January 2000

Health Care E-lert - Unionizing Housestaff - 1/7/00

3 min

Overturning a 23 year-old precedent, the National Labor Relations Board ("Board") recently decided that interns and residents are entitled to the protections of the National Labor Relations Act ("NLRA"). See Boston Medical Center Corp., 330 NLRB No. 30 (November 26, 1999). This decision will allow house staff members to unionize, will protect them from discriminatory treatment based on their union activity, and will permit them to engage in protected strikes under certain circumstances.

The Board's ruling turned on whether house staff members are "employees" as defined in the NLRA. In prior decisions involving Cedars-Sinai Medical Center and St. Clare's Hospital, the Board had held that interns, residents and fellows were excluded from the Act's coverage because their interests were primarily academic rather than economic. The Board had found, for example, that the stipend given to residents was a scholarship grant amounting to no more than a living allowance, not compensation for services rendered.

In its Boston Medical Center decision, a majority of the Board found that a plain reading of the NLRA, along with its interpretation of the statute's legislative history and the policy behind it, required them to overrule the its earlier decisions. The Board focused on the fact that the statutory definition of "employees" includes any employee, with narrow exceptions not including students. Moreover, the Board found that Boston Medical Center's house staff shared attributes indicative of employee status under the NLRA. For example, they work for an "employer" as defined in the NLRA, they receive compensation and other benefits such as vacation, and they provide a service to the public - patient care. Finally, the Board observed that nearly every other court or administrative agency to address the issue had ruled that house staff were employees, and that such rulings had not had the calamitous impact prophesied by the hospital.

The medical community's reaction to this ruling has been mixed. The American Medical Association, a proponent of collective bargaining rights for physicians, has lauded the decision, opining that it will give medical residents greater leverage to address patient care, practice and workplace concerns with the hospitals for which they work. In support of these goals, the AMA has created a national negotiating arm called Physicians for Responsible Negotiation. On the other hand, the Association of American Medical Colleges has criticized the decision, primarily because of the possibility of strikes. The AAMC further notes that teaching hospitals already provide an outlet for interns and residents to raise patient care concerns.

Although union organizing of house staff is nothing new, and several hospitals already have voluntarily recognized unions representing their house staff members, the Board's decision has broad implications. Union organizing efforts now will have legal protection and, if such efforts are successful, hospitals will be compelled to bargain over the terms and conditions of their residents' and interns' employment. These protections are almost certain to result in increased union organizing activity among house staff members.

For further information, please contact: Andrew Herzig.