Collective Bargaining for Our Education and Our Patients

The role of anesthesiology residents as employees is evolving. The establishment of collective bargaining has changed the job we do and how we are rewarded for it. Much of this change was established to address the growing concerns of resident work hours but has grown to encompass issues such as compensation, health care benefits and investment plans for our future.

The issue of collective bargaining gained national attention in 1976 when the National Labor Relations Board (NLRB) was asked to interpret the role of the resident under the National Labor Relations Act. A court found the status of university residents to be synonymous to that of university students who received support for housing. As students we did not have the right to negotiate collectively. An interesting situation arose when a community hospital joined a university hospital in Boston in 1996. The house staff at Boston City Hospital were already members of a collective bargaining unit, but the residents at Boston University were not. The Boston University House Officers Association petitioned the NLRB for recognition as a labor organization. In 1999 a court found that residents function much more like independent employees than students. Therefore the 1976 decision was overturned, and house officers were granted the right to bargain collectively.

Now many house officers belong to a house officers association of some sort. The Committee of Interns and Residents (CIR) represents more than 11,000 residents in California, the District of Columbia, Florida, Massachusetts, New Jersey and New York. The CIR is responsible for many of the changes from which we all benefit today. It was the first to agree upon many of the work conditions that we now consider standard such as an 80-hour work week limitation, a work day no greater than 24 hours, an average of one day off per week and calls no more frequent than every third night. Recently the Accreditation Council for Graduate Medical Education standardized these changes in all teaching programs. The House Officers Association at the University of Michigan is responsible for a significant pay raise, a pretax contribution to an investment plan of choice, competitive health care plans and improved working environments. Members of other groups enjoy some of the same benefits.

More importantly our patients benefit from the results of collective bargaining. There is growing publicity regarding medical errors and our ability to reduce their frequency. Patient care is certainly optimized if we are fully rested when we come to the bedside. Clearly the more alert we are, the better we can make decisions. The changes made by collective bargaining have improved the way we care for patients. By securing better working and teaching environments, we can focus all of our attention on patients and learning instead of logistics. Both the American Medical Association and ASA have stood in support of our right to collectively bargain because they see the benefit it provides to education and to patient care.

We must use this new-found tool responsibly. In 1980 the Boston City Hospital house staff went on a modified strike that still ensured appropriate coverage for patient care. Since then there have been no work stoppages. With thoughtful negotiation, work stoppage of any kind can be avoided. The ethical concerns related to work stoppage must be considered and prioritized when exercising the right to collective bargaining. We must not forget our duty and oath toward our patients when sitting down to bargain so as to avoid potential situations that may compromise their excellent care.

Michael F. Aziz, M.D., is a CA-2 resident at the University of Michigan, Ann Arbor, Michigan.