Interns' Right To Unionize At Hospitals Is Expanded

By Steven Greenhouse

The National Labor Relations Board ruled yesterday that interns and residents at privately owned hospitals had the right to form unions under federal law.

Labor leaders immediately applauded the board's decision, saying it could lead to improved conditions for hospital interns and residents. They said they would seek to unionize many of the nation's nearly 100,000 interns and residents, who often complain about notoriously long workweeks. Union officials predicted that interns and residents at many of the nation's 400 teaching hospitals would now push for shorter hours and lighter workloads.

Hospital officials attacked the decision, which involved the Boston Medical Center, saying that it would fuel tensions at hospitals and that collective bargaining would interfere with the educational mission of teaching hospitals.

In its 3-to-2 decision, the labor board, which is based in Washington, reversed a 1976 ruling that interns and residents at private hospitals were students, rather than employees, and thus did not have a right to unionize and bargain collectively. Because the federal law interpreted by the 1976 ruling does not cover public employees, the ruling did not apply to interns and residents at public hospitals. Many of them already have the right to unionize, granted at the state level.

To defend its conclusion that interns and residents are employees, the labor board noted that they worked long hours, made many medical decisions and received salaries and fringe benefits, including vacations and workers' compensation.

That hospital staff members might "also be students does not thereby change the evidence of their 'employee' status," the board's three-member majority wrote.

The two dissenters argued that the interns and residents were more students than employees.

The case pitted the A.F.L.-C.I.O., the American Medical Association and the American Medical Students Association, which all filed briefs on behalf of the interns, against the Association of American Medical Colleges, the American Hospital Association and the American Council on Education, which filed a brief on behalf of the hospital.

Jordan Cohen, president of the Association of American Medical Colleges, which represents 125 medical schools and 400 teaching hospitals, said the decision would hurt teaching hospitals.

"These are periods of medical training," Mr. Cohen said. "For these educational programs to fulfill their social obligation and to prepare students optimally for their future practice, it's critical that the educational aspects of these programs be the primary issues. The notion of collective bargaining and the threat of strikes or binding arbitration on issues that are fundamentally educational is an abhorrent idea that we believe will potentially violate the trust that must exist between learner and teacher."

Hospital and union officials estimate that more than 80 percent of the nation's 100,000 interns and residents worked at private hospitals. About 10,000 interns and residents are unionized, but most of them work at public hospitals. Close to 1,000 residents at private hospitals are unionized because their hospitals voluntarily agreed to bargain with them.

Dr. Ladi Haroona, president of the Committee of Interns and Residents, a group in New York that represents nearly all of the unionized residents, said, "This decision gives us the power to negotiate better conditions for the nation's residents and to advocate better for patients."

The ruling comes at a time when the American Medical Association and many unions are stepping up efforts to persuade tens of thousands of salaried physicians to join unions.

The ruling stems from a case involving a residents' union at Boston City Hospital, a public hospital that merged in 1996 into the Boston University Medical Center Hospital. The combined hospital, which serves as the main teaching facility for the Boston University School of Medicine, is private, but it voluntarily recognizes the union of residents and interns that has existed at Boston City Hospital since 1969.

That union, part of the Committee of Interns and Residents, was worried that there might be a merger with yet another private hospital and that the resulting hospital might refuse to recognize the union. Thus, the union asked the National Labor Relations Board to find that the workers had a federally protected right to unionize and bargain collectively, a right that would require a hospital to negotiate if a majority of employees voted to unionize.