and most important victory came last November, when the
National Labor Relations Board granted union rights to interns and residents
at the country's privately owned hospitals. That reversed a 1976 ruling that
those employed by such hospitals were students and thus not legally entitled
to collective bargaining.
Unionization campaigns by thousands of privately employed interns and
residents are certain to come soon. So are new drives by those working at
public hospitals, many of whom are covered by state laws or regulations
granting them bargaining rights.
Some of the most important of the drives at public facilities will be
waged at University of California hospitals, thanks to a recent ruling by
the state's Public Employee Relations Board. The board granted bargaining
rights to UC interns and residents who had waged a three-year struggle for
them in the face of stiff opposition from UC administrators.
The drives in California and elsewhere will be led by the Committee of
Interns and Residents, an affiliate of one of the country's largest and most
powerful unions --the Service Employees International Union, about half of
whose 1.1 million members are health care workers.
What the interns and residents want, above all, is to reduce their
working hours. Interns and residents average $29,000 to $37,OOO a year,
depending on their experience. But whatever they make, it comes in exchange
for many, many hours of work. Those at the Boston Medical Center who won the
Labor Relations Board ruling that granted union rights to interns and
residents are typical. As they told the board, "We work 80-100 hours a
week staffing the hospital around the clock, collect a paycheck and pay our
taxes, just like any other hospital employees."
Boston pediatrician Joshua M. Sharfstein noted, "Our medical
establishment remains wedded to an excessively grueling, risky, and outdated
system of training new physicians."
The traditionally long workweeks of trainees might be acceptable, Dr.
Sharfstein said, "if there were data to support the notion that heroic
work schedules are a necessary part of a physician's training. But no such
Dr. Abigail Zuger, a New Yorker who served her internship 18 years ago,
suggests that working such schedules might be of some value nevertheless.
Why, she says, it could help trainees develop empathy with patients:
"Stay awake every third night for three years, tired, aching, nauseated
and terrified that despite the very best intentions in the world you are
about to make a terrible mistake. With any luck at all you will get a vague
idea of how it must feel to be truly sick, powerless and frightened -- and
with any luck the lesson will stick even after it is all over."
There are no laws governing the hours of trainees except in New York
State, where they are limited to an average of no more than 80 hours a week.
Many hospitals elsewhere have voluntarily adopted the same limit, but it
falls far short of what's needed. Other industrialized nations do much
better. In Denmark, for instance, the average is under 50 hours. In The
Netherlands, the legal limit is 60 hours. The European Union is considering
regulations that would set the limit at 48 hours in those countries and all
if its other member-nations.
The moves for unionization by interns and residents are just part of a
wider movement of doctors generally to seek collective bargaining rights.
The main concerns of the experienced doctors are not cutting back overly
long working hours, but dealing effectively with the managed care system
that has seriously eroded the physician's traditional independence.
The anti-trust laws have denied union rights to the self-employed doctors
who once were the rule. But nearly half the country's 620,000 practicing
physicians are now working for others -- government agencies, hospitals,
health maintenance organizations and the like -- and about 45,000 of them
already have joined unions.
Most of the physicians' unions are affiliated with the AFL-CIO, but even
the once staunchly anti-union American Medical Association is organizing a
union. The AMA is also working with the AFL-CIO in the drive to organize
tomorrow's doctors -- the young interns and residents who must have union
rights if they are to finally win fair and decent treatment.
___________________________________________________________ Dick Meister, a
freelance columnist in San Francisco, has covered labor issues for four
decades as a newspaper and broadcaster reporter, editor and commentator. c
2000 Dick Meister